Weight Loss Title

Overview

In the past few years, there have been many new prescription weight loss drugs available on the market to patients. These drugs include Qsymia (Phentermine/Topiramate) and Belviq (Lorcaserin). Contrave, approved in September of 2014, will compete with these drugs.


Contrave consists of two different drugs that have been on the market for years, bupropion (to suppress appetite) as well as naltrexone (to decrease food cravings). It is important to note that none of the prescription weight loss drugs are "miracle" drugs or a "magic bullet" but they can help people adhere to a weight-loss diet.


Specifically, Contrave is indicated for as add on medication to a reduced-calorie diet and increased physical activity for chronic weight management in obese adults (BMI: > = 30) or in overweight adults (BMI: > = 27 ) with at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia). In terms of how Contrave compares to the other medications, let's take a look at three key areas: Effectiveness, adverse effects and cost.


Effectiveness

​Qsymia seems to lead to the most weight loss and therefore is the most effective. Studies show that patients on average  lose 20 pounds more than patients on placebo at 1 year. This compares to around 9 pounds with Contrave and  7 pounds with Belviq.


Adverse Effects

Out of the three new weight loss drugs, Belviq seems to be the best tolerated according to clinical trial data. Studies show that about 2% of patients will stop Belviq due to adverse effects. This is compared to up to 9% of patients on Qsymia .and 12% on Contrave. 

Each drug has their own set of side effects that patients need to be aware about. Contrave causes the most nausea due specifically to addition of naltrexone. 

Qsymia contains topiramate which is known to commonly cause impaired cognition, tingling hands and feet, and birth defects if taken during pregnancy. 

Belviq, while seemingly the best tolerated, works on the neurotransmitter serotonin and therefore must be used carefully with other drugs that affect serotonin. These include the popular class of antidepressants known as SSRI's. Common SSRI's include Zoloft, Prozac and Paxil.


Cost

​As with all drugs, the most important factor of cost is whether or not your insurance will pay for the medication. In general, most insurance companies do not pay for weight loss drugs. For patients paying cash, all cost about $7/day. The good news is they have discount programs available to patients. 


Final Words

In conclusion, each drug has positives and negatives. Again, these drugs are typically only recommend for patients with a BMI ≥ 30...or ≥ 27 with a weight-related condition (hypertension, diabetes, etc). It is often recommended 
 
It is recommend to stop these drugs if you don't lose 5% of your body weight in 12 weeks on maintenance doses. Such minimal weight loss isn't worth the possible adverse reactions.