Weight Loss Medication

We provide traditional weight loss medicine such as phentermine (Adipex), phendimetrazine (Bontril) and Contrave (Wellbutrin and naltrexone). Phentermine will suppress appetite for about 8 hours for most people. Typically we give this medicine 1 hour before lunch so that we can suppress lunch and dinner. The main side effects of phentermine are insomnia and dry mouth. Also, phentermine is like super caffeine, so it gives patients a lot more energy. Sometimes excessive energy may exacerbate anxiety in patients who have anxiety disorder. However most patients like the energy boost that phentermine provides. Oftentimes we add Topamax to phentermine depending on the clinical situation. Qsymia is a formulation of phentermine plus Topamax. However it is usually more cost effective to prescribe Topamax and phentermine as separate medicines than Qsymia. Phendimetrazine is similar to phentermine, but much less potent. Typically phendimetrazine is given as 2 tablets twice a day before lunch and dinner. Phendimetrazine is especially useful for patients who are too sensitive to phentermine. Contrave is a combination drug consisting of Wellbutrin and naltrexone. Wellbutrin is an antidepressant and naltrexone blocks opioid (addiction) receptors. If we think of food as a form of addiction, then Contrave is very effective for patients with a lot of stress eating and/or pleasure eating. Pleasure eating can be defined as eating while not hungry or when under stress. Semiglutide is a highly effective weight loss medicine that is marketed for diabetic patients (Ozempic or Rybelsus) or weight loss patients (Wegovy). In other words Wegovy and Ozempic are the identical medicine, and we used them interchangeably. Semiglutide (Ozempic/Wegovy) is a highly effective drug for weight loss, but is very expensive and is only covered by 20% of insurance companies. The out-of-pocket cost for these medicines is typically about $1,300 per month. For patients who cannot get insurance coverage for semiglutide, we offer Ozempic for $500 per 4 mg syringe. The syringe can last up to 4 months at the lowest dosage (0.25 mg injected once per week), 2 months at an intermediate dosage (.5mg injected once per week) and 1 month at the dose of 1 mg injected per week. Most of our patients have substantial weight loss with either the 0.25 mg/week dose or the 0.5 mg/week dose. Among other things, these drugs work by delaying gastric emptying. This means that after a modest meal the stomach remains full for a longer period of time. With modest fullness, the stomach suppresses appetite. However, if the patient chooses to eat even when they feel full (such as per pleasure eating), the stomach becomes over-distend and nausea is likely. Overeating, or pleasure eating, does not result in nausea when taking phentermine, phendimetrazine or contrave-but it does with Ozempic/wegovy. For this reason, the semiglutide drugs (Ozempic, Wegovy) are much more effective for weight loss than phentermine or phendimetrazine. In our experience we typically see 10-20 pound weight loss per month with the semiglutide (Ozempic and Wegovy). However these drugs must be titrated slowly to the lowest effective dose. We will start out at the lowest dose of Ozempic/wegovy and supplement with phentermine, or some other medication. Then we will gradually increase the weekly dose of Ozempic/wegovy depending on the weight loss and side effects. In this way we keep the nausea to a minimum while maximizing appetite suppression. Tirzepatide (Mounjaro), like semiglutide (Wegovy and Ozempic), works on the GLP1 (glucagon-like peptide-1 ) receptor of the brain. However Mounjaro also works on a second receptor of the brain called GIP (glucose-dependent insulinotropic polypeptide). So far we are still evaluating Mounjaro vs Wegovy/Ozempic in terms of both effectiveness and side effects. At this time we have not seen any advantages of one medicine over the other, but we are still evaluating. While many patients do very well with monotherapy, many patients do best with combination therapy. This may include Ozempic/wegovy at the lowest effective dose superimposed with either phentermine/phendimetrazine, Wellbutrin, naltrexone. Injections of B12, or Lipo-B, and be useful in many patients and they are offered as adjuncts to monotherapy or combination therapy. Other adjuncts may include diuretics and metabolic stimulants.