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News: Prescriber's Letter November 2014

weight loss  

Contrave (CON-trave) will compete with Belviq (lorcaserin) and Qsymia (phentermine/topiramate ER) for weight loss.

Contrave contains bupropion to suppress appetite...plus naltrexone to decrease food cravings.

None of these new meds are a “magic bullet”...but they can help some patients adhere to a weight-loss diet.

Weight lossQsymia seems to result in the most weight loss...an average of 20 pounds more than placebo at 1 year...compared to 9 pounds with Contrave, 7 pounds with Belviq, and 6 pounds with bupropion alone.

Adverse effectsBelviq seems to be the best tolerated.

About 2% of patients will stop Belviq due to adverse effects... compared to up to 9% of patients on Qsymia...and 12% on Contrave

Contrave causes the most nausea...due to the naltrexone.

Keep in mind, the topiramate in Qsymia can cause impaired cognition, paresthesia, and birth defects if taken during pregnancy.

Interactions.  Don’t prescribe Contrave with opioids...because the naltrexone will block opioid effects.

Try to avoid combining Belviq with other serotonergic drugs... SSRIs, tramadol, dextromethorphan, etc.

Cost.  All cost about $7/day...but they have discount programs.

Save these drugs for patients with a BMI ≥ 30...or ≥ 27 with a weight-related condition (hypertension, diabetes, etc). 

Stop these drugs if patients don’t lose 5% of their body weight in 12 weeks on optimal doses.  But consider long-term maintenance if the med is successful.

Watch for Saxenda 3 mg injection to be approved soon.  It’s a higher dose of liraglutide (Victoza)...to help suppress appetite. 

Document the BMI and treatment plan for obese and overweight patients at least every 6 months...to meet this quality measure.

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