Pharmacotherapy in Obesity Management
- There are four medications indicated for chronic obesity management in Ireland in addition to healthbehaviour supports: liraglutide 3 mg (Saxenda®), semaglutide 2.4 mg (Wegovy®), naltrexone/ bupropion (Mysimba®) in a combination tablet and orlistat (Xenical®). All four medications have been shown to be effective in producing weight loss greater than placebo for a duration of at least one year.
- Medications that are not approved as pharmacotherapy for obesity management should not be used for this purpose.
- The individual response to obesity-management pharmacotherapy is heterogeneous. In choosing the most appropriate obesity pharmacotherapy, consider mechanism of action, safety, potential side effects/ tolerability, contraindications, drug interactions, mode of administration and cost (see Table 1 and Table 2 of this chapter). There is a significant cost differential between products licensed for obesity management. Initial cost should be discussed with patients when choosing from available medications and ongoing affordability should be regularly reassessed.
- Pharmacotherapy for obesity management can be used for individuals with body mass index (BMI) ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 (BMI ≥ 28 kg/m2 in the case of orlistat) with adiposity-related complications, in conjunction with medical nutrition therapy, physical activity and/or psychological interventions (semaglutide 2.4 mg weekly [Level 1a, Grade A]1, liraglutide 3 mg [Level 2a, Grade B]2-4, naltrexone/bupropion 16 mg/180 mg BD [Level 2a, Grade B]5, orlistat 120mg TDS [Level 2a, Grade B])6.
- Pharmacotherapy may be used to maintain weight loss that has been achieved by health-behaviour changes, and to prevent weight regain (liraglutide 3 mg or orlistat 120 mg TDS) (Level 2a, Grade B)4,7.
- For people living with type 2 diabetes (T2DM) and a BMI ≥ 27 kg/m2, pharmacotherapy can be used in conjunction with health-behaviour changes for weight loss and improvement in glycaemia: semaglutide 2.4 mg weekly (Level 1a, Grade A)8, liraglutide 3 mg (Level 1b, Grade A)9, naltrexone/bupropion combination (Level 2a, Grade B)10, orlistat (Level 2a, Grade B)11.
- We recommend pharmacotherapy in conjunction with health-behaviour changes for people living with prediabetes and overweight or obesity (BMI > 27 kg/m2) to delay or prevent T2DM: liraglutide 3 mg (Level 2a, Grade B) 3, orlistat (Level 2a, Grade B)12.
- We do not suggest the use of prescription or over-thecounter medications other than those approved for weight management (Level 4, Grade D, Consensus).
- For people living with overweight or obesity who require pharmacotherapy for other health conditions, we suggest choosing drugs that are not associated with weight gain where potential differences in efficacy, tolerability and affordability allow (Level 4, Grade D, Consensus).
- Obesity medication can help you in your obesitymanagement journey when health-behaviour modifications alone have not been effective or sustainable.
- There are four medications approved for longterm obesity management in Ireland: liraglutide 3 mg (Saxenda®), semaglutide 2.4 mg (Wegovy®), naltrexone/bupropion in a combination tablet (Mysimba ®) and orlistat (Xenical®). These medications can help to improve health complications linked to excess weight, reduce weight by 5% – 10% and assist in maintaining this loss. These medications are approved by the European Medicines Agency (EMA) for use in Ireland and have been proven in robust clinical trials to be effective for obesity management.
- Medications that are not approved for obesity treatment may not be safe or effective for obesity management and should be avoided.
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