With the increasing demand for both Saxenda and Wegovy injections for weight loss, availability for these medications has decreased. Both Saxenda and Wegovy are currently listed on the FDAs drug shortage database and the projected duration of the shortage is unknown. Due to the increased shortage of these medications, patients are often left asking “what can I do now?” While it is difficult to start the injectable options currently, there are other oral medications that are readily available to help you obtain your goal weight. The three oral medication options we offer at St. Louis Bariatrics include Phentermine, Qsymia, and Contrave.

Phentermine

Phentermine (brand names: Adipex-P, Lomaira) is a medicine that reduces food intake by causing you to feel full more quickly after eating. Phentermine is classified as a controlled substance by the United States (US) Food and Drug Administration due to its potential for abuse, although the actual observed rate of abuse is extremely low. With Phentermine, you can expect to lose an average of approximately 15 to 17 pounds (7 to 8 kg). Common side effects of phentermine include an increase in blood pressure and heart rate, insomnia, dry mouth, constipation, and nervousness. You should not take phentermine if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or a history of drug abuse.

Phentermine is taken once or twice daily and is intended for short-term use (<12 weeks). If you do not lose at least 5 percent of your initial body weight after 12 weeks, you should stop the medication and discuss alternative options.

If not covered by insurance, phentermine is often available at an affordable cash pay price.

Phentermine-topiramate (Qsymia)

Phentermine and extended-release topiramate are available in combination as a single capsule (brand name: Qsymia). Topiramate is used for the prevention of migraine headaches and to treat seizures in people with epilepsy. People taking topiramate for these indications lose weight, but the way this works is uncertain. People taking this combination medication lose approximately 8 to 10 percent of their initial body weight after one year.

The dose of phentermine-topiramate is usually increased gradually, while weight loss is monitored. If you do not lose 5 percent of your initial body weight after 12 weeks on the highest dose, phentermine-topiramate should be discontinued gradually, as abrupt withdrawal of topiramate can cause seizures. The most common side effects are dry mouth, constipation, and a “pins and needles” sensation of the skin. There is also a risk of psychiatric (eg, depression, anxiety) and cognitive (eg, disturbance in attention) problems; this risk increases with larger doses of the medication. Although phentermine-topiramate improves blood pressure slightly, it is also associated with an increase in heart rate. Phentermine-topiramate should not be used during pregnancy because of the risk of birth defects. People who could get pregnant should take a pregnancy test before starting this medication (and monthly thereafter) to ensure that they are not pregnant. It should also not be used in people with cardiovascular disease (high blood pressure or coronary heart disease).

If not covered by insurance, Qsymia is available for self-pay patients through a mail order pharmacy for $98 per month.

Bupropion-naltrexone (Contrave)

Bupropion is a medicine that is used to treat depression and to prevent weight gain in people who are trying to quit smoking. Naltrexone is a drug used to treat alcohol and drug dependence. Together they work on two main areas of the brain both the hypothalamus (hunger center) and mesolimbic reward center (cravings) to help you lose weight. People taking combination bupropion-naltrexone (brand name: Contrave) lost approximately 5 to 6 percent of their initial body weight after one year. Common side effects include nausea, headache, constipation, insomnia, vomiting, dizziness, and dry mouth. The dose of bupropion-naltrexone is increased gradually over four weeks. If you do not lose at least 5 percent of your initial body weight after 12 weeks, the medication should be discontinued because benefit is unlikely.

Bupropion-naltrexone should not be used in people with uncontrolled high blood pressure, seizure disorders, or an eating disorder. It should also not be used by people who take (or have recently taken) certain other medications, including those containing bupropion, chronic opioids (narcotics), or monamine oxidase inhibitors. It is also not advised to take this medication with alcohol.

If not covered by insurance, Contrave is available for self-pay patients through a mail order pharmacy for $99 per month.

Not sure which medication is right for you? Contact St. Louis Bariatrics to schedule a virtual or in person consultation appointment.

*Individual results may vary.