Weight loss drugs: What are the options?

Key takeaways

• If a doctor recommends weight loss, there are several medications they may prescribe, including Ozempic, Wegovy, and Mounjaro.
• Some medications are specifically approved to manage weight, while others are prescribed off-label for this purpose.
• Some dietary supplements may claim to help with weight loss, but research is scarce on their effectiveness. Always speak with a doctor before taking a new supplement.

Overview

Prescription weight loss drugs typically work by reducing appetite and increasing energy expenditure. There are several prescription medications that may help you lose weight, such as:

• semaglutide (Ozempic)
• tirzapetide (Mounjaro)
• liraglutide (Victoza)

Dietary supplements that you can buy over-the-counter (OTC) for weight loss have different regulations than prescription medications. The manufacturer is responsible for safety and truth in labeling, and the FDA does not monitor the quality and safety of these products.

It’s difficult to tell whether OTC supplements can be effective for weight loss.

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Prescription weight loss drugs available in the U.S.

Some weight loss drugs are approved specifically for weight loss, while others may be approved for a different purpose but can still be used to help you lose weight.

For example, Ozempic is approved for use in people with type 2 diabetes. However, doctors may still prescribe it for weight loss. This would be considered an off-label use.

According to the Food and Drug Administration (FDA), “off-label” means using an approved drug for an unapproved purpose, in a different form, or at a different dose. These unapproved purposes must still be safe, effective, and prescribed by a healthcare professional.

Weight loss medications come in different forms, doses, and active ingredients. Your healthcare professional can advise you on which is best for your needs.

GLP-1 agonists

Glucagon-like peptide-1 receptor (GLP-1) agonists have FDA approval for treating type 2 diabetes.

Examples of GLP-1 agonists that doctors can prescribe for weight loss include:

• semaglutide (Ozempic, Rybelsus, Wegovy) 
• dulaglutide (Trulicity) 
• liraglutide (Saxenda) 
• exenatide (Byetta)  
• tirzepatide (Zepbound)

Most of these uses are considered off-label, but three specific brands of the GLP-1 active ingredients — Wegovy, Zepbound, and Saxenda — are also approved for weight loss in people with obesity, even if you don’t have diabetes.

What’s more, the majority of these medications are only available as brand-name drugs, with the exception of liraglutide. Generic liraglutide is now available as the first generic GLP-1 indicated for weight loss.

Research on GLP-1 agonists suggests that these drugs can be very effective for weight loss, with results varying depending on the drug.

For example, a study on liraglutide (Saxenda) found an average weight loss of around 6 kg. Research on semaglutide injections found a weight loss of 15.3 kg, and research on tirzapetide (Zepbound) suggests that participants lost up to 23.6 kg with the highest dose of the medication.

Semaglutide is available as oral tablets under the brand name Rybelsus. All other GLP-1 agonists, including the brands Ozempic and Wegovy and other GLP-1s like Mounjaro, are available as daily or weekly injections. 

Nausea, vomiting, headaches, and diarrhea are common side effects of GLP-1 agonists. Dizziness, indigestion, and infections are also possible.

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Orlistat (Xenical)

Orlistat is available in the United States under the brand name Xenical. It is a lipase inhibitor that blocks the absorption of dietary fat in your intestines. Instead, this fat passes through and is excreted in your stool.

Xenical is FDA approved for weight loss and weight management in people with obesity and overweight and to help prevent regaining weight after significant weight loss. 

Clinical studies have found that after 1 year of treatment, people taking Xenical lost an average of 13.4 pounds (lbs), or 6 kg, compared to 5.8 lbs (2.6 kg) in the placebo group.

This medication comes as an oral capsule you take with a meal containing dietary fats.

Side effects may include:

• loose or oily stools
• bowel urgency
• stomach pain
• anxiety
• irregular menstrual periods
• rectal discomfort

Phentermine and topiramate (Qsymia)

Qsymia is a combination of phentermine with topiramate. Phentermine is used as a weight loss aid, and topiramate as a medication for epilepsy and migraine. It’s available as a branded medication, or as a generic.

Qsymia is FDA approved for long-term weight management in people ages 12 years and older with obesity or overweight.

Phentermine increases metabolism and decreases appetite, while topiramate works on neurotransmitters — chemicals involved in brain signaling — to reduce hunger and increase the feeling of being full.

Some 2021 research suggests that phentermine and topiramate therapy led to an average weight loss of 7.73 kg, and a clinical trial published in 2022 found that adolescents who took Qsymia lost an average of 4.8% and 7.1% of their BMI, depending on the dose, over 56 weeks. Those who took the placebo gained an average of 3.3%.

Qsymia is available as an extended-release capsule in four different strengths. It is not safe to take during pregnancy.

The most common side effects are:

• dizziness
• changes to your sense of taste
• insomnia
• constipation
• dry mouth
• pins-and-needles sensation

Naltrexone and bupropion (Contrave)

Contrave is a combination drug containing naltrexone, an opiate antagonist, and bupropion, an atypical antidepressant.

Contrave works by depressing your appetite, making you feel full, and helping you burn energy. Like Qsymia, Contrave is FDA-approved for chronic weight management in people with a BMI of 30 kg/m2 or 27 kg/m2 with certain weight-related conditions. Unlike Qsymia, Contrave is not FDA-approved for use in adolescents. 

In four clinical trials, each lasting 56 weeks, people reached clinically significant weight loss while using Contrave.

The drug is available in an extended-release tablet. Your doctor will slowly increase your dosage over a specific time period until you reach a maintenance dose, which may differ for each individual.  

Contrave comes with a black box warning, the FDA’s strongest cautionary labeling. The label warns that Contrave may lead to a higher chance of suicidal thoughts and behaviors and neuropsychiatric reactions.

Doctors do not recommend Contrave for people with a history of hypertension, seizure disorder, or eating disorders.

Common side effects of Contrave may include:

• nausea
• constipation
• headaches
• vomiting

OTC weight loss drugs

OTC weight loss products are not regulated for safety or effectiveness by the FDA. They usually fall into the category of “dietary supplements.”

Manufacturers that sell dietary supplements must evaluate their safety and ensure product labels are truthful.

Examples of OTC weight loss supplements include:

• African mango
• caffeine
• carnitine
• green coffee bean extract
• green tea

However, according to the National Institutes of Health (NIH) Office of Dietary Supplements, many vitamins and supplements for weight loss only show a modest effect on weight, and some appear to have no effect at all.

It is highly advisable that you consult with a healthcare professional before taking any OTC weight loss drugs. These may interact with prescription medications or cause adverse health effects, particularly if you have chronic conditions.

Summary

Weight loss drugs are available as injections or tablets. They may be approved to treat chronic conditions in addition to managing weight loss. Some have approval for weight loss only in people with obesity and overweight.

A healthcare professional will assess your overall health and weight loss needs before recommending a prescription medication and corresponding dosage.

Unlike prescription medications, the FDA does not regulate OTC dietary supplements. The manufacturer is responsible for the safety of these products. It is a good idea to speak with a healthcare professional before taking an OTC supplement for weight loss.

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