Which Weight Loss Drug for this Complex Patient?
She is 35 y/o with a history of migraine, bipolar disorder, and hypertension. Years of structured diets and nutrition consult have failed. Which agent would you consider?
A 35-year-old woman presents to your office for assistance with weight loss. She has tried structured diets through a registered dietician for the past year with minimal weight loss. She has a history of frequent migraines, bipolar disorder, and hypertension. Her medications include phenelzine, fluoxetine, lithium, lisinopril, and sumatriptan. Currently, her BMI is 32 kg/m2 and her blood pressure is 152/96 mm Hg
Which drug or drug combination would be most appropriate for weight loss in this patient?
A. Orlistat
B. Bupropion-naltrexone
C. Phentermine-topiramate
D. Lorcaserin
E. Liraglutide
Please click here for answer/discussion
Answer: A. Orlistat. Orlistat would be the agent of choice in this situation as it causes maldigestion of dietary fat with a subsequent reduction in available calories from the meal.
- Lorcaserin is a selective agonist of the serotonin 2C receptor which in turn suppresses appetite. Lorcaserin should not be used alongside selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or triptans.
- Liraglutide is useful in obese patients who have co-morbid type 2 diabetes, which this patient does not have.
- Phentermine-topiramate can cause fetal anomalies and is not the drug of choice in women of childbearing age and is also contraindicated in patients with poorly controlled hypertension, bupropion-naltrexone should also be avoided in poorly controlled hypertension.
------------------------------------------
Suggested reading : Bray GA, Ryan DH. Medical therapy for the patient with obesity. Circulation. 2012;125:1695-703.
Clinical Tips for Using Antibiotics and Corticosteroids in IBD
January 5th 2013The goals of therapy for patients with inflammatory bowel disorder include inducing and maintaining a steroid-free remission, preventing and treating the complications of the disease, minimizing treatment toxicity, achieving mucosal healing, and enhancing quality of life.
