Review Article| Volume 92, P170-192, March 2019

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Pharmacotherapy of obesity: Available medications and drugs under investigation

Published:October 31, 2018DOI:


      • Obesity is a chronic, multifactorial disease, initially managed with lifestyle modifications
      • Upon failure an FDA approved medication can be started based on patient comorbidities
      • Many novel anti-obesity agents are currently in clinical trials
      • Bariatric surgery studies highlight the role of gut-derived hormones in weight loss
      • Agents referring to gastrointestinal hormones will more likely reach the market


      Obesity is a chronic disease with a continuously rising prevalence that currently affects more than half a billion people worldwide. Energy balance and appetite are highly regulated via central and peripheral mechanisms, and weight loss triggers a homeostatic response leading to weight regain. Lifestyle and behavioral modifications are the cornerstones of obesity management; however, they often fail to achieve or sustain long-term weight loss. Pharmacotherapy added onto lifestyle modifications results in an additional, albeit limited, weight reduction. Regardless, this weight reduction of 5–10% conveys multiple cardiovascular and metabolic benefits. In this review, evidence on the food and drug administration (FDA)-approved medications, i.e., orlistat, lorcaserin, phentermine/topiramate, liraglutide and naltrexone/bupropion, is summarized. Furthermore, anti-obesity agents in the pipeline for potential future therapeutic use are presented.


      Ach (acetylcholine), ACTH (adrenocorticotropic hormone), ADHD (attention-deficit hyperactivity disorder), AgRP (agouti-related peptide), AHI (apnea hypopnea index), AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid), ARC (arcuate nucleus), AVP (arginine-vasopressin), BAT (brown adipose tissue), BDNF (brain-derived neurotrophic factor), BED (binge eating disorder), BID (twice daily), BMI (body mass index), BOTOX (botulinum toxin), BW (body weight), CART (cocaine- and amphetamine-regulated transcript), CB1 (cannabinoid receptor type 1), CNS (central nervous system), CR (controlled release), CV (cardiovascular), CVD (cardiovascular disease), DA (dopamine), DBP (diastolic blood pressure), DIO (diet-induced obesity), FDA (Food and Drug Administration), eGFR (estimated glomerular filtration rate), FGF (fibroblast growth factor), fMRI (functional magnetic resonance imaging), GABA (gamma-aminobutyric acid), GCG R (glucagon receptor), GI (gastrointestinal), GIP R (gastric inhibitory peptide receptor), GLP (Glucagon-like peptide), HbA1c (glycosylated hemoglobin), HCl (hydrochloric), HDL-C (high density lipoprotein-cholesterol), HR (heart rate), HT R (hydroxytryptamin receptor), K (potassium), LDL-C (low density lipoprotein-cholesterol), MC (melanocortin), MC4R (melanocortin 4 receptor), MSH (melanocyte-stimulating hormone), NA (not available), Na (sodium), NAFLD (nonalcoholic fatty liver disease), Nal-Bup (naltrexone-bupropion), NE (norepinephrine), NPY (neuropeptide Y), NS (non-significant), NTS (nucleus of the solitary tract), OSA (obstructive sleep apnea), PCOS (polycystic ovary syndrome), PDE (phosphodiesterase), Phen-Top (phentermine/topiramate), POMC (proopiomelanocortin), PP (pancreatic polypeptide), PVN (paraventricular nucleus), PWS (Prader Willi syndrome), PYY (peptide YY), QD (once daily), RCT (randomized controlled trial), rhGH (recombinant human growth hormone), SBP (systolic blood pressure), sc (subcutaneous), SE (serotonin), SGLT (sodium-glucose cotransporter), TC (total cholesterol), T2D (type 2 diabetes), TC (total cholesterol), TG (triglyceride), TID (three times daily), TNF (tumor necrosis factor), TRH (Thyrotropin-releasing, ventromedial nucleus), WC (waist circumference), XR (extended release), y (year)


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