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Recommended Treatment

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Male Female {{ gender }}
Sedentary (Little to no exercise)
Light exercise (1–3 days per week)
Moderate exercise (3–5 days per week)
Heavy exercise (6–7 days per week)
Very heavy exercise (twice per day, extra heavy workouts)

History

Select as many histories as desired.

  • Diabetes Prevention
  • Type 2 Diabetes Mellitus
  • Hypertension
  • Cardiovascular Disease
  • Chronic Kidney Disease
  • Nephrolithiasis
  • Hepatic Impairment
  • Depression
  • Anxiety
  • Psychoses
  • Binge Eating Disorder
  • Glaucoma
  • Seizure Disorder
  • Pancreatitis
  • Opioids
  • Women of Reproductive Potential
  • Age > 65 years
  • Alcoholism/ Addiction
  • Post-Bariatric Surgery
Preferred Weight-Loss Medications: Individualization of Therapy
Key:   Preferred Drug   Use With Caution   Avoid
Orlistat Lorcaserin Phentermine/topiramate ER Naltrexone ER/ bupropion ER Liraglutide 3 mg
Diabetes Prevention (metabolic syndrome, prediabetes)     Insufficient data for T2DM prevention   Insufficient data for T2DM prevention
Type 2 Diabetes Mellitus
Hypertension Monitor heart rate
Monitor BP and heart rate
Contraindicated in uncontrolled HTN
Monitor heart rate
Cardiovascular Disease
 
 
CAD
Arrhythmia
CHF
 
 
Insufficient data
 
Monitor for bradycardia
Insufficient data
Monitor heart rate
Monitor heart rate, rhythm
Insufficient data
Monitor heart rate, BP
Monitor HR, rhythm, BP
Insufficient data
Monitor heart rate
Monitor HR, rhythm
Insufficient data
Chronic Kidney Disease
Mild
(50–79 mL/min)
Moderate
(30–49 mL/min)
Severe
(<30 mL/min)
 
 
Watch for oxalate nephropathy
 
 
Urinary clearance of drug metabolites
 
Do not exceed 7.5 mg/46 mg per day
Urinary clearance of drug
 
Do not exceed 8 mg/90 mg bid
Urinary clearance of drug
 
 
Avoid vomiting and volume depletion
Nephrolithiasis Calcium oxalate stones Calcium oxalate stones
Hepatic Impairment
Mild-Moderate
(Child-Pugh 5–9)
Severe
(Child-Pugh >9)
Watch for cholelithiasis
Not recommended
Hepatic metabolism of drug
Not recommended
Do not exceed 7.5 mg/46 mg per day
Not recommended
Do not exceed 8 mg/90 mg in AM
Not recommended
Watch for cholelithiasis
Not recommended
Depression








Insufficient safety data
Avoid combinations of serotonergic drugs
Avoid maximum dose: 15 mg/92 mg per day
Insufficient safety data
Avoid in adolescents and young adults




Anxiety Avoid max dose: 15 mg/92 mg per day
Psychoses Insufficient data Insufficient data Insufficient data Insufficient data Insufficient data
Binge Eating Disorder








Insufficient data; however, possible benefit based on reduction in food cravings
Insufficient data; however, possible benefit based on studies with topiramate
Insufficient data, though possible benefit based on studies with bupropion
Avoid in patients with purging or bulimia nervosa
Insufficient data
Glaucoma Contraindicated, may trigger angle closure May trigger angle closure
Seizure Disorder If discontinuing from max dose, taper slowly Bupropion lowers seizure threshold
Pancreatitis




Monitor for symptoms












Monitor for symptoms
Avoid if prior or current disease
Opioid Use Will antagonize opioids and opiates
Women of Reproductive Potential
Pregnancy
Breast-feeding
Use contraception and discontinue orlistat should pregnancy occur
Not recommended
Use contraception and discontinue lorcaserin should pregnancy occur
Not recommended
Use contraception and discontinue phentermine/topiramate should pregnancy occur (perform monthly pregnancy checks to identify early pregnancy)
Not recommended
Use contraception and discontinue naltrexone ER/bupropion ER should pregnancy occur
Not recommended
Use contraception and discontinue liraglutide 3 mg should pregnancy occur
Not recommended
Age ≥65 years * Limited data available Insufficient data Limited data available Insufficient data Limited data available
Alcoholism/
Addiction		   Might have abuse potential due to euphoria at high doses Insufficient data, though topiramate might exert therapeutic benefits Avoid due to seizure risk and lower seizure threshold on bupropion data  
Post-Bariatric Surgery Insufficient data Insufficient data Limited Data Available Insufficient data Data available at 1.8 – 3.0 mg/day

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The content of this website is provided only for medical education purposes. The author has made every effort to provide the most up to date clinical practice guideline information. The information contained herein may not reflect the current standard of care. Clinical judgement and the individualization of care supersedes any information contained herein. The content of this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Decision-making should be undertaken between a licensed healthcare provider in conjunction with patient input and with consideration of all of the relevant facts of the case. Website users are advised to contact their licensed healthcare provider with any questions regarding their personal condition. Do not delay seeking care based on the content of this website. Reliance on the content of this website is done so at the end-user’s own risk. If you believe you are having a medical emergency, contact your local EMS, healthcare provider, or present for emergency care.

Citation: Reprinted with permission from AACE. Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., . . . Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for comprehensive medical care of patients with obesity. Endocrine Practice, 22(Suppl 3), 1-203. http://dx.doi.org/10.4158/EP161365.GL