7 FDA-Approved Drugs for Weight Management
Medically reviewed by Femi Aremu, PharmD
For people with obesity, weight loss is often a difficult journey that requires lifestyle changes. Sometimes, when dietary changes and exercise are not enough, your healthcare provider may prescribe a weight loss medication.
Your provider may recommend one of these medications if you:
Have a body mass index (BMI) of at least 30
Have a BMI of 27 with an additional medical condition such as high blood pressure, type 2 diabetes, or high cholesterol
This article will discuss seven current Food and Drug Administration (FDA)–approved weight loss drugs on the market.
Photo Composite by Amelia Manley for Verywell Health ; Getty Images
Xenical (Orlistat)
Xenical (orlistat) can help you lose weight and keep it off. It belongs to a class of medications called lipase inhibitors.
Orlistat reduces the amount of fat absorbed in the gut after eating. When taking it, no more than 30% of your calories should come from fat. Because of how it works, orlistat is often a better choice for people who tend to eat fatty foods.
Dosing for Xenical is usually 120 milligrams (mg) three times daily. It comes as capsules that should be taken with food or up to one hour after a meal.
Orlistat can reduce the absorption of fat-soluble vitamins in the body; therefore, it's recommended to take a daily multivitamin at bedtime.
How Effective Is It?
Clinical trials have suggested that orlistat provides modest weight loss in people with obesity.
The XENDOS study evaluated orlistat's ability to prevent diabetes in individuals with obesity over four years. Over the course of the study, orlistat users lost, on average, about 13 pounds compared to 7 pounds in the placebo group. Orlistat also lowered the risk of developing type 2 diabetes.
If orlistat works for you, you might expect to lose at least 5% of your body weight in one year.
Orlistat has also been shown to reduce BMI, waist circumference, cholesterol, and low-density lipoprotein (LDL) levels (considered "bad" cholesterol).
However, it may not be as effective as other weight-loss medications. In another study, people who took the drug liraglutide (sold under the brand names Saxenda and Victoza) lost more weight (about 17 pounds) than those on orlistat (about 7 pounds) over seven months.
BMI
Body mass index is a dated, biased measure that doesn’t account for several important factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.
Other Considerations
You should not take Xenical if:
You are pregnant.
You have malabsorption syndrome.
You have cholestasis (the slowing or stalling of bile flow through your biliary system).
You have a known hypersensitivity to orlistat.
Additionally, certain medications can interact with Xenical, such as:
Cyclosporine
Levothyroxine
Anticoagulants, including Jantoven (warfarin)
Amiodarone
Antiretrovirals, such as Norvir (ritonavir)
While taking Xenical, you may experience these side effects:
Fatty stools
Gas with oily spotting
Increased stools that are more difficult to control
Increased defecation
Taking a fiber-containing supplement, like psyllium, along with Xenical can reduce some of the gastrointestinal (GI)–related side effects.
Alli (Orlistat)
Like Xenical, Alli contains the active ingredient orlistat. This version is available over the counter (OTC) and comes in a 60 mg capsule.
Alli works the same way as Xenical, by reducing the amount of fat absorbed in your gut. It is only for adults 18 or older.
Because Alli has the same active ingredient as Xenical, it has similar side effects and safety considerations to account for. However, Alli tends to be better tolerated than Xenical because it is a lower dose.
How Effective Is It?
In clinical studies, most people who took the 60 mg version of orlistat lost 5 to 10 pounds over six months.
Orlistat 60 mg has been shown to have 85% of the efficacy of the 120 mg orlistat dose.
Contrave (Bupropion-Naltrexone)
Contrave is a combination medication that consists of bupropion, an antidepressant, and naltrexone, an opioid antagonist. The two work together to help you lose weight along with a low-calorie diet and appropriate exercise.
Contrave is usually taken differently every week for the first month. Follow the dosing schedule prescribed by your healthcare provider. Do not take it with high-fat meals.
How Effective Is It?
In four clinical trials, people who were overweight or with obesity took Contrave for up to 56 weeks.
Overall, people who took Contrave lost more body weight than those who took a placebo. For example, in one study, 40% of participants who took Contrave lost at least 5% of their body weight, and 20% of participants lost at least 10%.
The average weight loss across all four studies ranged from 11 to 22 pounds for those taking the medication.
Contrave also helped lower hemoglobin A1c in people with type 2 diabetes.
Other Considerations
Do not use Contrave if you:
Are pregnant
Have uncontrolled high blood pressure
Have a seizure disorder
Are diagnosed with anorexia or bulimia
Have recently abruptly stopped drinking alcohol, benzodiazepines, barbiturates, or antiepileptic medications
Are using another medication that contains bupropion
Use opioids chronically
Have taken a monoamine oxidase inhibitor (MAOI) within the last two weeks
Have an allergy to any of the ingredients found in Contrave
While taking Contrave, the following side effects are possible:
Nausea or vomiting
Constipation
Headache
Dizziness
Trouble sleeping
Dry mouth
Mental changes
Increased blood pressure and heart rate
Low blood sugar
Safety Warning
Like other antidepressants, bupropion comes with the risk of increased suicidal thinking and behaviors, especially in children, adolescents, and young adults. Contrave's labeling includes a boxed warning to highlight this risk.
While taking Contrave, be aware of any changes in your mental well-being and contact your healthcare provider immediately if you notice any mood changes or have suicidal thoughts.
Saxenda (Liraglutide)
Saxenda (liraglutide) belongs to a class of medications known as glucagon-like-peptide receptor agonists (GLP-1), which work by stimulating the GLP-1 receptor in the brain. This can help to regulate appetite.
Saxenda is a medication injected subcutaneously (under the skin).
You'll usually take your dose once daily, with or without meals. When first starting treatment, your healthcare provider will have you start at a lower dose and then gradually increase it over the coming weeks.
Saxenda is also one of the obesity treatments that can be used in children ages 12 to 17 with obesity. Talk to your child’s healthcare provider about dosing, as it can vary for children.
How Effective Is It?
A large trial evaluated liraglutide in individuals who were overweight or had obesity. The participants had diabetes or prediabetes. By the end of the study (56 weeks), Saxenda users reported statistically significant weight loss compared with those who took the placebo.
In this study, 63% of the participants who took Saxenda lost at least 5% of their body weight. About 33% lost at least 10% of their body weight.
In another study of people without diabetes, Saxenda was more effective for weight loss than lifestyle interventions alone. It also showed sustained weight loss over two years.
Other Considerations
When taking Saxenda, common side effects can include:
Nausea or vomiting
Constipation or diarrhea
Low blood sugar
Do not start Saxenda if you:
Have had a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
Are pregnant
Have an allergy or sensitivity to any of the ingredients in Saxenda
When starting Saxenda, talk to your healthcare provider if you develop abdominal pain, nausea, or vomiting that does not go away.
Qsymia (Phentermine-Topiramate)
Qsymia is combination medication made up of phentermine, a medication similar to amphetamines, and topiramate, an anti-seizure medication. It works in the brain to reduce your appetite.
Usually, Qsymia is taken once daily in the morning because it can cause insomnia.
Children 12 years and older can take Qysmia if they have a BMI considered to be in the 95th percentile. Talk to your healthcare provider about your child’s BMI to determine if Qsymia is right for them.
How Effective Is It?
At the maximum dose in initial clinical studies, 70% of adult participants who took Qysmia lost at least 5% of their body weight in one year. Almost half lost 10% or more of their body weight.
In additional studies, Qysmia resulted in an average weight loss of about 17 pounds compared with a placebo. The amount of weight lost was dependent on the dose.
Other Considerations
For adults, common side effects can include:
Changes in taste
Insomnia
Constipation
Dry mouth
For children, common side effects can include:
Depression
Dizziness
Muscle aches and pains
Fever
Do not start Qsymia if you:
Are pregnant or thinking of becoming pregnant, or are breastfeeding
Have glaucoma
Have hyperthyroidism
Have an allergy or sensitivity to any of the ingredients in Qsymia
Are currently taking an MAOI or have taken one within two weeks
When starting Qsymia, watch for any changes in your mood. Talk to your healthcare provider about monitoring your kidney function, heart rate, and sodium and potassium levels. If your child takes Qsymia, monitor for signs of stunted growth.
Certain medications can interact with Qsymia. These include:
Sedatives, opioids, or hypnotics
Alcohol
Taking Qysmia Safely
Qysmia is categorized as a Schedule IV controlled substance because it contains phentermine. Phentermine has the potential for abuse and physical dependence. Do not abruptly stop taking Qysmia, as this can cause withdrawal reactions.
Do not stop taking Qysmia without consulting with your healthcare provider. They can help you safely come off the medication. Talk to your provider immediately if you feel you are becoming dependent on your medication.
Imcivree (Setmelanotide)
Imcivree belongs to a class of medications called melanocortin receptor agonists, which can affect fat formation in the body.
Imcivree is injected under the skin. It helps control your hunger and appetite if you have certain genetic dispositions that include:
Bardet-Biedl syndrome
Gene deficiencies such as pro-opiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor deficiency (LEPR)
If prescribed Imcivree, your dose may depend on your kidney health. It's important to rotate the area where you inject Imcivree to prevent injection site reactions or scarring on the skin.
How Effective Is It?
Two clinical trials studied how well Imicvree works in people with obesity due to gene deficiencies of POMC, PCSK1, or LEPR.
In these studies, 80% of people with POMC or PCSK1 deficiencies achieved at least 10% weight loss after one year. Forty percent of those with LEPR deficiency had a 10% weight loss in one year.
Other Considerations
The most common side effects seen with Imcivree are:
Changes in skin color
Injection site reactions
Nausea or vomiting
Headache
Diarrhea
Depression
Imcivree should not be used in infants or newborns as an ingredient found in Imcivree can be fatal to this population.
When taking Imcivree, watch for any changes in sexual function. For males, contact your healthcare provider if you develop an erection lasting longer than four hours. Watch for any changes in your mood.
Risk of Depression or Suicidal Thinking
Imcivree has caused new or worsening depression and suicidal thinking. Be mindful of any changes in mood, thoughts, or behaviors if you or someone you are caring for is taking this medication. Contact your healthcare provider immediately if you experience any symptoms of depression or suicidal ideation.
Wegovy (Semaglutide)
Like Saxenda, Wegovy is a GLP-1 receptor agonist. It stimulates the GLP-1 receptor in the brain, making you feel full.
Wegovy may be prescribed to children 12 and older with a BMI in the 95th percentile (considered obese).
Wegovy is given under the skin once weekly, at the same time every week, with or without meals.
How Effective Is It?
In studies, semaglutide was more effective at reducing body weight and HbA1c than placebo. When used in addition to lifestyle interventions, 2.4 mg of semaglutide once weekly resulted in an average weight loss of 15%.
More people who took semaglutide (86%) lost at least 5% of their body weight compared with those on placebo (13%). About seventy percent of users lost at least 10% of their body weight.
Studies have also shown semaglutide to be superior to some other weight-loss agents. Compared with liraglutide, more semaglutide users achieved weight loss greater than 5% or 10%.
Other Considerations
Common side effects seen with Wegovy may include:
Nausea or vomiting
Diarrhea or constipation
Abdominal pain
Headache
Tiredness
Let your healthcare provider know if you are taking any other medications, as Wegovy can affect their concentrations in the body.
Do not start Wegovy if you:
Have had a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2
Are pregnant, or if you are planning on becoming pregnant. Wegovy should be stopped at least 2 months before trying to conceive in both males and females
Have an allergy or sensitivity to any of the ingredients in Wegovy
What to Watch for
While taking Wegovy, watch for the following side effects:
When starting treatment, contact your healthcare provider if you develop abdominal pain, nausea, or vomiting that does not go away, as it could be a sign of a more serious side effect.
Wegovy can also cause depression or suicidal ideation. If this occurs, see your healthcare provider as soon as possible. They may need to take you off of the medication.
If you have type 2 diabetes, monitor for any changes in eyesight or a drop in your blood sugar.
Zepbound (tirzepatide)
Zepbound is a dual-acting glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. Zepbound activates these hormones, making you feel full.
Zepbound is a medication injected subcutaneously and is approved for adults with obesity.
The recommended maintenance dosage of Zepbound is 5-15 mg, injected once weekly.
How Effective Is It?
Two large trials evaluated Zepbound in individuals who were overweight or obese. By the end of the study (72 weeks), people who dieted, exercised and took Zepbound reported statistically significant weight loss compared to those who took the placebo.
Other Considerations
Common side effects seen with Zepbound may include:
Nausea or vomiting
Diarrhea or constipation
Abdominal pain
Tiredness
Takeaway
Zepbound (terzepatide) is an injectable weight-loss medication for adults with obesity. Terzepatide is also the active ingredient in Mounjaro, which is approved to treat diabetes. Zepbound may interact with Synthroid and increase the risk of MTC. Those with a personal or family history of (medullary thyroid carcinoma) MTC or with multiple endocrine neoplasia syndrome type 2 (MEN 2) should avoid it. Terzepatide is also the active ingredient in Mounjaro, which is approved to treat diabetes.
Summary
Medications like the ones mentioned above may be beneficial when diet and exercise are not enough to reach your weight goal. Your healthcare provider can help you find the best option based on your health goals, medical history, and personal preferences.
However, these medications aren’t quick fixes. Lifestyle changes are strongly recommended in obesity treatment. Continue eating a healthy, well-balanced diet and engaging in a consistent exercise routine, even after achieving weight loss goals.
Frequently Asked Questions
Can I take more than one weight loss medication at the same time?
It is not recommended to take more than one weight loss medication at the same time before speaking with your healthcare provider, as doing so may worsen possible side effects of the medication.
What kind of medications are available for weight loss if I’m pregnant?
Weight loss during pregnancy may cause complications for the fetus. Therefore, you should not take any weight loss medications while pregnant.
If I’m not overweight, but want to lose weight, can I use these medications?
No, these medications are indicated only if you are overweight or obese and should not be used with a BMI less than 27.
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