April 26, 2024 – Before it OzempicWegovy or Zepbound, there have been inexpensive, secure and effective weight reduction drugs. FDA-approved obesity drugs resembling Orlistat (brand name: Xenical), phentermine/topiramate (Qsymia) and extended-release naltrexone/bupropion (Contrave) have been available on the market for a long time.
“Some older obesity medications date back to the '50s and '60s – like phentermine, which is still one of the most widely prescribed drugs in the world,” said Anthony Auriemma, MD, medical director of Ascension Illinois Weight Loss Solutions.
While newer GLP-1 Drugs like Semaglutide (Ozempian, Ways) often end in greater weight reduction, but the benefits of more established drugs – resembling lower cost, sufficient availability and easier accessibility – make them helpful options, says Dr. Andres Acosta, an obesity expert on the Mayo Clinic.
“Many people say that GLP-1s are the first drugs to produce double-digit weight loss,” he said. “That's not true. Qsymia was already in double-digits, giving you 11% [of total body weight loss] at the medium dose and 13% at the high dose.”
And two inexpensive and effective drugs result in less weight loss: Contrave (about 9%) and Xenical (5 to 6%).
Some patients can get coupons from the drugmakers for Qsymia and Contrave for as little as $100 a month and for generic phentermine for as little as $20 a month, Auriemma said. Xenical is available for $200 to $300 a month. Compare that cost to GLP-1s like Ozempic, which can cost at least $500 to several thousand dollars a month.
An independent Evaluation of the Institute for Clinical and Economic Review found that Qsymia is the most cost-effective drug among semaglutide and other obesity drugs that preceded it. Qsymia's “dual mechanism” suppresses your appetite in the morning, and its extended-release feature can keep you full into the afternoon — meaning fewer snacks and excess calories, according to John Amos, CEO of VIVUS, the pharmaceutical company behind Qsymia.
Another important difference between older obesity drugs and newer GLP-1 preparations is that the former are taken orally, while the latter are given as injections.
“The really nice thing about older drugs like Phentermine, Contrave or Qsymia is that most of them have many of the Gastrointestinal Side effects that are heard about with GLP-1 drugs that people often have concerns about Nausea, Vomitand some talk about Gastroparesisor gastric paralysis,” Auriemma said.
Keep in mind: Some patients may need to take obesity medications for a long time, making finding a cost-effective drug even more important. It's also important to remember that there is no one-size-fits-all solution when it comes to treating obesity, as our bodies don't all respond the same to medications, nor do we all have similar eating habits and lifestyles. So current fads or waves of popularity shouldn't be the deciding factor when choosing a medication. Talk to your doctor about which obesity medication, if any, might be right for you, Auriemma said.
“If you possibly can't afford GLP-1, your insurance won't cover it, otherwise you don't have access to it, there are other options which might be already FDA-approved,” Acosta said. “When we do this cost-outcome mapping, those other drugs, particularly phentermine/topiramate, grow to be probably the most cost-effective.”