Leena Watts
Phentermine (Adipex-P) is an oral weight-loss medication. However, it is only approved for short-term use and may not suit everyone. Alternatives to Adipex-P include oral phentermine alternatives such as topiramate, Qsymia (phentermine/topiramate ER), and Contrave (naltrexone/bupropion). Orlistat (Xenical, Alli) is also available as a prescription or over-the-counter option. Wegovy and Zepbound are once-weekly injectable phentermine alternatives. While these alternatives seem to be the most effective, they also carry additional risks and side effects. Weight loss medications should be combined with regular exercise and a reduced-calorie diet for the best results.
| Characteristics | Values |
|---|---|
| Effectiveness | Phentermine (Adipex-P) is an effective weight-loss medication for some people. |
| Oral alternatives | Topiramate, Qsymia (phentermine/topiramate ER), Contrave (naltrexone/bupropion), and Orlistat (Xenical, Alli) |
| Injectable alternatives | Wegovy (semaglutide) and Zepbound (tirzepatide) |
| Side effects | Phentermine may cause insomnia, abnormal sensations, dizziness, altered taste, constipation, and dry mouth. |
| Contraindications | Uncontrolled hypertension, coronary artery disease, hyperthyroidism, glaucoma, and sensitivity to stimulants. |
| Pregnancy | Phentermine is not recommended for pregnant women as it may harm the unborn baby. |
| Interactions | Phentermine may interact with other medications such as benzphetamine, diethylpropion, MAO inhibitors, and certain herbs or supplements. |
| Diet and exercise | Phentermine should be combined with a reduced-calorie diet and regular exercise for best results. |
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What You'll Learn
Phentermine alternatives
Phentermine is the oldest and most widely used weight-loss medication. It is available as a 15 mg or 30 mg capsule or an 18.75 mg or 37.5 mg tablet. However, it is only approved for short-term use and may not be a safe option for those with a history of heart problems. Here are some alternatives to phentermine:
Topiramate
Topiramate (Topamax) is an oral medication that is FDA-approved to treat seizures and migraines. It is also commonly prescribed to reduce appetite and help patients feel full sooner. In clinical studies, people taking topiramate lost around 5% of their body weight within 24 weeks. Topiramate is available as Qsymia, a combination of phentermine and topiramate.
Orlistat
Orlistat (Xenical) is an older medication that is available by prescription as well as over the counter. It is an oral capsule taken three times a day with meals. Orlistat works directly in the digestive system to prevent the body from absorbing fats in the diet. In studies, over half of the adults taking orlistat lost at least 5% of their body weight after one year. Alli is the over-the-counter version of orlistat with a lower dosage, so the weight loss results will not be the same. Side effects of orlistat include loose stools, oily stools, and gas with oily spotting.
Naltrexone-bupropion
Naltrexone-bupropion (Contrave) combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain, decreasing cravings and appetite. Some patients may lose 5-10% of body weight. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day.
Liraglutide
Liraglutide (Saxenda) is an FDA-approved medication for long-term weight management.
Wegovy and Zepbound
Wegovy (semaglutide) and Zepbound (tirzepatide) are injectable phentermine alternatives. They are currently only approved for adults, and they are injected once weekly. In clinical studies, 80-90% of people taking the highest Zepbound dosage lost 5% or more of their starting body weight, with an average weight loss of around 20%. Side effects of Zepbound include nausea, diarrhea, heartburn, and injection site reactions.
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Topiramate
The most common side effects of topiramate include abnormal skin sensations (such as burning, tingling, or numbness), altered sense of taste, and slowed thinking and movements. It can also cause insomnia, dizziness, constipation, and dry mouth. It is important to note that topiramate may not be suitable for everyone, and it is essential to consult a healthcare professional before starting any new medication.
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Qysmia
The most common side effects of Qysmia include a "pins-and-needles" feeling, dry mouth, and constipation. It can also cause dizziness, insomnia, abnormal taste, altered vision, and constipation. More seriously, it may cause kidney stones, low potassium levels, and metabolic acidosis. It is also a controlled substance, which means it is more likely to be misused or cause dependence.
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Contrave
In terms of dosage, it is important to follow the instructions of a healthcare provider. Contrave should be swallowed whole and not chewed, cut, or crushed. It is typically taken once per day in the morning with a glass of water. The daily dose starts at 3.75 mg/23 mg and can be gradually increased to 15 mg/92 mg. It is important to note that Contrave should be used in conjunction with a reduced-calorie diet and increased physical activity for effective weight loss.
According to clinical studies, patients taking Contrave achieved an average weight loss of 3.7% to 8.1% over 56 weeks, with 36% to 57% of patients losing at least 5% of their body weight. This is considered a clinically meaningful treatment response. Contrave is generally well-tolerated, with mild adverse effects, and has not shown potential for abuse. However, it is important to discuss any health conditions, medications, and supplements with a healthcare provider before taking Contrave, as it may not be suitable for everyone.
Some common side effects of Contrave include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth. It is also important to note that Contrave may increase the risk of suicidal thoughts and actions, especially when first starting the medication. Contrave interacts with opioid medications, and it is important to resume opioid doses only under the supervision of a healthcare provider to avoid dangerous consequences.
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Orlistat
While Orlistat has been shown to be effective in promoting weight loss, it also has some side effects, most notably gastrointestinal issues such as steatorrhea (oily, loose stools) and flatulence. These side effects are more severe when beginning therapy but tend to decrease over time, especially with long-term compliance with a low-fat diet. It is important to note that Orlistat may also interact with certain medications and supplements, so it is crucial to consult a doctor or pharmacist before taking it.
Additionally, Orlistat has been associated with an increased risk of acute kidney injury and liver injury, although the evidence is inconclusive. It is also important to inform your doctor if you have any medical conditions, such as an eating disorder, diabetes, kidney stones, pancreatitis, gallbladder disease, or thyroid disease, as Orlistat may not be suitable for everyone.
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Frequently asked questions
There are several alternatives to Adipex (phentermine) that are available as oral pills, including topiramate, Qsymia (phentermine/topiramate), and Contrave (naltrexone/bupropion). Wegovy and Zepbound are injectable alternatives that are more effective but carry additional risks and side effects.
Topiramate is an oral medication that is FDA-approved to treat seizures and migraines. It is also prescribed off-label for weight loss as it reduces appetite and helps people feel full sooner.
Wegovy is a once-weekly injectable phentermine alternative. It is a glucagon-like peptide-1 receptor agonist (GLP-1 receptor agonist) and is indicated for obesity.
Zepbound (tirzepatide) is another once-weekly injectable phentermine alternative. It is indicated for obesity and seems to be one of the most effective phentermine alternatives.
Adipex (phentermine) may cause difficulty falling asleep or staying asleep if taken in the evening. It can also lead to dangerous increases in body temperature, requiring adequate fluid intake to avoid heat stroke. Phentermine is also associated with a risk of birth defects if taken during pregnancy.
