Chair, Donna H. Ryan, MD, FTOS, prepared useful Practice Aids pertaining to obesity management for this CME activity titled “Demystifying the Role of Incretin-Based Weight-Loss Pharmacotherapy: A Patient-Centered Approach to Overcoming Barriers and Addressing Underlying Causes of Obesity.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at http://bit.ly/3qWzNTq. CME credit will be available until July 14, 2022.

1. Guideline Recommendations
on Weight-Loss Pharmacotherapy1-3
Full abbreviations, accreditation, and disclosure information available at PeerView.com/XRQ40
1. Garvey WT et al. Endocr Pract. 2016;22(suppl 3):1-203. 2. https://stop.publichealth.gwu.edu/wcw. 3. Apovian CM et al. J Clin Endocrinol Metab. 2015;100:342-362.
American Association
of Clinical Endocrinologists The Endocrine Society
For individuals who fail to lose
weight or have weight regain
on lifestyle therapy alone
For individuals who have
weight-related complications,
particularly if the
complications are severe
For individuals who have
a BMI of ≥27 kg/m2
and one or more comorbidities
For individuals who have
a BMI of >30 kg/m2
WHO defines obesity as excess abnormal body fat that may impair one’s health
Waist circumference cut-off varies by population (≥23 kg/m2
for some ethnicities)

2. Weight-Loss Pharmacotherapy: Guidance on Dosing,
Administration, Titration, and Safety1-5
Full abbreviations, accreditation, and disclosure information available at PeerView.com/XRQ40
1. Garvey WT et al. Endocr Pract. 2016;22(suppl 3):1-203. 2. Apovian CM et al. J Clin Endocrinol Metab. 2015;100:342-362. 3. https://www.accessdata.fda.gov/scripts/cder/daf/. 4. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-
overweight-obesity. 5. Hall KD, Kahan S. Med Clin North Am. 2018;102:183-197.
• Cyclosporine, chronic malabsorption syndrome,
cholestasis, use with certain drugs
• Decreased absorption of fat-soluble vitamins,
steatorrhea, oily spotting, fecal urgency, oily
evacuation, increased defecation
Safety
• Pregnant or breastfeeding (fetal toxicity),
hyperthyroidism, glaucoma, MAOI,
sympathomimetic amines
• Insomnia, dry mouth, constipation, paresthesia,
dizziness, dysgeusia
• Uncontrolled hypertension, seizure disorders,
anorexia nervosa or bulimia, drug or alcohol
withdrawal, MAOI, opioid, bupropion
• Nausea, constipation, headache, vomiting, dizziness
• History of MTC or MEN 2, acute pancreatitis
• Nausea, vomiting
Orlistat
Phentermine/topiramate ER
Naltrexone ER/bupropion ER
Liraglutide 3.0 mg
Weight-loss agents should not be used in patients who are pregnant or breastfeeding
• History of MTC or MEN 2, acute pancreatitis
• Nausea, vomiting
Semaglutide 2.4 mg
3x/day
Lipid
excretion
(GI
tract)
Appetite
regulation
(CNS)
Liraglutide
3.0 mg 1x/day
Semaglutide
2.4 mg 1x/week
How
Medication When
Orlistat
Phentermine/
topiramate ER 1x/day
Naltrexone ER/
bupropion ER 2x/day
Naltrexone ER/Bupropion ER
Week 1 One tab (8/90 mg) by mouth each morning
Week 2 One tab (8/90 mg) by mouth twice daily
Week 3
Two tabs (16/180 mg) by mouth each morning
and one tab (8/90 mg) by mouth at bedtime
Week 4 Two tabs (16/180 mg) by mouth twice daily
Liraglutide
Start at 0.6 mg subQ once daily for 1 week; in weekly intervals,
increase the dose until a dose of 3.0 mg is reached
Semaglutide 2.4 mg
Start at 0.25 mg subQ once weekly for 4 weeks; in 4-week
intervals, increase the dose until a dose of 2.4 mg is reached
Phentermine/Topiramate ER
Starting 3.75/23 mg by mouth once daily (2 weeks)
Recommended 7.5/46 mg by mouth once daily
Escalation 11.25/69 mg by mouth once daily
Maximum 15/92 mg by mouth once daily
Orlistat
120 mg by mouth three times daily before meals
60 mg by mouth for the OTC formulation
Titration Schedules
Dosing and Administration