Page 14 - IMO-2-2

Innovative Medicines & Omics Pharmacotherapy of obesity

Table 1. (Continued)
Drug (trade name)/Form Dose Mechanism of Adverse effects Contraindications FDA approval
action
Semaglutide (Wegovy® for Starting dose: 0.25 mg Mimics GLP-1, Nausea, vomiting, Personal/family history 2021
®
weight loss and Ozempic once weekly increasing insulin diarrhea, of medullary thyroid
for type 2 diabetes)/SC Max dose: 2.4 mg once secretion, reducing constipation, carcinoma or multiple
®
injection (Rebelsus ) weekly glucagon, slowing abdominal pain, endocrine neoplasia type
tablets Rebelsus dosage starts at gastric emptying, and lesser appetite 2, history of pancreatitis,
3 mg daily, increasing to reducing appetite to pregnancy, breastfeeding,
7 mg or 14 mg promote weight loss. diabetic retinopathy.
®
Tirzepatide (Mounjaro )/ Starting dose: 2.5 mg Activates both GIP Nausea, vomiting, Personal or family 2022
Titration: increase dose
and GLP-1 receptors, diarrhea, decreased
history of medullary
SC injection by 2.5 mg weekly until the enhancing insulin appetite, constipation, thyroid carcinoma or
maintenance dose of secretion, reducing abdominal pain, multiple endocrine
12.5 mg daily glucagon release, and injection site neoplasia syndrome
Max dose: 15.0 mg and improving reactions; serious type 2, pregnancy and
glucose control and effects may include breastfeeding, severe
satiety. pancreatitis, gastrointestinal disease
gallbladder issues,
and kidney problems
Metformin (Glucophage Immediate‑Release (IR) (1) It modulates 1. Gastrointestinal In severe kidney 1994
®
Immediate release-IR , Tablets the hypothalamus, (most common): disease (eGFR<30 mL/
Glucophage Sustained Adults: 500 mg twice daily the brain’s appetite nausea, diarrhea, min/1.73 m²), acute or
®
release-SR /Tablets, or 850 mg once daily with control center, abdominal pain, unstable conditions that
Glucophage Extended meals leading to reduced bloating, loss of can cause lactic acidosis,
®
Release-ER /Tablets) Titration: Increase by hunger and lower appetite, flatulence metabolic acidosis
500 mg weekly or 850 mg food intake. (gas) (including diabetic
every two weeks based on (2) Increases 2. Vitamin ketoacidosis), contrast dye
tolerance insulin sensitivity, deficiency: Vitamin procedures (e.g., CT scan
Max dose: 2,550 mg/day metformin helps B12 deficiency (with with IV contrast), alcohol
(divided into 2 – 3 doses) lower insulin levels, long-term use), abuse (chronic heavy
Extended-Release (ER) which prevents fat causing fatigue, drinking), pregnancy and
Tablets storage and supports numbness/tingling, breastfeeding (use with
Adults: 500 mg or 1,000 mg fat breakdown. (3) memory issues caution)
daily with dinner. Reduces hepatic 3. Lactic acidosis
Titration: Increase by glucose production, (rare but serious):
500 mg weekly. which helps in better Symptoms: weakness,
Max dose: 2,000 mg/day glucose regulation dizziness, difficulty
Sustained-Release (SR) and reduces fat breathing, irregular
Tablets accumulation. heartbeat, severe
Adults: 500 mg once daily (4) Alters gut fatigue, confusion
with dinner microbiome, 4. Hypoglycemia
Titration: Increase by promoting (low blood sugar):
500 mg weekly based on beneficial bacteria Rare, only occurs
tolerance that influence if combined with
Max Dose: 2,000 mg/day metabolism and insulin or other
(some guidelines allow up to weight regulation. diabetes medications.
2,500 mg in divided doses) (5) Slows gastric 5. Metallic taste in
For children: emptying, leading mouth: Some people
Metformin SR/ER to prolonged satiety, report a metallic or
starting dose: 500 mg once which helps reduce bitter taste, which
daily with dinner overall calorie usually fades over
Titration: Increase by consumption. time.
500 mg weekly based on
tolerance
Max dose: 2,000 mg/day
(in one or two doses)
Immediate-release (IR)
starting dose: 500 mg twice
daily
Max dose: 2,000 mg/day
(divided into 2 – 3 doses)
Abbreviations: CT: Computed tomography; eGFR: Estimated glomerular filtration rate; GLP: Glucagon-like peptide; IV: Intravenous;
MAOI: Monoamine oxidase inhibitor; SC: Subcutaneous; FDA: Food and Drug Administration, GIP: Gastric inhibitory polypeptide.

Volume 2 Issue 2 (2025) 8 doi: 10.36922/imo.8316