Weight loss medications like phentermine, or Adipex, have been around for many years and can be very effective when used in a monitored regimen. We utilize it frequently in our practice and see excellent results, however in Ohio patients are only allowed to be on phentermine for 3 consecutive months. Frequently we will do phentermine therapy for the allowed 90 days and then switch a patient over to one of the new drugs that is approved for long-term use. So what are your options?
There are 3 drugs that are approved for long-term use now and are allowed to be used after phentermine, but the therapy should be continuous, which means you have to go straight into one of these medications the month after you finish your phentermine.
The 3 choices are:
- Wegovy (or Saxenda)
Qsymia is usually my first choice, primarily because it comes in four different strengths, which allows for greater dosing flexibility. It also contains a small amount of phentermine, so we know that patients who have done well on pure phentermine will likely tolerate and lose weight with Qsymia. The smaller dose typically yields significantly less appetite suppression than the what the patient has been accustomed to, so don’t expect the same speed of weight loss with Qsymia! The cost of the medication from the pharmacy is usually around $100-$125/month with the manufacturer’s coupon.
Contrave is probably also one of my favorites because it can be used for maintenance of weight loss regardless of the patients body mass index. We have coupons here in the office so that patients can get the medication for around $100/month (depending on the pharmacy and insurance coverage). This medication causes nausea with alcohol and cannot be used with many anti-depressants. Patients who take Contrave and follow a dedicated regimen of healthy eating and exercise typically lose about 3-5 pounds per month.
Wegovy and other GLP-1 agonists like Saxenda or Mounjaro are my last choice, typically because of the tremendous cost of these medications ($1500+/month). However, if you are one of the lucky ones that has coverage for these drugs, that would likely catapult it to the first-place position.
Dr. Trace Curry