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Table 1 Approved medications for obesity in adolescents

From: The adolescent with obesity: what perspectives for treatment?

Medication

Indication

Dosage

Mechanism of action

Side effects

Contraindications/warnings

Weight loss in adolescents

Approved

by FDA

Approved

by EMA

Orlistat

Long-term management of obesity in adolescents 12 years of age and older

120 mg three times a day with meals

Reduction of the absorption of the fatty acids consumed by food through inhibition of gastrointestinal lipases

Mostly gastrointestinal (flatulence; fecal urgency/incontinence; fatty, oily stools), generally of mild-to-moderate intensity.

Mineral deficiency.

Rare but serious associations of hepatic and renal illness with orlistat use have been described in the product brochure.

Chronic malabsorption syndrome, cholestasis

BMI decreased by 0.55 kg/m2 at 12 months.

A reduction in BMI of at least 5% was observed in 26.5% of participants in the orlistat group and 15.7% participants in the placebo group [52]

Yes

No

Phentermine

Short-term management of obesity in individuals > 16 years of age

From 15 mg to 37.5 mg daily

Increase in catecholamines and serotonin activity in the central nervous system resulting in appetite suppression

Increases in heart rate and blood pressure, dry mouth, insomnia, constipation, worsening anxiety, irritability

Cardiovascular disease hyperthyroidism, active drug use, glaucoma, agitated states, pregnancy

BMI reduction of 4.1% at 6 months [53]

Yes

No

Liraglutide

Treatment of obesity in adolescence (12–17 years)

Starting dose: 0,6 mg; titration up to 3 mg daily

Glucagon-like peptide (GLP)-1 analog inducing weight loss through increased insulin secretion and counteraction of glucagon secretion depending on blood glucose levels, induction of satiety by slowing gastric emptying, and suppression of appetite by acting on the parts of the central nervous system affecting food consumption

Gastrointestinal events including nausea, vomiting, and diarrhea

Reports of pancreatitis, cholelithiasis, cholecystitis.

It should be used with caution in patients with thyroid diseases.

Clinically significant episodes of hypoglycemia have been reported in adolescents treated with liraglutide

Liraglutide superior to placebo with regard to the change from baseline in the BMI SDS at week 56 (estimated difference, −0.22). A reduction in BMI of at least 5% was observed in 43.3% of participants in the liraglutide group and 18.7% participants in the placebo group [54]

Yes

Yes