文獻資訊
Title: Medications for Obesity: A Review
Authors: Kimberly A Gudzune, Robert F Kushner
Journal: JAMA
PMID: 39037780
本文整理 Table 1 (藥物成效) + Table 2 (特定疾病的使用) + Table 3 (劑量及適用族群)
藥名: Orlistat
## 作用機轉: Intestinal lipase inhibitor
## 成效與使用時間: 12 月
- 平均降體重: -10.2 %
- 平均降收縮壓: -6 mmHg
- 平均降LDL: -9.4 %
- 平均降腰圍: -9.6 cm
- 副作用: Oily fecal spotting (27%), flatus with discharge (24%), fecal urgency (22%), steatorrhea (20%), oily discharge (12%), increased defecation (11%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Use
- 心血管疾病: Use
- 高血壓: Use (lower BP)
- 糖尿病: Use (lower A1c)
- 腎臟病(GFR<50): Use
- 肝功能不全: Use with caution; monitor cholelithiasis
- 老年人(>65歲): Limited data
## 使用方式?
- 劑量: Oral tablet taken with fat-containing meals 3 times a day (120 mg)
- 交互作用: Levothyroxine, Warfarin, Amiodarone, Cyclosporine, AEDs, Antiretroviral drugs
- 適合使用族群: Adults with type 2 diabetes to lower A1c, HTN to lower BP, HLD to lower LDL, type 2 diabetes prevention, Weight-loss maintenance, Adolescents
- 需小心使用族群: History of frequent diarrhea, Oxalate nephrolithiasis, Following a high-fat diet (eg, low-CHO, ketogenic) as increased GI side effects
- 需避免使用族群: History of Malabsorption, Cholestasis
藥名: Phentermine
## 作用機轉: Sympathomimetic amine
## 成效與使用時間: 6 月
- 平均降體重: -6.1 %
- 平均降收縮壓: -6.4 mmHg
- 平均降LDL: Not reported
- 平均降腰圍: -6.6 cm
- 副作用: Xerostomia (12%), insomnia (11%), headache (10%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Use with caution; limited data
- 心血管疾病: No
- 高血壓: Use with caution; baseline BP controlled; limited data
- 糖尿病: Unknown
- 腎臟病(GFR<50): Unknown
- 肝功能不全: Unknown
- 老年人(>65歲): Unknown
## 使用方式?
- 劑量: Oral tablet or capsule taken daily in the morning (15 mg, 30 mg, or 37.5 mg) or oral tablet taken up to 3 times a day (8 mg)
- 交互作用: Alcohol, MAOIs
- 適合使用族群: Adults with no AOM coverage for lowest out-of-pocket costs
- 需小心使用族群: History of Insomnia, Insufficient sleep, Frequent constipation
- 需避免使用族群: History of CVD, Substance use disorder, Agitated states, Glaucoma, Hyperthyroidism, Uncontrolled HTN
藥名: Phentermine-topiramate
## 作用機轉: Sympathomimetic amine combined with GABA augmentation
## 成效與使用時間: 12 月
- 平均降體重: -10.9 %
- 平均降收縮壓: -2.9 mmHg
- 平均降LDL: -8.4 %
- 平均降腰圍: -10.9 cm
- 副作用: Paresthesia (20%), xerostomia (19%), constipation (16%), headache (11%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Use with caution; avoid maximum dose (15/92 mg) to decrease risk of adverse mood effects
- 心血管疾病: Use with caution; monitor HR
- 高血壓: Use (lower BP)
- 糖尿病: Use (lower A1c)
- 腎臟病(GFR<50): Limit dose to 7.5/46 mg daily
- 肝功能不全: Limit dose to 7.5/46 mg daily
- 老年人(>65歲): Limited data
## 使用方式?
- 劑量: Oral capsule taken daily in the morning, with manufacturer-recommended titration up to 15/92 mg
- 交互作用: Alcohol, OCPs, Amitriptyline, Nonpotassium-sparing diuretics, AEDs, Carbonic anhydrase inhibitors, MAOIs
- 適合使用族群: Adults with type 2 diabetes to lower A1c, HTN to lower BP, Central adiposity to lower WC, Lack AOM coverage as lower out-of-pocket costs
- 需小心使用族群: History of Insomnia, Insufficient sleep, Frequent constipation, Nephrolithiasis, MDD, Occupation requiring mental acuity
- 需避免使用族群: History of Narrow-angle glaucoma, Hyperthyroidism, People with pregnancy potential who do not use effective contraception as risk of birth defects (oral clefts)
藥名: Naltrexone-bupropion
## 作用機轉: POMC neuron stimulation
## 成效與使用時間: 12 月
- 平均降體重: -6.1 %
- 平均降收縮壓: -0.1 mmHg
- 平均降LDL: -2.0 %
- 平均降腰圍: -6.2 cm
- 副作用: Nausea (33%), constipation (19%), headache (18%), vomiting (11%), dizziness (10%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Unknown; avoid in young adults
- 心血管疾病: Use with caution; monitor BP/HR
- 高血壓: Use with caution; baseline BP controlled; monitor BP/HR
- 糖尿病: Use (lower A1c)
- 腎臟病(GFR<50): Limit dose to 8/90 mg daily
- 肝功能不全: Limit dose to 8/90 mg daily
- 老年人(>65歲): Limited data
## 使用方式?
- 劑量: Oral tablet taken up to twice a day (8/90 mg), with manufacturer-recommended titration
- 交互作用: Opioids, SSRIs or TCAs, Antipsychotics, β-Blockers, Type 1C antiarrhythmics, Digoxin, Ticlopidine or clopidogrel, Levodopa or amantadine, AEDs, Antiretroviral drugs, MAOIs
- 適合使用族群: Adults with Type 2 diabetes to lower A1c, Central adiposity to lower WC, Lack AOM coverage as lower out-of-pocket costs with discounts
- 需小心使用族群: History of MDD, SMI, Liver disease, Following a high-fat diet (eg, low-CHO, ketogenic) as increased adverse effects
- 需避免使用族群: History of Substance use disorder, Narrow-angle glaucoma, Seizure disorder, Anorexia or bulimia, Uncontrolled HTN, Chronic opioid use
藥名: Liraglutide
## 作用機轉: GLP-1 receptor agonist
## 成效與使用時間: 12 月
- 平均降體重: -8.0 %
- 平均降收縮壓: -4.2 mmHg
- 平均降LDL: -3.0 %
- 平均降腰圍: -8.2 cm
- 副作用: Nausea (39%), diarrhea (21%), constipation (19%), vomiting (16%), injection site reaction (14%), headache (14%), dyspepsia (10%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Use; monitor mood
- 心血管疾病: Use; monitor HR
- 高血壓: Use (lower BP)
- 糖尿病: Use (lower A1c)
- 腎臟病(GFR<50): Use
- 肝功能不全: Use with caution; limited data
- 老年人(>65歲): Limited data
## 使用方式?
- 劑量: Subcutaneous injection administered daily with multidose pen, with manufacturer-recommended titration up to 3.0 mg
- 交互作用: GLP-1 receptor agonists, Insulin, Sulfonylureas, Meglitinides
- 適合使用族群: Adults with Type 2 diabetes to lower A1c, HTN to lower BP, Central adiposity to lower WC, Adolescents
- 需小心使用族群: History of Frequent nausea, Frequent constipation, Frequent diarrhea, Cholelithiasis, Pancreatitis
- 需避免使用族群: History of Severe gastrointestinal disease, Suicide attempts, Personal or family history of medullary thyroid carcinoma
藥名: Semaglutide
## 作用機轉: GLP-1 receptor agonist
## 成效與使用時間: 16 月
- 平均降體重: -14.9 %
- 平均降收縮壓: -6.2 mmHg
- 平均降LDL: Not reported
- 平均降腰圍: -13.5 cm
- 副作用: Nausea (44%), diarrhea (30%), vomiting (24%), constipation (24%), abdominal pain (20%), headache (14%), fatigue (10%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Use; monitor mood
- 心血管疾病: Use; monitor HR
- 高血壓: Use (lower BP)
- 糖尿病: Use (lower A1c)
- 腎臟病(GFR<50): Use
- 肝功能不全: Use; monitor cholelithiasis
- 老年人(>65歲): Limited data
## 使用方式?
- 劑量: Subcutaneous injection administered weekly with single-dose pen, with manufacturer-recommended titration up to 2.4 mg
- 交互作用: GLP-1 receptor agonists, Insulin, Sulfonylureas, Meglitinides
- 適合使用族群: Adults with Type 2 diabetes to lower A1c, HTN to lower BP, Central adiposity to lower WC, CVD to lower major adverse cardiac events, HFpEF to lower heart failure symptoms
- 需小心使用族群: History of Frequent nausea, Frequent constipation, Frequent diarrhea, Cholelithiasis, Pancreatitis, Diabetes-related eye disease
- 需避免使用族群: History of Severe gastrointestinal disease, Suicide attempts, Personal or family history of medullary thyroid carcinoma
藥名: Tirzepatide
## 作用機轉: GIP/GLP-1 receptor agonist
## 成效與使用時間: 17 月
- 平均降體重: -20.9 %
- 平均降收縮壓: -7.6 mmHg
- 平均降LDL: -8.6 %
- 平均降腰圍: -18.5 cm
- 副作用: Nausea (28%), diarrhea (23%), vomiting (13%), constipation (11%), abdominal pain (10%), dyspepsia (10%)
## 特定疾病是否可用?
- 憂鬱/焦慮: Use; monitor mood
- 心血管疾病: Unknown
- 高血壓: Use (lower BP)
- 糖尿病: Use (lower A1c)
- 腎臟病(GFR<50): Use
- 肝功能不全: Use; monitor cholelithiasis
- 老年人(>65歲): Limited data
## 使用方式?
- 劑量: Subcutaneous injection administered weekly with single-dose pen, with manufacturer-recommended titration up to 15.0 mg
- 交互作用: GLP-1 receptor agonists, Insulin, Sulfonylureas, Meglitinides
- 適合使用族群: Adults with Type 2 diabetes to lower A1c, HTN to lower BP, HLD to lower LDL, Central adiposity to lower WC
- 需小心使用族群: History of Frequent nausea, Frequent constipation, Frequent diarrhea, Cholelithiasis, Pancreatitis, Diabetes-related eye disease
- 需避免使用族群: History of Severe gastrointestinal disease, Suicide attempts, Personal or family history of medullary thyroid carcinoma
