weight reducing medicines,their efficacy and side effects

Weight loss drugs should be started if BMI(body mass index) more than or equal to 27 kg/m2 with one or more obesity associated co-morbid conditions (e.g., type 2 diabetes. hypertension, and dyslipidemia) and by patients with BMI more than equal to 30 kg/m2 who are motivated to lose weight.The approved drugs are:
1.Orlistat
Doses- 60mg or 120mg three times a day (during or up to 1 h after a  meal)
Average weight loss in one year-2.5 kg (60 mg); 3.4 kg (120 mg)
Common side effects- Abdominal pain/discomfort, oily spotting/stool, fecal urgency, flatulence, malabsorption of fat soluble vitamins (A, D, E, K) and medications (e.g., cyclosporine, thyroid hormone replacement, or anticonvulsants),potentiation of the effects of warfarin
Uncommon/serious side effects-Liver failure and oxalate nephropathy.

2.Lorcaserin
Dose- 10 mg twice daily
Average weight loss in one year-  3.2 kg
Common side effects- Hypoglycemia, headache, fatigue
Uncommon/serious side effects-Serotonin syndrome , suicidal ideation, heart valve disorder ,bradycardia

3.Phentermine/topiramate combination
Dose: 3.75 mg/23 mg once a day for 14 days, then increase to 7.5 mg/46 mg once a day. Maximum dose: 15 mg/92 mg once a day.
Average weight loss in one year- 6.7 kg with 7.5 mg/46 mg dose; 8.9 kg with 15 mg/92 mg
Common side effects-Paresthesia, xerostomia(dry mouth), constipation, headache
Uncommon/serious side effects-Topiramate is teratogenic and has been associated with cleft lip/palate

4.Naltrexone/bupropion combination
Dose- 8 mg/90 mg tabs Maximum dose: two tablets  twice daily for a total daily dosage of naltrexone 32 mg/bupropion 360 mg
Average weight loss in one year-2.0–4.1 kg with 32 mg/360 mg
Common side effects-Nausea, constipation, headache, vomiting
Uncommon/serious side effects-Depression,precipitation of mania, contraindicated in patients with a seizure disorder

5.Liraglutide (injection in pen form)
Dose: 3 mg s.c. once a day (maintenance dose achieved after starting from lower doses)
Average weight loss in one year-5.8–5.9 kg
Common side effects-Hypoglycemia, nausea, vomiting, diarrhea, constipation, headache
Uncommon/serious side effects-Pancreatitis, thyroid C-cell tumors in rodents, contraindicated in patients with personal/family history of medullary thyroid carcinoma or MEN2(multiple endocrine neoplasia), acute renal failure

Why sugars are not under control even with regular insulin doses- Its a common problem that despite taking heavy dose of insulin, some patient will have uncontrolled sugars.Here asking about the technique of insulin will be very helpful instead of blindly further increasing the dose of insulin.This hardly takes 2 minutes even in a busy OPD. To save time doctors can have ready made instruction sheets to be given to the patients.This will help in adequate management of diabetes.I see almost every third patient on previously insulin therapy, using it in an improper way.Though patient will say- doctor I am chronic patient of diabetes,I know very well how to take insulin shots.Here comes the importance of counseling.And insulin doses can be decreased.It will not take time before patient says to his friend circle that this particular doctor has brought down my insulin units!