Over Ozempic? Here's 4 Alternative Medications for Weight Loss
- Dr. Alexandra LaStella, PharmD
- Apr 7, 2024
- 4 min read
Maybe it's out of stock at your pharmacy. Maybe you couldn't afford an outrageous $1,000.00 per month (with a coupon). Maybe you don't like having to prick your skin every week. Maybe you had side effects that stopped you from continuing.
Don't fret! Regardless of the reason you're opting out of Ozempic - we are here to help.
Below you will find a list of non-Ozempic weight loss drugs which have proven efficacy and safety as weight loss treatment tools. Please remember that this information is only meant to educate; not to promote any of the following, nor to diagnose/treat any given condition. Always speak to your doctor before deciding that any medication is right for you. Additionally, these products are all meant to be used in conjunction with diet and exercise, which is ultimately necessary to achieve the best results. Enjoy!
Metformin (Glucophage, Glumetza)
How it Works: A tried and true classic. Metformin is a drug in its own class, and it is our first step in treatment of Type 2 diabetes. That is because Metformin improves insulin activity in many ways, and is relatively safe to use in comparison with other diabetic drugs. To spare you the confusion and explanation, we'll just explain that it uniquely alters metabolism and liver function to create an overall effect of decreased blood sugar and improved health among diabetics. Weight loss is likely to occur, but not as profoundly as compared to the next options.
Who Can't Try it?
Anyone with a: history of metabolic acidosis, B12 deficiency, severe GI issues, unable to swallow
Potential Side Effects: Stomach upset (nausea, vomiting, diarrhea) is common
*take with food to minimize risk of stomach upset
Pro Tip: Increase your dose slowly. An effective, steady increase can be done weekly/biweekly as follows* Beginning with week 1:
500mg once daily --> 500mg twice daily -->750mg twice daily -or- 1000mg twice daily *if well tolerated and good response (2000mg per day is the target dose)
Phentermine (Lomaira, Adipex-P)
How it Works: Appetite-suppressing activity due to stimulating effects (CNS stimulation, energy/focus promoting, think "fight" when considering fight or flight (adrenaline) response.
Who Can't Try It?
Women trying to become pregnant**, history of Cardiovascular Disease, already taking another stimulant
**in most cases, pregnant women should not be losing weight with medication - speak to your doctor before any attempt at weight loss.
Potential Side effects: Increased heart rate, anxiety, nervousness, restlessness, stomach upset
Pro Tip: If Lomaira is too expensive, have your doctor switch to generic Phentermine. It is available in slightly different strengths, but will be significantly cheaper. P.S. goodrx has a good coupon for generic Phentermine.
Bupropion + Naltrexone (Contrave)
How it Works: a combination of 2 medications; bupropion is typically used as an antidepressant or as a smoking cessation aid, but it also has appetite-suppressing qualities due to CNS stimulation (increased energy/focus. Think "fight" when considering fight or flight (adrenaline) response). Naltrexone is a medication which is often use to treat substance use disorders due to its ability to "turn off" pleasure responses, and it makes sense in this regard - Naltrexone reduces the "pleasure" sensation that we receive when we eat something delicious. You know, that euphoria of the first bite of your favorite indulgence.
If not enjoying your food sounds depressing, don't worry - that's what the Bupropion is there for! (just kidding)
Who Can't Try it?
Anyone with a: history of seizures, anyone already taking Bupropion in another formulation (Wellbutrin XL, Zyban, Forfivo XL, or Aplenzin) and/or certain other stimulants, certain psychiatric conditions (*ask your doctor), history of anorexia
Potential Side Effects: Stomach upset, restlessness, anxiety, nervousness, dry mouth.
Pro Tip: If Contrave is too expensive, have your doctor create 2 prescriptions instead: 1 for Bupropion, and 1 for Naltrexone. Both are available as generics for a much more reasonable price. P.S goodrx has a good coupon for both generic drugs.
Other GLP-1 agonists (Saxenda, Victoza, etc.)
How it Works: GLP-1 is a naturally occuring substance in our bodies. Imagine GLP-1 as a molecule who is pretending to be Glucagon. Glucagon drives sugar into cells, thereby reducing blood sugar. GLP-1 agonists, or glucagon-like-peptide -1 promoters increase the activity of Glucagon (because they mimic Glucagon) and bind to the same receptors. Very sneaky, GLP-1. As a result of that increased level of GLP, we can better lower blood sugar. And good news! We can decrease sugars for an extended period of time (1-7 days). Bad news? These are all under-the-skin (subcutaneous) injectables; they must be stored properly, and are often expensive/not covered by insurance.
**An ORAL option? Semaglutide (Rybelsus) is an oral tablet. It is the only GLP-1 agonist that can be taken by mouth. However, it is not FDA approved for weight loss as of this post's most recent update. That means it most likely won't be covered by insurance for weight loss, and that the FDA has not determined whether or not Rybelsus to be a safe and effective option for weight loss. Speak to your provider for more information.
Who Can't Try it?
Anyone with a: Family or Personal history of MTC (Medullary Thyroid Cancer), phobia or other inability to self-administer subcutaneous injection.
Potential Side Effects: Stomach upset is common. Possibility for gastric mobility issues, pancreatitis, medullary thyroid cancer in those who are predisposed
Pro Tip: All GLP-1i Drugs are difficult to get at this time. You can thank the Kardasians, Oprah, and just about every other celebrity. Some pharmacies have better acquisition ability than others. When choosing a product, keep in mind: Saxenda and Victoza are daily injections. Ozempic, Wegovy, Mounjaro are weekly injections.
*No resources here. Proud to report this is all from my education, experience, and memory.
If you would like to add something, or to correct any misinformation above, please do let us know with a comment, or an email to info@pharmawrite.co
