What are the side effects of these medications?

• Bupropion/naltrexone side effects include nausea, headache, constipation, dizziness, and insomnia. • Zonisamide side effects include nausea, dizziness, fatigue, dry mouth, concentration difficulties, numbness and tingling. • Topiramate side effects include dizzines, dry mouth, numbness and tingling, concentration difficulties, altered taste.

Where do I get these medications?

Contrave® (naltrexone/bupropion) is available through a manufacturer-partnered delivery pharmacy or can be prescribed to a local commercial pharmacy. The individual generic components — bupropion and naltrexone — as well as zonisamide and topiramate, may also be prescribed and filled at most retail pharmacies.

How do I take these medications?

Contrave® (naltrexone/bupropion) is a capsule that is taken twice daily. Generic bupropion and naltrexone are tablets that are taken once or twice daily. Topiramate comes in capsule or tablet form that is taken twice daily. Zonisamide is a capsule that is taken daily.

Medication is the strategic tool

Weight loss medications can be powerful tools when used strategically and under physician supervision. At YooshMD, medication is part of a structured metabolic program — not a standalone solution.*

GLP-1 receptor analogs

Zepbound® (tirzepatide)

Dual GIP and GLP-1 receptor agonist, enhances satiety, delays gastric emptying, and improves insulin sensitivity.

Wegovy®, Ozempic®† (semaglutide)

GLP-1 receptor agonist that enhances satiety, delays gastric emptying, and improves glycemic control through glucose-dependent insulin secretion.

GLP-1 medications are indicated for patients with a BMI of >30 or >27 with one or more weight-related comorbidity (high blood pressure, high cholesterol, etc). They are contraindicated in pregnant patients and those with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia (MEN2) syndrome. They are used cautiously in those with gastroparesis, kidney disease, and pancreatitis.

Numerous clinical studies have been conducted which demonstrate the safety and efficacy of these medications. In one study, (https://www.nejm.org/doi/full/10.1056/NEJMoa2206038)patients who took 15 mg tirzepatide over a 72 week interval lost 20% of their body weight on average compared to placebo. Another study (https://www.nejm.org/doi/full/10.1056/NEJMoa2032183)showed that patients who took 2.4 mg of semaglutide over 68 weeks lost 15% of their body weight compared to placebo. Significant weight loss was achieved even with shorter duration and lower doses in both trials.

If insurance will will be used to purchase medications, then the prices will vary depending on our formulary. Our team will do their best to streamline the paperwork and prior authorization process to get the medication approved for you. Medications can also be purchased directly from their respective pharmaceutical company at a reasonable cost. Zepbound® via LillyDirect® starts at $299/month. Wegovy® via NovoCare Pharmacy® starts at $149/month for tablets and $199/month for injection pens.

*If medications are used for reasons other than weight loss (such as diabetes or liver disease), then long-term use is necessary.

†While brand Ozempic® is molecularly identical to Wegovy®, it is technically used off-label for weight loss.

Appetite suppressants

Contrave® (Bupropion/naltrexone)‡

Norepinephrine and dopamine reuptake inhibitor + mu opioid receptor antagonist. Suppresses appetite and increases energy expenditure via the POMC pathway.

Topiramate

Voltage gated ion channel inhibitor. Suppresses appetite via the NPY/AgRP pathway. This medication is used off-label for weight loss.

Zonisamide

Voltage gated ion channel inhibitor. Suppresses appetite and increases energy expenditure via the POMC pathway. This medication is used off-label for weight loss.

‡Bupriopon and naltrexone may be prescribed separately as an off-label formulation.

Appetite suppressants are indicated for patients with a BMI of >30 or >27 with one or more weight-related comorbidity (high blood pressure, high cholesterol, etc). They are contraindicated in pregnant patients. Bupropion/naltrexone is contraindicated in those who have uncontrolled hypertension, liver disease, history of seizures, eating disorders such as anorexia and bulimia, chronic opioid use, and MAOI use. Zonisamide is contraindicated in those with sulfonamide allergies.

Patients who took bupropion/naltrexone on average lost 8% of their body weight at 52 weeks compared to placebo, according to this study.(https://contravehcp.com/efficacy/cor-1-study/) In fact, a majority of the weight loss occurs in the first 16 weeks of therapy. Patients who took 400 mg of zonisamide on average lost 7% of their body weight at 52 weeks compared to placebo, according to this study.(https://pmc.ncbi.nlm.nih.gov/articles/PMC3753218/) Patients who took 384 mg of topiramate daily lost 6% of their body weight at 24 weeks compared to placebo, according to this study.(https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2003.102)

If you choose to use insurance for medication, pricing will vary based on your specific plan and formulary. Our team assists with prior authorizations when applicable, though approval cannot be guaranteed. Contrave® (naltrexone/bupropion) is available through a partnered mail-order pharmacy for approximately $99 per month with self-pay. In some cases, the individual generic components (bupropion and naltrexone) may be prescribed separately, which can be a lower-cost option when paying out of pocket. Topiramate and zonisamide are available as generic medications and are typically low cost.

Other medications

Metformin

Biguanide that reduces hepatic glucose production and improves peripheral insulin sensitivity. May modestly reduce appetite and improve metabolic efficiency. This medication is used off-label for weight loss.

Xenical®, Alli® (orlistat)

Gastrointestinal lipase inhibitor that reduces dietary fat absorption by blocking pancreatic and gastric lipases. Decreases caloric intake through partial fat malabsorption.

While Orlistat is FDA-approved for weight loss, our program generally combines it with other therapies to augment them on a case-by-case basis. Metformin has been shown in various studies t(https://www.sciencedirect.com/science/article/abs/pii/S1871403X20306244)o produce an average of 5% body weight reduction compared to placebo, but it is generally also used in combination with other medications.

If you choose to use insurance for medication, pricing will vary based on your specific plan and formulary. Our team assists with prior authorizations when applicable, though approval cannot be guaranteed. Orlistat has an over-the-counter formulation (Alli®) which costs between $50-$90 for a one month supply. Self-pay for Xenical® is not cost-effective. Metformin is available as a generic medication and is typically low cost.

Medical Disclaimer

This information is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Actual prescriptions and medical care depend on an individualized evaluation by a licensed healthcare provider. All medications carry potential risks, side effects, and contraindications which must be thoroughly discussed with your clinician. Individual results vary. We do not guarantee specific weight loss outcomes. Any percentage estimates referenced on this website are derived from randomized clinical trials evaluating lifestyle modification in combination with FDA-approved weight loss medications compared to placebo. Outcomes in clinical practice may differ based on individual health status, adherence, and other factors.

MD

Yoosh

Yoosh

Medication is the strategic tool

Weight loss medications can be powerful tools when used strategically and under physician supervision. At YooshMD, medication is part of a structured metabolic program — not a standalone solution.*

GLP-1 receptor analogs

Zepbound® (tirzepatide)

Wegovy®, Ozempic®† (semaglutide)

Who is eligible for these medications?

What are the side effects of these medications?

How effective are these medications?

How much does these medications cost?

Where do I get these medications?

How do I take these medications?

*If medications are used for reasons other than weight loss (such as diabetes or liver disease), then long-term use is necessary.

†While brand Ozempic® is molecularly identical to Wegovy®, it is technically used off-label for weight loss.

Appetite suppressants

Contrave® (Bupropion/naltrexone)‡

Topiramate

Zonisamide

‡Bupriopon and naltrexone may be prescribed separately as an off-label formulation.

Who is eligible for these medications?

What are the side effects of these medications?

How effective are these medications?

How much does these medications cost?

Where do I get these medications?

How do I take these medications?

Other medications

Metformin

Xenical®, Alli® (orlistat)

Who is eligible for these medications?

What are the side effects of these medications?

How effective are these medications?

How much does these medications cost?

Where do I get these medications?

How do I take these medications?

Medical Disclaimer