A practical guide to using medicines to manage overweight and obesity
Shared decision making
Discuss with the person the medicines available to them. Not all medicines are available in all settings and this may impact choice. If someone has a choice of medicines available to them, discuss the factors that might be important to them when they make a decision. This may include method of administration, frequency of dosing, duration of treatment, contraindications, adverse effects, monitoring requirements and if relevant, whether they are planning pregnancy and the impact on any contraception they are taking.
Use the information in table 2 and the summary of product characteristics (SPCs) for the medicine to discuss the person's options, depending on their clinical circumstances and preferences.
| Tirzepatide | Semaglutide | Liraglutide | Orlistat | |
|---|---|---|---|---|
|
Setting |
Prescribed in primary care or a specialist overweight and obesity management service. |
Prescribed in a specialist overweight and obesity management service. |
Prescribed in secondary care by a specialist overweight and obesity management service. |
Prescribed in all settings, including primary care. Also available in a lower dose from a pharmacy. |
|
Route and frequency |
Weekly subcutaneous injection. |
Weekly subcutaneous injection. |
Daily subcutaneous injection. |
Oral capsule, up to 3 times a day. |
|
Pregnancy and contraception |
Do not use in pregnancy or in women of childbearing potential not using contraception. Switch to a non-oral contraceptive method, or add a barrier method of contraception, for 4 weeks on initiation and after each dose escalation |
Do not use in pregnancy. Women of childbearing potential are recommended to use contraception (semaglutide SPC). |
Do not use in pregnancy (liraglutide SPC). |
Caution in pregnancy. The use of an additional contraceptive method is recommended to prevent possible failure of oral contraception that could occur in case of severe diarrhoea (orlistat SPC). |
|
Planning pregnancy |
If a person wishes to become pregnant, tirzepatide should be stopped at least 1 month before a planned pregnancy because of the long half-life of tirzepatide. If pregnancy occurs, stop tirzepatide (tirzepatide SPC). |
If a person wishes to become pregnant, or pregnancy occurs, semaglutide should be stopped. It should be stopped at least 2 months before a planned pregnancy because of the long half-life |
If a person wishes to become pregnant or pregnancy occurs, liraglutide should be stopped (liraglutide SPC). |
No information in SPC on planning pregnancy. Use with caution in pregnancy. |
|
When to stop treatment |
If less than 5% of the initial weight has been lost after 6 months on the highest tolerated dose, decide whether to continue treatment, taking into account the benefits and risks of treatment for the person. |
Consider stopping if less than 5% of the initial weight has been lost after 6 months of treatment. |
Stop after 12 weeks on the 3.0 mg/day dose if at least 5% of the initial body weight has not been lost |
Stop after 12 weeks if at least 5% of the initial body weight has not been lost (orlistat SPC). |
Semaglutide and liraglutide are recommended for use within specialist weight management services, which are usually accessed for up to 2 years.
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