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Weight loss medication alternatives

If not Ozempic… then what?

It’s always hard when you’ve found something highly effective, to then try and find something that does the same job.

Today’s email is all about weight loss medications, an overview of the alternatives, combination medications and what the future holds in terms of supply of Wegovy and Mounjaro and other new weight loss medications.

Let’s look at the effectiveness of semaglutide first.

Studies show that semaglutide 2.4mg produces, on average, 10-18% weight loss, depending on which study design you look at (STEP 1, STEP 2, STEP 3, STEP 4).

And this explains why we have experienced a worldwide shortage of this medication – it works!

However, until semaglutide 2.4mg becomes available, you are probably thinking, “What is going to be the next best thing for me to use?” This is when we turn to the evidence to guide us.

There are very few head to head trials comparing weight loss medications, which is the most accurate way of assessing how effective one medication is compared to the others.

From the head to head trials that we do have, we know that these are the medications that are most effective to least effective when it comes to weight loss.

Most effective

Semaglutide (Wegovy)

Liraglutide (Saxenda)

Dulaglutide (Trulicity)

Exenatide (Byetta)

Least effective

If you need help with the most effective weight loss tools, then click here to speak with one of our Alevia Doctors.

Note:

Saxenda is an approved weight loss medication, and is readily available in Australia. Cost is approximately $387 a month.

The knock on effect from the Ozempic shortage, is that Trulicity which is manufactured by Ely-Lilly is now in short supply.

Byetta is an old drug that has been superseded by the newer and more effective GLP-1s and is going to be withdrawn from the market once supply has been consumed.

Compounded Semaglutide?

Ozempic is still expected to be in short supply for most of 2024.

Compounding is a process whereby the medicine is made from scratch. Compounded medication has the same molecular structure as semaglutide – the medicine that is in Ozempic, but it is made up with different liquids, and comes in either pre filled syringes or a multidose vial.

Compounding medications can help to fill a gap whilst Ozempic is unavailable, or other treatments have failed or have been deemed unsuitable for the patient.

Whilst these compounding pharmacies are regulated, these medications do not undergo the same rigorous testing for safety, quality or efficacy as branded Ozempic does and so it is not guaranteed to be as effective as Ozempic. However, for the foreseeable future, compounding is the most secure way of accessing this medication.

There are only 3 or 4 pharmacies around Australia that are compounding this medication and our Alevia doctors can connect you  to these reputable pharmacies.

What are my other options?

The other alternative medications approved for weight loss include:

Liraglutide (Saxenda) – similar to ozempic but given as a once daily injection.

Naltrexone/Buproprion (Contrave) – a medication that decreases both hunger and cravings.

Orlistat (Xenical) – rarely used anymore due to unpleasant side effects.

Phentermine (Duromine) – a mild stimulant, which suppresses appetite.

Off label medications

Topiramate (Topamax) – a migraine and epilepsy preventative which also increases satiety or fullness.

If you’d like to find out more about these medications and their suitability for you then book an appointment with your Alevia Doctor

How do I know which medication is best for me?

So when considering medication alternatives, effectiveness is one factor, but so is cost and tolerability as well as how these medications might impact on other health conditions. That is why it is worth discussing alternatives with your Alevia Bariatric GP to find out what are the best alternatives or combination of therapies, in your particular health circumstances.

A word about scams

This time of high demand for Ozempic is ripe for scams and rip offs that you need to be aware of.

Alevia is aware of a number of other companies that are offering semaglutide direct to consumers.

The first thing to note is that the drug company Novonordisk has a patent for semaglutide which lasts for 10 yrs and during this time it is illegal for any other company to manufacture semaglutide. This is designed to protect the enormous amount of time and money that goes into the research and development of these molecules. 

The other issue is one of safety and tolerability. No other medications have been approved by the TGA for safety and supply in Australia.

All medicines supplied in Australia must be included in the Australian Register of Therapeutic Goods (ARTG), and all registered medicines are fully assessed by the TGA for safety, quality and effectiveness before they can be sold.

This leaves patients at risk of scams, from illegal or potentially unsafe products. Check with your Alevia doctor before handing over hundreds of dollars for a product that you may not receive or which are potentially unsafe.

Sometimes weight maintenance is the goal

When it comes to alternative medications, the goal at this stage, is to get the best appetite suppression possible, until more effective medications become available again. This might mean that you are using more will power, and focusing in on diet and exercise to maximise the benefits here. This might mean that you look at ketogenic diets again to get some natural appetite suppression, as ketosis can be AS EFFECTIVE, IF NOT MORE, than some weight loss medications. This might also mean that you are leaning on your Alevia doctor to help with accountability and medication adjustments to keep you on track.

But the good news is, the future is bright when it comes to weight loss treatment.

HTirzepatide (Mounjaro) is a new weight loss medication that was due to be released in 2022/2023 but due to the supply issues with Ozempic, was pushed back to Sept 2023. There are already supply issues with this medication but compounded products are available.

The trials on Tirzepatide show up to 22.5% weight loss with this once weekly injection of 15mg if patients who have a BMI of 30 and above or 27 and above with obesity complications.

This medication is a combination of a GLP-1 and GIP agonist. In other words, this medication mimics our natural gut fullness signals, and works on both the brain and the gut to diminish hunger and reduce food intake. The results are extremely promising and tell us that behind this Ozempic shortage, new and even more effective treatments are coming our way.

Wegovy (Semaglutide 2.4mg) has already been approved for weight loss by the TGA and it is anticipated to reach our shelves in the second half of 2024.

So now is not the time to give up hope, it is a time of great hope and opportunity.

Yes, we definitely have to find some short term solutions to try to prevent weight regain. This is super important, as you don’t want to have to go back to the starting line again. But on the other side of this medication shortage, will be the time to put the foot on the accelerator pedal and achieve weight loss and thus, improvements in health, with highly effective treatments. In fact, medical treatments, may help those patients who have been considering bariatric surgery as their only option.

So reach out, have that conversation with your Alevia doctor, set your realistic goals during this difficult time and then get ready for control of weight to become easy again.

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