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Pharmacotherapy for Weight Loss in Cirrhosis and Liver Transplantation: Translating the Data and Underused Potential
Author(s) -
Brown Sara A.,
Izzy Manhal,
Watt Kymberly D.
Publication year - 2021
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.31595
Subject(s) - medicine , phentermine , liraglutide , weight loss , cirrhosis , orlistat , topiramate , bupropion , liver transplantation , pharmacotherapy , population , transplantation , intensive care medicine , obesity , diabetes mellitus , type 2 diabetes , psychiatry , smoking cessation , epilepsy , endocrinology , environmental health , pathology
Background and Aims Thirty percent of patients with cirrhosis are obese and the prevalence of obesity increases after transplant to >40% post‐transplant. There are currently four weight loss medications approved by the FDA for treatment of obesity (orlistat, phentermine‐topiramate, naltrexone‐bupropion, and liraglutide). The aim of this review was to investigate the data on the use of these weight loss medications and alternative medicines in patients with cirrhosis and in liver transplant recipients (LTRs). Approach and Results While there is paucity of data for these medications in patients with cirrhosis and LTRs, Liraglutide appears to be generally safe in view of its pharmacokinetic properties. Phentermine‐topiramate seems to have the highest weight loss potential but special consideration should be given to neuropsychiatric disorders, cardiovascular comorbidities, and drug interactions. There are emerging data on use of alternative medicines for weight loss but more data are needed. Conclusions The use of weight loss medications is feasible in this patient population but the decision of which medication to prescribe should be individualized based on the degree of renal and hepatic impairment, other co‐morbidities, and concomitant medications.