The FDA has approved lorcaserin (10 mg orally twice daily) for weight loss (trade name: Belviq). It is a selective serotonin 2C receptor agonist that acts centrally to increase satiety, while avoiding the serotonin 2B receptor in heart valves (141). Specifically, lorcaserin stimulates pro-opiomelanocortin (POMC) neurons in the arcuate nucleus to release alpha-melanocortinstimulating hormone (a-MSH), which acts in the paraventricular nucleus to suppress appetite. In two randomized, placebo-controlled, phase 3 trials, weight loss over 1 year was 5%–6% (slightly less than that of Phen/Topiramate) (10). Routine cardiac echocardiography is not recommended since the RR of cardiac valvulopathy from lorcaserin versus placebo is 1.16 (95% CI, 0.81–1.67) (141). Although well tolerated, common adverse effects of lorcaserin are headache, nausea, dizziness, fatigue, dry mouth, and constipation.
Medication are an adjunct to diet exercise
Paul Tapia M.D.
Diplomate of the American Board of Obesity Medicine