Various prescription weight loss options are available in South Africa. This article describes 7 different weight loss options available to you via Whatsup Doc telemedicine services: Ozempic, Mounjaro, Saxenda, Orlistat, Duromine, Relislim and Metformin.
1. OZEMPIC
(Always read the medication leaflet before use)
How does Ozempic work for weight loss purposes?
The active ingredient in Ozempic “Semaglutide” works by mimicking a naturally occurring hormone called GLP-1. This hormone works by instructing the brain that the stomach is full. It also slows digestion by increasing the time it takes for food to leave the body. This is similar to the effect of bariatric surgery. It does work for weight loss, according to research. However, it’s important that people continue to make lifestyle changes to help their weight loss, such as eating right and exercising.
It is important to develop strict diet and exercise habits that can be maintained after stopping Ozempic to ensure that you do not re-gain the weight that you have lost.
How Semaglutide affects the body:
- Effects on the digestive system
During treatment with this medicine, you may experience nausea, vomiting, or diarrhoea. These side effects can cause dehydration. It is important that you drink plenty of fluids to prevent dehydration. This is especially important if you have kidney problems. Talk to your doctor if you have any questions or concerns.
Severe and on-going stomach pain could be due to acute pancreatitis – see a doctor straight away.
- Low blood sugar
Combining a sulfonylurea or an insulin with this medicine might increase the risk of getting low blood sugar levels.
- Pregnancy and breastfeeding
This medicine should not be used during pregnancy and breastfeeding, as it is not known if it affects an unborn baby. Therefore, use of contraception is recommended while using this medicine.
If you wish to become pregnant, discuss how to change your treatment with your doctor, as you should stop using this medicine at least 2 months in advance. If you become pregnant while using this medicine, talk to your doctor right away, as your treatment will need to be changed.
Click here for more info and how to use Ozempic:
____________________
2. Mounjaro
(Always read the medication leaflet before use)
How Does Mounjaro Work for Weight Loss?
Mounjaro contains Tirzepatide, which helps with weight loss by:
- Reducing appetite – You feel full faster and stay full for longer.
- Slowing digestion – Food stays in your stomach longer, reducing hunger.
- Regulating blood sugar levels – Helps the body use insulin better, preventing sugar spikes that can lead to fat storage.
While Mounjaro is approved for type 2 diabetes, it is also used for weight loss in people without diabetes.
How Does Tirzepatide Affect the Body?
Tirzepatide mimics two natural hormones in your body:
- GLP-1 (Glucagon-Like Peptide-1) – Lowers blood sugar levels, slows stomach emptying, and reduces hunger.
- GIP (Glucose-Dependent Insulinotropic Polypeptide) – Improves insulin function and may help burn fat.
These combined effects help with weight loss, blood sugar control, and reduced cravings.
Click here for more info and how to use Mounjaro:
____________________
3. SAXENDA
(Always read the medication leaflet before use)
How does Saxenda work for weight loss purposes?
The active ingredient in Saxenda “Liraglutide” is a glucagon-like peptide-1 (GLP-1) receptor agonist, which mimics a natural hormone involved in regulating appetite and food intake. It works by acting on areas of the brain responsible for hunger control, promoting a feeling of fullness, and reducing hunger signals. This leads to decreased food intake, helping people lose weight when combined with diet and exercise
How Liraglutide effects the body
- Appetite Regulation: It primarily targets appetite control by slowing gastric emptying, meaning food stays in the stomach longer, reducing feelings of hunger.
- Blood Sugar Control: Although not primarily for diabetes, it can help improve blood sugar levels by increasing insulin secretion and reducing glucagon release, making it beneficial for people with pre-diabetes.
- Weight Reduction: Over time, the reduction in calorie intake helps reduce body weight, which can also have positive effects on related conditions like high blood pressure, sleep apnea, and metabolic syndrome.
Click here for more info and how to use Saxenda:
____________________
Comparison of Saxenda, Ozempic and Mounjaro
| LIRAGLUTIDE | SEMAGLUTIDE | TIRZEPATIDE | |
| Brand name | Saxenda | Ozempic | Mounjaro |
| Estimated Price | R2800 to R4800 a month | R1500 to R3000 a month | R4000 a month |
| Ease of Use | Daily injection with a pre-filled pen. | Weekly injection with a pre-filled pen. | Weekly injection. Only available in vial form in South Africa (not a pre-filled pen). |
| Effectiveness | Average weight loss of 4–6% of body weight. | Average weight loss of 12–15% of body weight. | Average weight loss of 15–20% of body weight. |
| Safety | Common side effects include nausea, vomiting, and diarrhoea. | Similar side effects to liraglutide; potential risk of thyroid C-cell tumours. | Comparable side effects; may have a higher incidence of gastrointestinal issues. |
____________________
4. Orlistat
(Always read the medication leaflet before use)
Price: +/- R700 per month
How does Orlistat work for weight loss purposes?
Orlistat is a lipase inhibitor, meaning it blocks the enzyme lipase, which is responsible for breaking down fat in the digestive system. By inhibiting lipase, about 25-30% of dietary fat is not absorbed and is instead excreted in the stool. This can potentially give the stool an oily consistency.
Contraindications:
Orlistat is not recommended for individuals who:
- Have chronic malabsorption syndrome (difficulty absorbing nutrients).
- Have cholestasis (a liver condition where bile flow is reduced).
- Are pregnant or breastfeeding.
- People using certain medications like Levothyroxine, Warfarin, Cyclosporine
Warnings and Precautions:
Liver injury: Rare cases of severe liver injury have been reported with orlistat use, though this is uncommon. Patients are advised to report any symptoms of liver issues, such as yellowing of the skin or eyes, dark urine, or persistent fatigue.
Kidney stones: In rare cases, orlistat may increase the risk of kidney stones, particularly in people prone to oxalate stones due to changes in how the body handles oxalates from the diet.
Nutritional Considerations: Because orlistat decreases fat absorption, it can also reduce the absorption of fat-soluble vitamins (A, D, E, and K). To counter this, it’s recommended to take a multivitamin containing these vitamins at least 2 hours before or after taking orlistat.
Side Effects:
Common side effects of orlistat are mainly gastrointestinal due to the unabsorbed fat in the intestines. These include:
- Oily, loose stools
- Frequent or urgent bowel movements
- Flatulence
- Fatty or oily discharge
- Abdominal discomfort
These side effects may decrease over time, especially if dietary fat intake is reduced. To minimize side effects, it is recommended to eat meals with about 15 grams of fat or less.
____________________
5. DUROMINE
(Always read the medication leaflet before use)
Price: +/- R700 per month
How does Duromine work for weight loss purposes?
Duromine is a brand name for the drug phentermine, a prescription medication used primarily for weight loss. It is an appetite suppressant that works by stimulating the central nervous system, which includes the brain and nerves. This stimulation decreases hunger, helping patients reduce caloric intake. It may also increase heart rate and blood pressure.
Precautions and Contraindications:
Duromine is not suitable for everyone. It is contraindicated in people with:
- Heart disease or hypertension
- A history of stroke
- Hyperthyroidism
- Glaucoma
- History of substance abuse
- Pregnancy or breastfeeding
- It is also not recommended for people taking monoamine oxidase inhibitors (MAOIs) or certain antidepressants.
Side effects:
Common:
- Increased heart rate
- Elevated blood pressure
- Insomnia
- Dry mouth. Drink water throughout the day to stay hydrated and help manage dry mouth.
- Nervousness or anxiety
- Dizziness
- Headache
Severe:
- Chest pain
- Difficulty breathing
- Severe headache or vision changes
- Heart palpitations
It is important to check your blood-pressure and heart rate before starting and while using Duromine. If you experience high blood-pressure (>140/90 mmHg) or a fast resting heart rate (>100 beats per minute), do not use Duromine.
____________________
6. RELISLIM
(Always read the medication leaflet before use)
Price: +/- R500 per month
How does Relislim work for weight loss purposes?
Relislim is a medication marketed for weight loss, containing Cathine, which acts as an appetite suppressant. It works primarily by stimulating the central nervous system to curb hunger. There is a risk of addiction, therefore it is prescribed for a short duration – maximum of 1 month at a time.
Mechanism of Action for Weight Loss:
- Appetite Suppression: Like other stimulants, cathine can help reduce appetite by interacting with the central nervous system. It promotes the release of norepinephrine and dopamine, two neurotransmitters that play a role in appetite control. By increasing the availability of these chemicals, cathine can help to curb hunger and make it easier for individuals to reduce their caloric intake.
- Increased Metabolic Rate: Cathine stimulates the body’s metabolism, leading to an increase in energy expenditure. This boost in metabolism means that individuals may burn more calories even at rest, which, combined with reduced calorie intake and exercise, can promote weight loss.
- Enhanced Physical Activity: The stimulant effects of cathine can enhance alertness, energy levels, and focus, potentially making physical activity feel easier and more enjoyable. Increased physical activity can complement the calorie-burning effect, further aiding in weight loss.
How to use Relislim:
Relislim is typically taken as an oral tablet. The usual dosage is one tablet at breakfast, followed by one tablet at lunch. Avoid use after lunch, to prevent insomnia (a potential side effect).
POTENTIAL SIDE EFFECTS:
Relislim, like other stimulants, can cause a range of side effects. These include:
- Common Side Effects:
- Insomnia: Due to its stimulating properties, sleep disturbances are common if taken later in the day.
- Dry mouth: Reduced saliva production is a common side effect. Drink water throughout the day to stay hydrated and help manage dry mouth.
- Increased heart rate and palpitations.
- Nervousness or restlessness: Feelings of anxiety or jitteriness are possible.
- Elevated blood pressure: Due to the stimulant effects, blood pressure can increase.
- Serious Side Effects (less common but require medical attention):
- Cardiovascular problems: Increased risk of high blood pressure, rapid heart rate, or arrhythmias.
- Psychological effects: In some cases, patients may experience mood changes, anxiety, or even depression.
- Addiction potential: Because Relislim contains cathine, there is a risk of dependency, especially if used for extended periods.
- Withdrawal symptoms: After discontinuation, some users may experience fatigue or depression as the body adjusts.
It is important to check your blood-pressure and heart rate before starting and while using Relislim. If you experience high blood-pressure (>140/90 mmHg) or a fast resting heart rate (>100 beats per minute), do not use Relislim.
____________________
7. METFORMIN
(Always read the medication leaflet before use)
Price: +/- R100 per month
How does Metformin work for weight loss purposes?
Metformin is a commonly prescribed medication for managing type 2 diabetes, but it is also used off-label for weight loss, particularly in people with insulin resistance or conditions like polycystic ovary syndrome (PCOS). While not primarily a weight-loss drug, metformin can help some individuals lose weight as part of its effects on blood sugar regulation.
How Does It Work for Weight Loss?
Metformin primarily works by improving insulin sensitivity and lowering blood sugar levels, which can indirectly contribute to weight loss. It helps by:
- Reducing Gluconeogenesis: Metformin reduces the amount of glucose produced by the liver, helping lower blood sugar levels.
- Improving Insulin Sensitivity: By making the body more responsive to insulin, it helps cells absorb glucose more efficiently, preventing insulin spikes that can lead to fat storage.
- Reducing Appetite: Some patients report reduced hunger or cravings while on metformin, likely due to more stable blood sugar levels.
- Preventing Weight Gain: Although metformin is not a strong weight loss agent, it may help prevent further weight gain in individuals, especially those with diabetes or PCOS.
However, the weight loss effect of metformin tends to be modest. On average, patients may lose around 2-3% of their body weight over time. Its impact is greater when combined with dietary changes and exercise.
How Does It Affect the Body?
Metformin influences several key systems in the body:
- Glucose Metabolism: It reduces the amount of glucose absorbed from the gut, decreases glucose production in the liver, and enhances glucose uptake by the muscles. This results in lower blood sugar levels.
- Appetite Regulation: Metformin may affect hunger hormones like ghrelin, reducing appetite for some individuals.
- Lipid Metabolism: It may have favourable effects on lipid (fat) metabolism, potentially lowering cholesterol and triglyceride levels.
- Weight: While it doesn’t directly cause significant fat burning, metformin may promote modest weight loss by stabilizing blood sugar and improving the body’s metabolism of carbohydrates.
How Is It Taken?
- Dosage: Metformin is usually taken as an oral tablet, and the dosage can vary based on the individual’s condition. For weight-management, it is usually prescribed at doses ranging from 500 mg to 1000 mg per day.
- Timing: It is generally taken with meals to reduce gastrointestinal side effects. Extended-release versions are often taken in the evening.
Potential Side Effects:
Metformin is generally well-tolerated, but it can cause several side effects, especially gastrointestinal ones. The most common and serious side effects include:
- Common Side Effects:
- Gastrointestinal Issues: Nausea, diarrhoea, bloating, and abdominal discomfort are the most frequent complaints, particularly when starting the medication.
- Metallic Taste: Some individuals report a metallic taste in the mouth.
- Loss of Appetite: While this can be beneficial for weight loss, it can also lead to unintended under-eating.
- Serious Side Effects:
- Lactic Acidosis: This is a rare but potentially life-threatening condition where lactic acid builds up in the body. It is more likely in people with kidney problems, liver disease, or severe heart conditions. Symptoms include muscle pain, difficulty breathing, fatigue, and unusual drowsiness.
- Vitamin B12 Deficiency: Long-term use of metformin may reduce the absorption of vitamin B12, which can lead to deficiency over time. This can cause symptoms like fatigue, nerve damage (neuropathy), or anaemia.
- Hypoglycaemia (low blood sugar): is uncommon with metformin on its own but can occur when combined with other diabetes medications like insulin or sulfonylureas.