II. Background
- Released in U.S. in 2013
- Removed from market February 2020 in U.S. due to cancer risk
III. Efficacy
- Weight loss is 7 pounds more than Placebo in one year
- Weight loss of at least 5% in up to 47% of patients at one year
IV. Mechanism
- Serotonin 2C (5HT-2C) Agonist that increases satiety
- Active at pro-opiomelanocortin (POMC) Neurons of the Hypothalamus
- POMC is cleaved into a-Melanocyte Stimulating Hormone (MSH)
- MSH binds Hypothalamus melanocortin 4 receptors, resulting in decreased food intake
- Thomsen (2008) J Pharmacol Exp Ther 325(2): 577-87 [PubMed]
V. Dosing
- Lorcaserin (Belviq) 10 mg orally twice daily
- Belviq XR preparation available for once daily use in 2017
- Stop medication if 5% weight loss is not achieved at 12 weeks
VI. Adverse Effects
- Cancer Risk
- No associated valvulopathy
- Lorcaserin has 100 fold greater neurologic 5HT-2C affinity over cardiac valve 5HT-2B affinity
- Well tolerated
- More specific, and does not appear to carry same valvular heart disease risks as with fenfluramine
- Constipation
- Cough
- Dry Mouth
- Fatigue
- Nausea
- Hypoglycemia
VII. Drug Interactions
-
Serotonergic Medications (e.g. SSRI, Dextromethorphan)
- Serotonin Syndrome risk
VIII. References
- (2013) Presc Lett 20(7): 37
- Erlandson (2016) Am Fam Physician 94(5): 361-8 [PubMed]
- Fidler (2011) J Clin Endocrinol Metab 96:3067-3077 [PubMed]