RIO is able to prescribe weight loss medications to help with losing the weight, whilst working on behaviour change and interventions to help keep the weight off. There have been many weight loss medications that have been available over the years but RIO will only prescribe those that have been proven with evidence to be effective and safe.
Many over the counter weight loss products have never been proven to be effective, and over the years there have been medications that have been shown to have questionable safety.
Fortunately Dr Capehorn is an expert in weight loss medications and feels happy to recommend any of the medications that are currently approved for use in the UK and Europe. Currently we are happy to consider prescribing:
Orlistat may be available on the NHS in your area.
You should not aim for any more than ½ stone (3kg) per month unless your Doctor has advised this for specific reasons.
What is Saxenda (Liraglutide 3.0mg) and how does it work?
Saxenda is a Glucagon-like Peptide-1 analogue, or GLP-1 analogue. Liraglutide is the chemical name and "Saxenda" is the brand name. It comes as a once daily injection (although very small diabetic needles) taken at any time of day. It is injected subcutaneously in the abdomen, thigh or upper arm, although this and the timing can be changed without any dose adjustment.
The RIO Obesity Specialist Nurse will train you on how to give these injections, and everything else you need to know about taking your Saxenda medications.
Liraglutide has been licensed and available on the NHS as a diabetes drug at a lower dose of 1.2mg for some time, and is considered to be safe and effective. More recently clinical trials have shown that at a dose of 3.0mg it is highly effective for weight loss, and at the present time, it is considered to be the most effective weight loss medication licensed for use in the UK. However, as this current moment in time it is not available on the NHS. It works on receptors inside your gut and your brain, and should make you lose weight and feel more full. Clinical trials suggest that most people can expect to lose 4-6kg without any other changes in behaviour, and that an impressive 2/3 (63%) will reach at least 5% weight loss from baseline.
Does Saxenda have any side-effects and is it safe for me to take?
Like most medications, Saxenda has rare but potential side-effects. Most of these side-effects are gastro-intestinal. Many people (more than 1 in 10) initially report nausea (and occasionally vomiting) when starting to take Saxenda, however this can settle within a matter of weeks if the medication is continued, and anti-sickness medication can be prescribed and taken. Some people report diarrhoea, yet others report constipation, but most report no change in bowel habits. If you are worried about the likelihood of side-effects the RIO team can discuss these in more detail with you.
If you are on certain medications, RIO may advise that you see your Dr with a view to reducing these, as some (eg diabetes or blood pressure medications) may no longer be needed, or at the same dose.
Saxenda should NOT be used in conjunction with any other GLP-1 analogue, or a diabetic medication called a DPP4 inhibitor, so please bring a list of your medications with you to your RIO appointment.
In rare cases, Saxenda can increase the risk of acute gallbladder disease (which may be due to the rapid weight loss). It can also cause a very slight increase in heart rate (by just 2-3 beats per minute) but this is not considered to be clinically harmful. Very occasionally some people have reported hypersensitivity reactions.
Saxenda should NOT be used if you have a family history of medullary thyroid carcinoma or if you have Multiple Endocrine Neoplasia syndrome type 2, or if you are pregnant or breast-feeding. At present it is not yet known whether patients with a history of pancreatitis are at an increased risk whilst using Saxenda as these patients were not included in clinical trials. Saxenda should be used with caution in patients with renal failure, and avoided in patients with a history of suicidal attempts or active suicidal thoughts.
Saxenda is NOT licensed for use in children under 18 years of age
How do I get my prescriptions?
All of your Saxenda prescriptions and medications can be arranged by RIO, and delivered free of charge, together with any additional items (eg needles) and support, via our partner pharmacy, Good Measure. You just pay a single price of £300 per month, and there are no other hidden extras as there can be from other places, together with the knowledge that you are getting it from somewhere with experience in having used the medication as early as the clinical trials.
Your medication should be increased slowly to reduce the likelihood of any side-effects. The following table is a suggestion on how best to increase your medication up to the maximum dose, but it can be increased more slowly if required:
Dose escalation schedule:
| WEEK | DAILY DOSE |
|---|---|
| 1 | 0.6mg |
| 2 | 1.2mg |
| 3 | 1.8mg |
| 4 | 2.4mg |
| 5 and onwards | 3.0mg |
Your medications should be refrigerated, but do NOT store in a freezer. After initial use, it can be stored at room temperature for up to 30 days.
All future prescriptions will be provided by RIO and Good Measure Pharmacy. We recommend that you continue to attend RIO as part of their weight management programme whilst taking Saxenda, and engage with behaviour change to prevent any weight regain after stopping the medication.
See pricing for SaxendaWhat is Mysimba (Naltrexone and Bupropion) and how does it work?
Mysimba is a combination medication made up from 2 different active substances that work together. It includes Naltrexone hydrochloride (8.0mg) + Bupropion hydrochloride (90mg). It involves taking two tablets twice daily (after 4 weeks), best taken at the same time of day, each day.
The RIO Obesity Specialist Nurse will explain everything else there is to know about taking your Mysimba weight loss medication.
Both Naltrexone and Buproprion have been licensed and available on the NHS individually for many years. Naltrexone has been used to help prevent cravings in those addicted to opiate painkillers or alcohol. Buproprion (often known by the brand name "Zyban") has been used to help stop smoking. Both drugs are considered to be safe and effective.
More recent clinical trials have found that in combination this medication is very effective for weight loss. However, as this current moment in time it is not available on the NHS. It works on 2 areas of the brain that is involved in controlling how much food you eat and energy you use. As a result it can help reduce hunger and help control cravings, thereby reducing weight. Clinical trials suggest that most people can expect to lose 4-6kg without any other changes in behaviour, and that over half (55%) will reach at least 5% weight loss from baseline.
Does Mysimba have any side-effects and is it safe for me to take?
Like most medications, Mysimba has rare but potential side-effects. Most of these side-effects are gastro-intestinal. Many people (more than 1 in 10) initially report nausea (and occasionally vomiting) when starting to take Mysimba, however this can settle within a matter of weeks if the medication is continued, and anti-sickness medication can be prescribed and taken. Some people report constipation, headaches or difficulty sleeping, but most report no problems. If you are worried about the likelihood of side-effects the RIO team can discuss these in more detail with you.
If you are on certain medications, RIO may advise that you see your Dr with a view to reducing these, as some (eg diabetes or blood pressure medications) may no longer be needed, or at the same dose. Mysimba should NOT be used in conjunction with any opioid (codeine based) analgesia, eg cocodamol or morphine based painkillers, or other specific medications for depression or Parkinson's disease called monoamine oxidase inhibitors (MAOIs), or following recent use of sedative medications.
In rare cases, Mysimba can increase the risk of fits (seizures), or your risk of mental health problems, or reduce your tolerance to alcohol. If using Mysimba makes you dizzy then you should not drive or use machines.
Mysimba should NOT be used if you have a brain tumour, a known allergic reaction to either Naltrexone or Bupropion, uncontrolled blood pressure, bipolar disease, an eating disorder, or if you have recently stopped heavy alcohol intake, or if you are pregnant or breast-feeding. Saxenda should also not be used if you have severe liver disease or severe kidney disease.
Mysimba is NOT licensed for use in children under 18 years of age
How do I get my prescriptions?
All of your Mysimba prescriptions and medications can be arranged by RIO, and delivered free of charge, together with any help and support, via our partner pharmacy, Good Measure. You just pay a single price of £150 per month, and there are no other hidden extras as there can be from other places, together with the knowledge that you are getting it from somewhere with experience in having used the medication before.
Your medication should be increased slowly to reduce the likelihood of any side-effects. The following table is a suggestion on how best to increase your medication up to the maximum dose, but it can be increased more slowly if required:
Dose escalation schedule:
| WEEK | MORNING | EVENING |
|---|---|---|
| 1 | 1 tablet | nothing |
| 2 | 1 tablet | 1 tablet |
| 3 | 2 tablets | 1 tablet |
| 4 and beyond | 2 tablets | 2 tablets |
All future prescriptions will be provided by RIO and Good Measure Pharmacy.
All future prescriptions will be provided by RIO and Good Measure Pharmacy. We recommend that you continue to attend RIO as part of their weight management programme whilst taking Mysimba, and engage with behaviour change to prevent any weight regain after stopping the medication.
See pricing for MysimbaWhat is Xenical (Orlistat) and how does it work?
Xenical is a pancreatic lipase inhibitor. Orlistat is the chemical name and “Xenical” is the brand name. The dose is one (120mg) tablet, three times a day. Ideally this should be taken just before or up to one hour after each of 3 regular meals.
The RIO Obesity Specialist Nurse will explain everything else there is to know about taking your Xenical weight loss medication.
Xenical has been licensed and available on the NHS for the last 20 years. It is proven to be safe and effective.
This drug works on the food that you eat. Even if you eat a low-fat diet, all our food contains some fat. Whilst taking Xenical, 1/3 of any fat that you eat will not be absorbed. Therefore, unless you use it as an excuse to eat more, or drift back into bad habits whilst taking it, you cannot fail to lose at least some weight whilst taking this medication.
Clinical trials suggest that most people can expect to lose 2-3kg without any other changes in behaviour, and that nearly half (44%) will reach at least 5% weight loss from baseline. However, without dietary change there may be unwanted side-effects.
Does Xenical have any side-effects and is it safe for me to take?
Like most medications, Xenical has potential side-effects. Most of these side-effects are gastro-intestinal, however they only tend to occur when eating high fat foods, and can include loose yellow stools (motions), urgency to pass a motion, wind or abdominal discomfort. This is due to the excess fat passing through your system. If this happens you should consider choosing to eat foods with a lower fat content. If side-effects are too bad, you must inform your Doctor. If you are eating a low-fat diet you should not have any significant change in bowel habits. you are worried about the likelihood of side-effects the RIO team can discuss these in more detail with you.
Many people believe that because of the way Xenical works, there will be no weight loss if you are not eating a high fat diet, as it works on the fat you consume. However, even on a low fat diet, up to 30% of your calories may be coming from fat, and Xenical can reduce calorie intake by 1/3 of this, ie up to 10% of your total daily intake. Although this may only be 200-300kcals per day, it will soon add up, and can lead to 1-2 lbs per week of additional weight loss, over and above normal calorie restriction and increased physical actvity. This additional calorie deficit will soon add up and over time can speed up weight loss.
Xenical should NOT be used if you have malabsorption problems, gallbladder problems (such as reduced gallbladder activity eg after a cholecystectomy), any eating disorders, or if you are pregnant or breast-feeding. It should be considered with caution in known bile duct obstruction, impaired liver function and pancreatic disease.
Xenical is currently the only weight loss medication licensed in he UK for use in children under 18 years of age. It can be used in appropriate children as young as 12 years of age on the advice of the RIO clinician.
How do I get my prescriptions?
All of your Xenical prescriptions and medications can be arranged by RIO, and delivered free of charge, together with any help and support, via our partner pharmacy, Good Measure. You just pay a single price of £95 per month, and there are no other hidden extras as there can be from other places, together with the knowledge that you are getting it from somewhere with experience in having used the medication before.
However, please remember that you may be entitled to get generic Orlistat on the NHS, although you may have a care pathway that you need to follow, that may also include starting and stopping criteria that need to be met. Please consult your own Doctor.
All future prescriptions will be provided by RIO and Good Measure Pharmacy. We recommend that you continue to attend RIO as part of their weight management programme whilst taking Xenical, and engage with behaviour change to prevent any weight regain after stopping the medication.
See pricing for Xenical