In today's episode I'm going to cover the GLP1 medications on the horizon. These include CagriSema, retatrutide, survodutide, and amycretin. Then I'll compare and contrast the currently approved GLP1s. I'll go over which weight loss medications are approved at which ages for pediatrics. Lastly, I'll go over the hurdles of insurance coverage and give you an example of how the requirements for payment change and what those requirements are.

Today I will be covering the GLP1 medications. Starting with exenatide and dulaglutide and then covering liraglutide (Saxenda), semaglutide (Wegovy), tirzepatide (Zepbound), and orforglipron (Foundayo). I'll go over how they are different, which work better, which are better tolerated, how to customize them, how they compare, and when I would pick each one.

Ok, so last time I discussed some of the downsides of GLP1 medications, and this will be part 2 of those downsides. First, I'll discuss eating disorders. How prescribing GLP1 medications in a world with eating disorders is complicated, and how GLP1 medications can actually induce eating disorders; something call "agonorexia." Then, I'll talk about drug interactions. Most of those listed on the package insert are not terribly important, however there are actually several that no one talks about and many of them apply to use with psychiatric medications! Lastly, I'll talk about cost, frequent shortages, and the world of compound pharmacies. I'll discuss how these pharmacies have really taken off with these medications, when they are legit, when they aren't, and how to know the difference.

Ok, so I've exalted the benefits of GLP1s and last time I went over how to customize to your patient. Today I will be going over some of the downsides. I'll cover the really serious stuff first that actually never happens in some cases or rarely happens in others. Then in the second half I'll go over the stuff that actually happens pretty frequently and bothers patients and how to combat it to customize these medications to get the best out of them for those that need and respond to them!

Today continuing with GLP-1 agonists, I will talk about the subtleties of dosing. It's a lot more than what the drug manufacturers publish. Simply following their simple instructions will not work for most patients, so I will discuss how to personalize. Next I will discuss how long patients will need to take the medications, and what to do when it's time to maintain their weight. Lower the dose? Change to a different med? Change the frequency? All these and more so have a listen and learn how to personalize obesity treatment with these highly effective medications, so that patients have the most benefit!

Today we finally reach the GLP-1 medications! It's been a long slog through obesity medication, but I feel like this is what everyone has been waiting for. I will start off today by telling you how these medications work on the many parts of the body on which they do work. I will then go through the long list of benefits that they have on these various body systems, and I will back it up with the scientific literature. The benefits are massive and probably even more than you imagined, so have a listen! And don't worry I'll talk about all the stuff you need to be careful about on the next couple episodes, so it's not always rosy as with anything.

Today we will finish up on medications used for weight loss prior to going in to the GLP-1 medications. I will be discussing several medications today. These are medications that you will use less often, but most of them have important roles to play with some patients, so it's important to have them in your arsenal to personalize care. I'll discuss metformin (Glucophage), topiramate (Topamax), orlistat (Xenical), pramlintide (Symlin), Lorcaserin (Belviq), Gelesis100 (Plenity), Setmelanotide (Imcivree), and SGLT2 inhibitors.

Today is the last episode on ADHD, and I will finish off by talking about the effects of estrogen on ADHD symptoms both during the menstrual cycle and perimenopause. I will discuss using hormone replacement therapy as well as changes to ADHD medications to combat these symptoms. I will also discuss comorbid autism, anxiety, depression, and bipolar disorder as well as treating executive functioning which does not respond well to medication.

Today I will continue with weight loss medications, and we will focus on two of the newer options. First the phentermine/topiramate ER combination pill known as Qsymia. Then I will talk about the naltrexone/bupropion combination pill known as Contrave. You may be thinking to yourself, why even bother with these now that GLP1 medications are so effective and everyone is using them? Well, these medications definitely have their place and they are not as straightforward as you may think they are. There is a lot of nuance that you can use in prescribing them, and there are a number of things that you want to be careful about as well. These can be great for those where GLP1s are not an option, for those that have comorbid conditions in which these medications also treat, and also they are often needed prior to GLP1s if you are trying to get insurance to cover the GLP1, so definitely do not miss this one!

Today we will finish up the medications for ADHD with the remaining non-stimulant medications. There are actually quite a few non-stimulants with more than half being used off label. I will talk about the alpha 2 agonist medications guanfacine and clonidine, which are the FDA approved medications. Then, I will talk about off label options like TCAs and bupropion. Lastly, I will discuss two new medications on the horizon likely to be approved soon, solriamfetol and centanafadine. I will finish with saffron, which is one of the few herbal options which shows some promise.