Are Older Weight-Loss Medications Outdated? Older vs. Newer Options Compared

Weight-loss medications have changed dramatically over the past few decades. Not long ago, the best option was a pill that suppressed appetite or blocked fat absorption. Today, newer medications — such as glucagon-like peptide-1s (GLP-1s) — are helping many people lose significantly more weight than was previously possible.

These newer medications have gotten a lot of attention. So you may be wondering whether older weight-loss medications are still worth considering. The answer depends on your situation. 

Older medications are often available as generics and may work well for certain people. But newer medications may be a better fit for people with certain health conditions or requiring more weight loss. Here’s how they compare.

Weight-loss medication overview

Weight-loss medications can be put into three categories: older medications, combination pills, or GLP-1 medications. Each category works differently and has its own benefits and risks. The best fit for you depends on your health goals, preferences, and budget.

But it isn’t always an either-or choice. In some cases, healthcare professionals prescribe medications from different categories together. You may also switch from one category to another.

The chart below breaks down the options.

Both older and newer weight-loss medications can help people lose weight. Here are some important differences to consider.

How much weight loss is possible

One of the biggest differences between older and newer weight-loss medications is how much weight people lose.

Older medications and combination pills usually help people lose about 5% to 10% of their starting body weight; some people lose more. GLP-1 medications, particularly Wegovy and Zepbound, can lead to greater weight loss — often 15% to 20% of starting body weight or more.

If your goal is modest weight loss, an older medication or combination pill may be enough to help you reach it. But if you’re hoping to lose a greater amount of weight, your prescriber may recommend a GLP-1 medication.

How they’re taken

Another major difference is how these medications fit into your daily routine. Older medications are usually pills that you take once or several times daily. Appetite suppressants, such as phentermine, are approved only for short-term use (up to 12 weeks).

Newer medications are available as both pills and injections approved for weight loss and long-term weight maintenance. Most injections are administered once weekly, while newer pills are taken every day.

If you prefer to avoid injections, an oral medication may be appealing. But administration requirements differ:

• Phentermine: Timing and frequency depends on the dose and formulation

• Orlistat: Taken 3 times daily with fat-containing main meals

• Contrave: Best taken with food, but don’t take it with a high-fat meal

• Qsymia: Taken in the morning, with or without food

• Wegovy pill: Must be taken on an empty stomach with a small amount of water, followed by a 30-minute waiting period before eating or taking other medications

• Foundayo: Taken anytime of day, with or without food

How they work

Older and newer weight-loss medications help people lose weight in different ways.

• Older medications: Most work by reducing appetite or blocking the absorption of fat from your diet.

• Combination pills: Contrave helps reduce hunger and food cravings. Qsymia combines an appetite suppressant with topiramate to help people eat less.

• GLP-1 medications: Wegovy, Foundayo, Saxenda, and Zepbound simulate hormones that help regulate appetite and fullness. They may also help counter hormonal changes after weight loss that can make it harder to keep weight off.

These differences can help you decide which approach may be a better fit. Appetite suppressants may be useful if hunger is a major challenge for you. Orlistat works by reducing fat absorption and can help limit regain after weight loss. But it requires more attention to what you eat, since your diet should have no more than 30% of its calories from fat.

For long-term weight management, combination pills and GLP-1s are good options to consider. GLP-1s may be particularly helpful for maintaining weight loss. This is because they address some of the body’s natural responses to losing weight.

Good to know: It’s possible to regain weight after stopping a weight-loss medication. For this reason, most are often taken long term, as long as they’re working and well tolerated. Your prescriber can help determine how long you should continue treatment.

Additional health benefits

For many people, weight loss isn’t the only goal. Some GLP-1 medications are also approved to treat other health conditions, such as:

• Wegovy (pill and injection) lowers the risk of serious cardiovascular problems in certain adults with heart disease.

• Wegovy injections also treat a form of fatty liver disease.

• Zepbound treats moderate-to-severe obstructive sleep apnea in certain adults.

If you’re living with one of these health conditions, or are at higher risk for developing them, your prescriber may recommend a GLP-1 medication over other weight-loss options. If you don’t have these conditions, an older medication may still be an appropriate option.

Side effects and risks

Every weight-loss medication has potential side effects and risks. The side effects you experience often depend on how the medication works.

Interactions

Weight-loss medications can interact with other prescription medications, over-the-counter products, and supplements. The types of interactions differ depending on the medication:

• Older medications: Stimulant medications, such as phentermine, can interact with alcohol as well as medications that increase heart rate or blood pressure. Orlistat can reduce the absorption of fat-soluble vitamins and some medications.

• Combination pills: Contrave interacts with opioids and medications that increase the risk of seizures. Qsymia can interact with birth control pills and other medications that affect the central nervous system.

• GLP-1 medications: GLP-1 pills and injections may affect how you absorb oral medications, such as birth control pills. They can also increase the risk of low blood glucose (sugar) with certain diabetes medications. Unlike other GLP-1s, Foundayo can affect how your liver breaks down certain medications.

If you take multiple medications, ask your healthcare team to check for interactions before you start a weight-loss medication. They can help determine which option is the safest choice for you.

Costs and availability

Cost is often one of the biggest deciding factors with weight-loss medications.

Older medications and Qsymia are available as generics. Some, such as orlistat (alli), can even be purchased over the counter without a prescription.

Newer medications are usually brand-name products, so they tend to cost more. But manufacturer copay savings cards, GoodRx discounts, and programs like GoodRx for Weight Loss may help lower the price and improve access.

If cost or insurance coverage is your biggest concern, an older medication can be a good starting point. If you’re able to use insurance or savings programs, a newer medication may become much more affordable.

How to choose

The newest medication isn’t necessarily the best one for you. When deciding on a weight-loss medication, you and your prescriber should consider:

• Your weight-loss goals: If you’re looking for more significant weight loss, newer GLP-1 medications generally lead to greater results than older medications.

• Your medical history: Some medications aren’t recommended for people with certain health conditions, such as heart disease, seizure disorders, and thyroid conditions. But others may provide additional health benefits in certain cases.

• Whether you prefer pills or injections: Effective options are available in both forms.

• Your budget and insurance coverage: Older medications are often available as lower-cost generics. Newer medications may require insurance coverage, savings programs, or coupons to make them affordable.

• Potential side effects: Every medication has benefits and risks that should be weighed against your preferences and health goals.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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