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Best adjunct meds for weight loss? Zyprexa munchies...


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Hey all, recently put on zyprexa a couple days ago (2.5mg) and the hunger is strong on this one.  I contacted my pdoc who'd like to reassess in a week before making any decisions but offered the following as possible adjuncts: Topiramate, Psychostimulants, Metformin or Naltrexone.

Any one have any experience with these meds?  I need something to help with the hunger, and by extension any potential weight gain.  I'm very concerned that it'll put me at risk for diabetes, but only 2 days in, it seems like the zyprexa is already helping.

In regards to stims, which have you used?  Anyone on modafinil?  Does it suppress appetite as well as say, Dexedrine or Adderall?

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Topiramate didn't really affect my appetite that much at 200 mg/day (half the max dose), but supposedly females are affected more than males in that regard. A medicine related to it, zonisamide, which I take, did suppress my appetite a little at first, but the effect has since gone away. I hear the same thing about it—females being affected more than males—as with topiramate.

I only took a low dose of metformin, 500 mg ER, but I can definitely say it didn't affect my appetite or weight. I moved on to Victoza since it's the same thing as Saxenda, except my insurance will actually pay for it—Victoza was on step therapy, but being that I had been on a first line diabetes medicine (metformin), my insurance was willing to pay for the Victoza. One of the downsides is the max dose possible with Victoza is 1.8 mg and the weight loss dose (that of Saxenda) is 3 mg max. I will say I dropped 15 lb rather rapidly, but it also came back just as rapidly. It does a good job of suppressing appetite though if I take it in the morning. Another downside is having to give yourself the subcutaneous injections of the medicine, but you get used to that. So if you do give metformin a try and don't have any luck with it, I'd highly recommend you give Victoza a try if your doctor will prescribe it to you. Mine was more than eager to do it as his words when I asked him what he thought about it were "I think it's one hell of a drug!" lol

I haven't tried naltrexone by itself, but I did try Contrave, the combination of bupropion and naltrexone, and I didn't have much success with it nor did I really like it. It made my stomach hurt really bad, made me nauseated all the time, which I guess is conducive to suppressing appetite, but it was so annoying and painful. I think it was the naltrexone that was causing it. Bupropion has made me feel icky before when first starting it and when going up on the dosage, but never like this. Very unpleasant experience. Plus I didn't lose much weight, to begin with. Plus if you ever need to take anything like hydrocodone or if you end up having to have surgery, you've got the naltrexone in your system blocking the opioids.

The best weight loss experience I've had has definitely been with stimulants of the amphetamine class (not methylphenidate or dexmethylphenidate, which did nothing for me at all, not just weight loss wise). I've taken just about all the stimulant products, both the ones marketed for ADHD and the ones marketed for weight loss.

  • Adderall (up to 40 mg) — 1st stimulant for ADHD, lost 30 lb in a month on this
  • Adderall XR (up to 60-90 mg) — for some reason I feel like this works better than regular Adderall, probably because my insurance requires that I have brand name for some reason...
  • Dexedrine (15 mg) — not really that effective for me
  • Dexedrine Spansules (30-45 mg) — probably the most effective appetite suppressant of the amphetamines for me, lost 50 lb over 5 months following a ketogenic diet while on Dexedrine Spansules
  • Desoxyn (15 mg) — really effective appetite suppressant, maybe not the most effective in promoting weight loss
  • Evekeo (20 mg) — didn't notice really much of an effect on appetite or weight, but I only took it for a month—it was a free trial, and my pdoc wasn't really willing to go up on the dosage, and I wasn't wowed by 20 mg/day, so I didn't really stick with this one...
  • Vyvanse (70 mg) — just made my heart race really, really fast... that's all it did for me
  • ———
  • Stimulants I've not tried: Dyanavel XR, Adzenys XR-ODT
  • ———
  • Adipex-P (37.5 mg) — 1st stimulant for weight loss, lost 30 lb in the first month on this the first time I took it, the rest of the times I've taken it, it hasn't had that drastic of an effect, but by far probably the most effective anorexigenic
  • Tenuate (25 mg 3x/day) — does a good job at appetite suppression and weight loss
  • Tenuate Dospan (75 mg) — for some reason the extended release version did nothing for me
  • Bontril-PDM (35 mg 3x/day) — does a pretty good job at appetite suppression, a less decent job at promoting weight loss
  • ———
  • Stimulants I've not tried: Bontril 105 mg ER, Didrex 50 mg

It's difficult to do, but if I had to rate them in terms of efficacy, I'd say:

Appetite suppression: Dexedrine Spansules ≈/> Desoxyn > Adderall XR > Adderall > Dexedrine > Evekeo > Vyvanse
Weight loss: Dexedrine Spansules ≈/> Adderall XR/Adderall ≈ Desoxyn > Dexedrine > Evekeo > Vyvanse

I've also been on both modafinil and armodafinil. Modafinil at 400 mg doesn't even compare to the amphetamines for me as far as appetite suppression—I don't notice it doing a thing to my appetite. Armodafinil though, on the other hand, made me lose weight without trying, at 250 mg.

These are just my experiences, YMMV of course.

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Currently on Naltrexone  ... has worked awesome for me.  I still get hungry, but the voracious appetite is not there.  Lost some weight on it. 

Topomax didnt affect my weight.

Currently on Modafinil ... has not affected my weight ... or if it does, it isn't noticeable.  I take it to keep me awake.

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Topamax didn't seem to help me.  I was stable, but not able to lose and I wasn't taking a significant weight gaining medication then like I was recently.  Provigil helped me with wakefulness but my insurance pulled the prior authorization and I don't remember being on it long enough to notice an appetite effect.

i was able to lose weight while on adderall and adderallXR.  I didn't completely lack an appetite (which you will hear from some I think), but it was reduced.

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I'd change my diet. See if cutting back on carbohydrates helps. Even if you dont lose weight you wont become diabetic. I'm on seroquel which isn't as bad as zyprexa but still causes metabolic problems in some and my weight is still obese but my blood work is perfect since cutting out the carbs. I'm still going for that model look so thinking about getting off though for something else.

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FWIW ... while changing your diet, changing your diet to cut back on carbs is a lot easier said than done, especially if there are cravings ... at least for me, there are times when when you "have" to have the carbs, and I would go out of my way to eat what I want (carbs).

I think it is YMMV on changing your diet.

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