Anti-obesity medications, the new frontiers in metabolic dysfunction-associated fatty liver disease: Efficacy, limitations, and future directions

Table 1 Management of adverse events of anti-obesity medications

Medication/class	Common adverse events	Management strategies
GLP-1 RAs (semaglutide, liraglutide, tirzepatide)	(1) Nausea, vomiting, diarrhea, constipation, early satiety; rare pancreatitis; (2) Skin lesions; (3) Ozempic face; (4) Ocular adverse events; (5) Blurred vision; and (6) NAION	(1) Slow dose titration; small low-fat meals; short-term antiemetics; dose reduction if persistent symptoms; evaluate severe abdominal pain; (2) Topical corticosteroids and antihistaminic, changing injection sites and switching medications in severe hypersensitivity; (3) Fat volume restoration, fillers, microneedling and laser in addition to nutritional supplements; and (4) Close observation and ophthalmological consultation
Orlistat	Steatorrhea, fecal urgency, bloating, abdominal cramps	Dietary fat restriction (< 30% calories); patient education; vitamin A, vitamin D, vitamin E, vitamin K supplementation
Phentermine/phentermine-topiramate	Insomnia, dry mouth, constipation, tachycardia, hypertension	Morning dosing; hydration and fiber; monitor BP and heart rate
Naltrexone-bupropion	Nausea, headache, anxiety, BP elevation, mood changes	Gradual titration; BP monitoring; mood surveillance

GLP-1 RA: Glucagon-like peptide-1 receptor agonist; NAION: Nonarteritic anterior ischemic optic neuropathy; BP: Blood pressure.