Key takeaways
The FDA has approved five prescription weight loss pills: Wegovy (semaglutide), Qsymia (phentermine/topiramate), Xenical (orlistat), Lomaira (phentermine), and Contrave (naltrexone/bupropion).
Of these, the Wegovy pill is the strongest weight loss pill available.
Along with a healthy diet and exercise routine, these drugs can help you lose a modest amount of weight.
Here's what we'll cover
Key takeaways
The FDA has approved five prescription weight loss pills: Wegovy (semaglutide), Qsymia (phentermine/topiramate), Xenical (orlistat), Lomaira (phentermine), and Contrave (naltrexone/bupropion).
Of these, the Wegovy pill is the strongest weight loss pill available.
Along with a healthy diet and exercise routine, these drugs can help you lose a modest amount of weight.
Looking for the strongest weight loss pill to help you reach your goals? While injectable medications like Wegovy and Zepbound have gained attention for their effectiveness, not everyone wants to start a weekly injection. Fortunately, there are powerful prescription weight loss pills that can offer real results — no needles required.
What is the strongest prescription weight loss pill?
The most effective weight loss pill available is the Wegovy pill. It’s a daily oral tablet that contains the same active ingredient as injectable Wegovy, semaglutide.
In about a year and three months, people taking oral Wegovy lost nearly 14% of their body weight. That makes it nearly as effective as the Wegovy injection, which has a nearly 15% average weight loss.
Top prescription weight loss pills ranked by effectiveness
Below we list the strongest weight loss pills, in order of their effectiveness in clinical studies (i.e. their maximum potential average weight loss observed in these trials). Keep in mind, though, that individual results may vary, and there’s more to taking these medications than just weight loss.
All of these pills are approved by the US Food and Drug Administration (FDA) specifically for weight loss. And all of these medications require a prescription from a licensed healthcare provider.
1. Wegovy pill (semaglutide) — 13.6%
How effective is it? In clinical trials of the Wegovy pill, people taking 25 mg daily lost nearly 14% of their body weight in 64 weeks (about a year and three months).
Here’s a general timeline of weight loss based on the research:
2% weight loss in the first month
4% weight loss in the first two months
6% weight loss in the first three months
13.6% weight loss in 64 weeks (about a year and 3 months)
The Wegovy pill is an oral formulation of semaglutide — the same active ingredient in injectable Wegovy. Semaglutide (and, thus, the Wegovy pill) works by slowing down digestion and boosting satiety (fullness) signals in the brain.
Who is it for? The Wegovy pill is FDA-approved alongside diet and exercise for:
Weight loss and maintenance in adults with obesity and overweight
Cardiovascular risk reduction in adults with obesity or overweight and heart disease.
The pill is taken daily in the morning with 4 ounces or less of water on an empty stomach, at least 30 minutes before eating, drinking anything else, or taking other medications.
Who should avoid it? You should avoid using oral Wegovy (or any semaglutide medication, for that matter) if you are pregnant, breastfeeding, or have a personal or family history of thyroid cancer.
How much does it cost? On Ro, the Wegovy pill has a cash price of $149–$299 per month, depending on the dose. If you have commercial insurance that covers Wegovy, you may be able to get the pill for as low as $25 per month with the manufacturer’s savings offer.
2. Qsymia (phentermine/topiramate) — 5%–10.6%
How effective is it? In clinical trials, 70% of people taking Qsymia lost at least 5% of their body weight within one year. Some people can lose up to 10.6% of their body weight in that time.
Another study found that continued treatment with Qsymia can help people maintain weight loss for up to two years. The medication works by reducing appetite and controlling binge-eating behavior.
Who is it for? Qsymia (phentermine/topiramate) is approved to reduce excess body weight and maintain weight loss long term in people ages 12 and older with obesity or adults with overweight and a weight-related medical condition. It should be used alongside diet and exercise.
Qsymia comes as an extended-release oral capsule and is taken once daily in the morning with or without food.
Who should avoid it? You should avoid using Qsymia if you are pregnant (or trying to be), have glaucoma (i.e. high pressure in the eye that can lead to vision problems), thyroid problems (hyperthyroidism), or are taking a monoamine oxidase inhibitor (MAOI) medication.
Because of phentermine’s potential for abuse, the US Drug Enforcement Agency (DEA) considers it a controlled substance.
How much does it cost? Without insurance, Qsymia costs $250–$280 per month, while generic phentermine/topiramate costs $213–$365. Eligible individuals can save $65–$75 per month with the Qsymia Savings Card.
3. Xenical (orlistat) — 3%–9.7%
How effective is it? In one analysis, 44% of people taking Xenical lost at least 5% of their body weight within one year — nearly twice as many as those on a placebo.
Other studies have found that people lose anywhere from 3% to nearly 10% after one year of taking orlistat.
It works by decreasing your body’s absorption of fat from food by up to 30%.
Orlistat is also available in a lower-dose version called Alli that’s available over the counter. It produces less weight loss than prescription-strength Xenical.
Who is it for? Orlistat is FDA-approved for weight loss in people with obesity or overweight, alongside diet changes. It’s also approved to help prevent weight regain after someone has lost weight.
Orlistat comes as a capsule that’s taken three times a day with fat-containing meals. Xenical is the prescription-strength version of orlistat.
Who should avoid it? You should avoid Xenical if you are pregnant or breastfeeding or if you have chronic malabsorption syndrome (a digestive disorder affecting the small intestine) or cholestasis (a liver condition).
How much does it cost? Without insurance, Xenical costs $638–$725 per month.
4. Lomaira (phentermine) — 8%–9%
How effective is it? In seven months, people taking phentermine (Lomaira) can lose over 8% of their body weight, or at least 8 pounds, according to clinical studies.
Phentermine is a nervous system stimulant that suppresses appetite.
Who is it for? Phentermine is only FDA-approved for weight management on a short-term basis (12 weeks). It comes as an oral tablet and an oral capsule that is taken once daily in the morning.
Who should avoid it? You should avoid phentermine if you are pregnant or breastfeeding, recently used MAOIs, or have anxiety, heart disease, thyroid problems, glaucoma, uncontrolled high blood pressure, or a history of seizures or substance abuse.
As a stimulant, phentermine is a controlled substance that has a potential risk of abuse and dependence.
How much does it cost? Without insurance, Lomaira and generic phentermine cost around $40 per month. Eligible individuals can save up to 25% on Lomaira with the manufacturer savings card.
5. Contrave (naltrexone/bupropion) — 4%–5%
How effective is it? In clinical trials, roughly half of people taking Contrave lost at least 5% of their body weight in one year. That’s twice as many people who implemented lifestyle changes alone. One analysis of these same trials reported the overall average weight loss on Contrave to be a little over 4%.
Contrave works by reducing food cravings and appetite.
Who is it for? Contrave (naltrexone/bupropion) is FDA-approved for long-term weight management, along with a reduced-calorie diet and increased physical activity, in adults with obesity or overweight with at least one weight-related health condition, such as high blood pressure.
It comes as an extended-release oral tablet and is taken twice-daily with or without food.
Who should avoid it? You should avoid Contrave if you have uncontrolled high blood pressure, seizure disorders, eating disorders, chronic opioid use, recently stopped taking certain medications (e.g. benzodiazepines, barbiturates, antiseizure drugs), or used MAOIs in the past 14 days.
Since Contrave may increase blood pressure and heart rate, it may not be safe for people with a history of heart problems, heart attack, or stroke. And like other weight loss medications, it isn’t recommended during pregnancy.
How much does it cost? Without insurance, Contrave costs $750–$790 per month. If you’re eligible for the CurAccess savings program, you can pay $99 per month or less.
Quick comparison: strongest weight loss prescription pills
| Active ingredient(s) | Approved for long-term weight management? | Average weight loss | Frequency |
|---|---|---|---|---|
Wegovy pill | Semaglutide | Yes | 13.6% | Once daily |
Qsymia | Phentermine/topiramate | Yes | 4%–10.6% | Once daily |
Xenical | Orlistat | Yes | 3%–9.7% | Thrice daily |
Lomaira | Phentermine | No | 8%–9% | Once daily |
Contrave | Naltrexone/bupropion | Yes | 4%–5% | Twice daily |
Who is eligible for weight loss pills?
Most weight loss pills are meant for adults over 18 years old with either:
Obesity (body mass index or BMI of 30 kg/m2 or more)
Overweight (BMI of 27 kg/m2 or more) with at least one weight-related health problem, such as high blood pressure, type 2 diabetes, or heart disease
The easiest (albeit imperfect) way to determine your weight category is to measure your BMI. You can easily calculate your BMI by using Ro’s calculator:
Find out how much you could lose
Provide your biometric data to get started.
0.0
Your BMI
Underweight
< 18.5
Healthy weight
18.5 - 24.9
Overweight
24.9 - 29.9
Obesity
> 30
Many weight loss pills are contraindicated for people with certain health conditions or taking specific medications. For example, people who are pregnant or breastfeeding should not take weight loss pills. Other common contraindications include uncontrolled high blood pressure and taking MAOIs.
Be sure to tell your healthcare provider about any health conditions you may have as well as any medications you are taking.
How well do weight loss pills work?
The FDA-approved weight loss pills we’ve mentioned have different mechanisms of action, but they all mainly work by suppressing your appetite.
Some do so by activating parts of your brain involved in appetite regulation, such as semaglutide, naltrexone/bupropion, phentermine/topiramate, and phentermine. This can lead to fewer cravings and less hunger.
Others, such as orlistat, work by blocking how much fat you absorb from food, so you absorb fewer calories overall.
Additionally, semaglutide also works by slowing down digestion.
How much weight you lose on weight loss pills can depend on the medication and other lifestyle changes you make. Improving your diet and increasing your physical activity may lead to more weight loss.
In general, people tend to lose from 3% up to 14% of their body weight after one year of taking weight loss pills in combination with lifestyle changes.
How long do I need to take weight loss pills?
How long you need to continue taking weight loss pills depends on several factors and varies from person to person.
If a weight loss medication works safely and effectively for you, your healthcare provider may recommend taking it long-term to help you keep the weight off. The Wegovy pill, for example, is actually intended for long-term use.
One exception to this rule is phentermine, which is only FDA-approved for short-term use (up to 12 weeks).
What to consider when choosing a weight loss pill
You might be wondering why you’d choose one weight loss pill over another if many of them achieve similar results. It’s generally going to come down to a few key factors, which your healthcare provider will go over with you:
How much weight you need (or want) to lose: The Wegovy pill is the most effective weight loss pill currently available. In clinical trials, people taking 25 mg lost nearly 14% of their body weight in 64 weeks (about a year and three months).
Side effect tolerance: If you try one medication and can’t handle the side effects (hey, it happens!), your healthcare provider may recommend trying a different weight loss pill.
Medical conditions or medications: Certain medical conditions and medications may make you ineligible for some weight loss pills, but eligible for others. For example, if you have glaucoma or a history of drug abuse, phentermine would be contraindicated, but oral Wegovy could be a good fit.
Cost: While some of these options are available as lower-cost generic drugs, cost may be a factor if your insurance doesn’t cover certain weight loss medications. Brand-name Contrave and Xenical can cost several hundreds of dollars out of pocket. But the Wegovy pill and Qsymia can cost less than $300, on average. See your insurance plan’s drug formulary to determine which, if any, medications are covered.
Other weight loss medications and treatments
The drugs mentioned above are the weight loss pills that carry FDA approval. However, other drugs may be used off-label to help with weight loss. Off-label simply means that a drug is being used for a condition that it was not originally approved to treat.
For example, metformin is approved to treat type 2 diabetes but may be prescribed off-label for weight loss. In a study of people with type 2 diabetes, the average one-year weight loss was just over 6%.
Other common options for weight loss include GLP-1 injections and surgery.
Weight loss injections
The FDA has approved three injectable drugs for weight loss:
Wegovy (semaglutide): This is a GLP-1 drug with the same active ingredient as the Wegovy pill. A large clinical trial that included people with obesity and no type 2 diabetes showed an average weight loss percentage of 14.9% in 68 weeks on a 2.4 mg dose of injectable Wegovy.
Zepbound (tirzepatide): This GLP-1/GIP medication has the same active ingredient as Mounjaro (approved for diabetes). In a 72-week clinical trial, people with type 2 diabetes lost up to 14.7% of their body weight on average when taking the highest dose of 15 mg. In another trial, people with obesity and no type 2 diabetes lost up to 20.9% of their body weight on the 15 mg dose.
Saxenda (liraglutide): This is another GLP-1 drug that can help people lose around 5%–7% of their body weight.
All of these drugs are administered through a tiny needle in an injection, and they work similarly. They slow down digestion, keeping you feeling fuller longer. They also act on the part of the brain that sends hunger signals, keeping you from feeling hungry to begin with.
These drugs also have similar side effect profiles, primarily related to digestion (e.g. bloating, diarrhea, constipation, gas, etc.). For most people, the side effects of GLP-1s are usually mild to moderate and tend to ease over time as your body gets used to the medication.
Weight loss surgery
While surgery is the most invasive form of weight management, many of these procedures have been shown to help with weight loss, including:
Gastric banding: An inflatable band is placed around the stomach to create a smaller pouch, reducing how much food you can eat and making you feel fuller faster.
Sleeve gastrectomy: This procedure removes most of your stomach, leaving you with a smaller stomach that requires less food to feel full. It can also affect the gut hormones that play a role in hunger, feeling full, and blood sugar control.
Gastric bypass: This is a complicated surgery that reduces the size of your stomach and rearranges the small intestine to decrease calorie absorption. It can also affect your gut hormones.
Weight loss surgery can be an effective option for managing weight, but it does come with a risk of side effects and potential complications, such as nausea, vomiting, heartburn, abdominal pain, and infections. Some of these procedures can increase your risk for nutrient deficiencies, like vitamin B12, iron, and folate deficiencies.
Will I gain weight back if I stop weight loss medication?
Unfortunately, even the strongest weight loss pills only work as long as you take them. When you stop them, you will likely gain some weight back.
Think of medications as another tool to manage your weight — just like diet and exercise. If you stop exercising, you are likely to gain weight back. Similarly, stopping the medication can result in weight regain as well.
Do weight loss pills replace diet and exercise?
Weight loss pills should not replace diet and exercise.
Weight loss drugs should be part of a comprehensive treatment plan that includes lifestyle modifications, such as a reduced-calorie diet, regular exercise, and behavioral interventions (think: better sleep, reduced stress). Shifting to an active, healthy lifestyle may also help you minimize weight regain if you stop taking weight loss medications.
People taking weight loss pills along with lifestyle modifications lose, on average, 3% to 14% of their initial weight after one year.
Bottom line
If you’ve struggled to lose weight, weight loss pills or other weight loss medications, along with a healthy diet and exercise routine, might be just the ticket to help you achieve your goals.
In general order of effectiveness, the strongest weight loss prescription pills are Wegovy (semaglutide), Qsymia (phentermine/topiramate), Xenical (orlistat), Lomaira (phentermine), and Contrave (naltrexone/bupropion).
These weight loss pills can help you lose anywhere from 3% to nearly 14% of your body weight.
Weight loss pills are only appropriate for certain people, namely adults with either obesity (BMI >30) or overweight (BMI >27), along with at least one weight-related health condition.
Injectable weight loss medications (e.g. Wegovy, Zepbound) are another, slightly more effective (on average) option for weight loss.
Your healthcare provider will help you determine which option is right for you.
Frequently asked questions (FAQs)
Is the Wegovy pill or injection more effective?
Although the two have not been compared directly, existing research suggests the Wegovy injection can be slightly more effective than the Wegovy pill. Keyword being slightly.
What’s the difference between Ozempic and Wegovy?
Ozempic and Wegovy contain the same active ingredient but in different strengths. They are also approved for different indications.
DISCLAIMER
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Wegovy Important Safety Information: Read more about serious warnings and safety info.
Zepbound Important Safety Information: Read more about serious warnings and safety info.
GLP-1 Important Safety Information: Read more about serious warnings and safety info.
Ozempic Important Safety Information: Read more about serious warnings and safety info.
Mounjaro Important Safety Information: Read more about serious warnings and safety info.
Saxenda Important Safety Information: Read more about serious warnings and safety info.
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