Beyond Ozempic: Other (Less Expensive) FDA-Approved Weight Loss Medications

When most people say “weight-loss medication,” they usually mean Ozempic, Wegovy, Mounjaro, or Zepbound. These GLP-1 drugs have skyrocketed in popularity…and price.

• Zoom In: These medications can cost up to $1,500 a month out of pocket (and that’s if you can even get them!).

Unfortunately, most physicians aren’t well-informed about the clinical use of these medications. They don’t know who’s a good candidate, who isn’t, and they miss opportunities to help women struggling with post-menopausal weight gain. They may WANT to prescribe one, but they may have no experience managing patients on these drugs, so are understandably reluctant to do so.

Since I’m board-certified in Obesity Medicine, this is a topic I’m passionate about. Here’s the mini-med school on the ‘other’ weight loss medications that are FDA-approved, evidence-based, and won’t obliterate your budget:

1. Phentermine

Phentermine has been around since the 1950s and is one of the most-prescribed weight-loss drugs in the U.S.

• The How: It works on your central nervous system to suppress appetite and help you feel full longer.

Typically, people see 5-10% body weight reduction over 3-6 months.  

Cost: As low as $20–30 per month.  

Cons: It’s a stimulant (similar to amphetamines), so it may raise your blood pressure or heart rate. It’s not an option if you have cardiac disease, hypertension, or anxiety.

It’s also FDA-approved for only 12 weeks, though some obesity specialists use it longer with careful monitoring.  

2. Phentermine + Topiramate (Qsymia)

This combination drug (sold as Qsymia) pairs phentermine with topiramate, a medication used for migraines and seizures. Qsymia can be used long-term and works better than phentermine alone.

• The How: It stimulates satiety, decreases appetite, and increases energy expenditure. Basically, it makes you less hungry and burns slightly more calories.

Studies show 9–10% weight loss over one year. At my former medical practice in New Jersey, this was my go-to weight loss medication for most of my patients who needed pharmacologic support.

Cost: Generic versions run about $80–100 per month.  

Cons: Side effects can include tingling sensations, increased risk of kidney stones, cognitive “fog,” and serious birth-defect risk if taken during pregnancy.

3. Bupropion + Naltrexone (Contrave)

Contrave works on brain pathways tied to reward and craving. It’s particularly helpful for those who struggle with emotional eating. Trials show 4–8% weight loss.

Cost: Up to $800 without insurance. But Contrave offers savings and discount programs that can get your co-pay down to $20-$199 a month.

Cons: Can raise blood pressure, worsen insomnia, and increase seizure risk. And because Bupropion (one of Contrave’s main ingredients) affects dopamine, it’s been associated with suicidal thoughts in young adults.

4. Orlistat (Alli, Xenical)

Orlistat is the only over-the-counter option. You can buy the lower-dose version (Alli) without a prescription, or get the higher-dose version (Xenical) from your doctor. It’s safe for long-term use.

• The How: Orlistat blocks your body from absorbing about 30% of dietary fat. In other words, you lose weight by reducing calorie absorption, not by suppressing appetite.

People lose around 5-10 pounds over six months.

Cost: Around $60 a month.

Cons: If you eat high-fat meals, you might get oily stools, fecal incontinence (unable to control bowel movements), and loss of vitamins A, D, E, and K.

5. Metformin

Metformin is used to treat type 2 diabetes. But recently, it’s become an unsung hero for weight management, especially in women with insulin resistance.

In the Diabetes Prevention Program trial, participants taking metformin lost about 5–6% of body weight and kept it off for over a decade.

• Bonus Benefits: Metformin is being studied as an anti-cancer, pro-longevity tool. It also improves insulin sensitivity and may reduce the risk of diabetes and cardiovascular disease.

Cost: Inexpensive generics range from $4–10 a month.

Cons: Weight loss is modest compared to other options. Some people may experience mild nausea or GI upset.

It’s also not FDA-approved specifically for weight loss. However, ABOM (American Board of Obesity Medicine) experts often use it off-label.  

The Bottom Line

None of these medications (and that includes GLP-1s) replaces the fundamentals of strength training, protein, and sleep. But affordable options beyond the $1,500-a-month injectables do exist.

It can be tricky to find which medication is best for you and your budget. But it’s worth finding out. Almost every negative health outcome that increases with age (heart disease, diabetes, joint problems) is connected to excess body weight.

That’s why I’m a strong believer in being proactive and treating weight gain after menopause with all the tools available in your toolbox.