Are you struggling to achieve your weight loss goals despite your best efforts?
At Pure Medicine, we understand that weight management can be challenging, and we're here to offer comprehensive solutions tailored to your unique needs.
Dr. Pastorek has decades of experience guiding patients through their weight loss journeys. He is excited to introduce you to a range of medical weight loss strategies, which will make a significant difference in your path to a healthier you.
When traditional approaches to weight loss, such as diet and exercise, aren't yielding the desired results, medical weight loss medications can provide a valuable adjunct to your efforts. These medications are designed to support your weight loss journey by targeting specific mechanisms in your body to help regulate your appetite.
Many of our patients use weekly B12 lipotropic injections to help with energy levels and weight loss.
These injections are not required as part of a medical weight loss plan, but they are available for purchase at Pure Medicine and can be given once a week by our staff.
$35 per injection
Phentermine is an appetite suppressant that works by affecting the central nervous system, reducing hunger, and promoting feelings of fullness. It is normally taken once a day, alone or sometimes with other weight loss medication(s). This medication is not for everyone. Those with cardiac arrhythmias (fast/irregular heartbeats), uncontrolled high blood pressure, substance abuse disorders, severe anxiety, and those who are at high risk for stroke or heart attack, may not be candidates for phentermine.
Phentermine is FDA approved for short term weight management (typically 3-6 months at a time, followed by a 3–6-month break). It is classified by the DEA as a schedule IV-controlled medication, meaning there is a low to moderate potential for abuse. In other words, after about 6 months of use, the medication can be habit forming, which is why it is only prescribed for 3-6 months at a time, followed by a break. Patients also notice that after a few months of taking phentermine, they build up a tolerance to the medication, so while it works great to suppress your appetite in the first 2-3 months, it becomes less effective after that.
Typical side effects from phentermine (more noticeable the first few days of use) include dry mouth, constipation (also a result of eating less on the weight loss diet), palpitations/tachycardia, elevated blood pressure, insomnia, moodiness, and dehydration. Most patients notice the dry mouth, and a significant percentage of patients need melatonin or other medication to help with their insomnia. Constipation is usually addressed by use of magnesium supplementation (titrated as needed) and stool softeners.
At Pure Medicine, Dr. Pastorek requires monthly visits while on phentermine due to the controlled nature of the prescription, so he can monitor your weight loss, vital signs, and help mitigate any ongoing side effects. Many patients opt for telemedicine visits for their monthly check-ins (requires the ability to check blood pressure/pulse/weight at home to submit for the appointment).
Depending on risk factors, some patients may require cardiac clearance (EKG, calcium scoring, stress testing, and/or blood pressure logging, and some may possibly need an official clearance by a cardiologist).
For those who are not a candidate for phentermine, there are other medical weight loss options available (see below).
While on phentermine, Dr. Pastorek recommends an 800-1000 Calorie/day diet for most patients (difficult to follow without the help of the medication, but doable while on the medication), daily weights, food logging (MyFitnessPal is a popular food logging app), and a 20-minute walk on days you don’t exercise. Moderate intensity exercise is encouraged, and Dr. Pastorek recommends building good exercise habits, since increasing time/intensity of exercise is important to keep the weight from coming back once the weight loss medication is discontinued.
Like phentermine, phendimetrazine also acts as an appetite suppressant. It stimulates the central nervous system to help you consume fewer calories.
Phendimetrazine is a shorter-acting medication, so unlike phentermine, which is given once daily, phendimetrazine is prescribed to be taken three times daily.
Phendimetrazine is classified by the DEA as a schedule III-controlled medication, meaning there is moderate potential for abuse.
Typically, Dr. Pastorek will sometimes switch patients from phentermine to phendimetrazine after a few months of phentermine therapy if there is a plateau due to building a tolerance to phentermine. The benefit of phendimetrazine is that it is essentially taken before each meal and has a significant appetite-suppressant effect an hour or so after being taken. The downside is that many people have a difficult time remembering to take the midday and/or evening doses, and when doses are missed, appetites return with a vengeance.
Still, phendimetrazine can be a good weight loss medication when fighting for that last few pounds of weight loss towards the end of the diet, when phentermine’s effectiveness wanes.
Side effects / restrictions of phendimetrazine are almost identical to the side effects of phentermine (see above).
Semaglutide is an injectable medication taken once a week that mimics a hormone in the body to regulate blood sugar and decrease appetite. It has gained so much recognition for its potential to promote significant weight loss, that supply-chain issues have developed a few times in the last year.
Wegovy and Ozempic are virtually the same medication (semaglutide), made by the same pharmaceutical company (Novo Nordisk A/S).
The 2 differences between Wegovy and Ozempic include:
1. Wegovy is FDA approved for weight loss, while Ozempic is FDA approved for Type 2 Diabetes Mellitus.
2. Dosing: The typical starting dose for Wegovy and Ozempic is 0.25mg per week for the first month. In the 2nd month, the dose is increased to 0.5mg per week, and in the 3rd month, the dose is increased to 1mg per week.
For the 4th month, Wegovy dosing increases to 1.7mg, and for the 5th month and beyond, the maintenance dose for Wegovy is 2.4mg
For Ozempic, the dosing in the 4th month increases to 2mg, which is also the maintenance dose.
Basically, dosing is titrated up to a maintenance dose of 2.4mg per month for Wegovy but only 2mg for Ozempic (not a huge difference).
Semaglutide (Wegovy/Ozempic), unlike phentermine/phendimetrazine, is FDA approved for long-term use and is not considered a controlled substance by the DEA.
Studies have shown that most people taking semaglutide for weight loss can expect to lose about 15% of their body weight over a 60-week period (just over a year).
Because semaglutide is not a controlled substance, monthly visits with Dr. Pastorek are not required, and he typically will see patients on semaglutide for a follow-up visit around 3-6 months after initiating therapy for a weight check and to discuss any side effects or diet challenges.
The most common side effect patients experience on semaglutide (Wegovy/Ozempic) is nausea. Patients usually have mild to moderate nausea 1-2 days after the first injection, and the nausea is usually not as bad after the 2nd, 3rd, and 4th injections. As the dose is titrated up, it’s not uncommon for the nausea to worsen, but most patients notice that the nausea isn’t much of an issue once they are stable on the maintenance dose.
There are a handful of patients who cannot tolerate the semaglutide due to severe nausea, but most people notice mild to moderate symptoms that improve over time.
“Gastroparesis” is a buzzword that has come up recently in the news when discussing this relatively new weight loss medication. While gastroparesis literally means “stomach paralysis,” an actual medical definition of the term is:
A disorder characterized by delayed movement of food from the stomach into the small intestine because of impaired stomach motility, resulting in nausea, vomiting, and a feeling of fullness.
The stomach and intestines are constantly moving. Peristalsis is the involuntary constriction and relaxation of the muscles of the stomach and intestines, and the goal of peristalsis is to keep food moving the correct way (down, not up) while your body digests it.
In certain conditions, like diabetes for example, the nerves in the digestive system that allow for normal peristalsis, become damaged over time, and the result is gastroparesis. Gastroparesis is common in people who have been diabetics for years, and it’s managed by eating smaller portions of food to allow for the stomach to have extra time to empty (eating a big meal when dealing with gastroparesis usually results in nausea/vomiting). There are also some medications that can be used to treat gastroparesis.
Semaglutide (Wegovy/Ozempic) has been shown to cause gastroparesis, however the gastroparesis caused by semaglutide is mild for most people and usually, mostly if not completely, resolves by the 4th month of treatment. For those few patients who have severe nausea/vomiting, they typically stop treatment after a few doses, and their gastroparesis resolves within a few days / weeks.
Other side effects of semaglutide (Wegovy/Ozempic) reported by some patients include abdominal pain, constipation, and diarrhea. These side effects are usually mild and don’t typically result in discontinuation of treatment.
The biggest issue with Wegovy and Ozempic is the pricing, with supply-chain issues being a close second. In Dr. Pastorek’s experience, insurance covers the cost of the medication for about 1/3 of his patients. If not covered, the cash price can exceed $1500 per month!
As an alternative, compounding pharmacies can offer a significantly less-expensive alternative by combining semaglutide with some sort of vitamin B compound. It is thought that the vitamin B helps mitigate the nausea/gastroparesis symptoms, but by compounding the semaglutide with a vitamin, the compounding pharmacies are able to sell the semaglutide ‘off patent.’ Compounded medications aren’t normally covered by insurance, but the cash price of the starting dose of semaglutide runs around $100 per month up to approximately $250 per month once on the maintenance dose (2.4 or 2.5mg depending on the compounding pharmacy).
Dr. Pastorek typically recommends patients stick to a 1000-1400 Calorie diet while on semaglutide (Wegovy/Ozempic). He also recommends checking your weight daily, logging your food (MyFitnessPal is a popular food-logging app), and walking 20 minutes daily on days you don’t exercise. Semaglutide (Wegovy/Ozempic) can be continued until you feel comfortable stopping or weaning down the dose, and if you start gaining weight after stopping the medication, it can be easily resumed, which makes it a much more versatile option than medications like phentermine.
Contraindications to semaglutide (Wegovy/Ozempic):
Mounjaro is only FDA approved for Type 2 Diabetes, however Zepbound (also tirzepatide) is a new medication that is FDA approved for weight loss.
Unlike semaglutide (Wegovy/Ozempic), Mounjaro/Zepbound (tirzepetide) mimics 2 hormones in the body (not 1) to regulate blood sugar and decrease appetite.
According to the weight loss studies, Mounjaro/Zepbound (tirzepatide) results in slightly more weight loss over about a 1-year period compared to semaglutide (Wegovy/Ozempic).
Most insurance companies will only pay for Mounjaro for diabetics, and likely due to the cost of this medication, many insurance companies won’t approve Mounjaro for diabetics unless they have tried and failed cheaper alternatives. Zepbound is indicated for weight loss, however not all insurance companies cover Zepbound.
Side effects for Mounjaro/Zepbound (tirzepatide) are similar to semaglutide (Wegovy/Ozempic), and the diet plan for tirzepatide is similar to the one for semaglutide
Tirzepatide is sold by some compounding pharmacies, though currently, it is a bit more difficult to find than semaglutide, and the cost is closer to $500 per month (almost twice as expensive as compounded semaglutide).
Contraindications to tirzepatide:
Qsymia is a combination medication that contains phentermine and topiramate.
While phentermine suppresses appetite, topiramate helps with reducing food cravings.
Qsymia is often used when patients have a difficult time tolerating the side-effects of phentermine (rapid heart rate/palpitations, insomnia, high blood pressure), as it allows for a lower dose of phentermine (7.5 to 15mg vs 37.5mg).
The topiramate helps augment the lower dose of phentermine to achieve weight loss results like full-dose phentermine but with a much lower side effect profile.
Because Qsymia contains phentermine, it also is classified by the DEA as a schedule IV-controlled medication, meaning there is a low to moderate potential for abuse. While on Qsymia, Dr. Pastorek requires monthly visits (in office or telemedicine) to appropriately monitor vital signs, efficacy, and side effects.
Qsymia can be used slightly longer than phentermine, since the phentermine dose is lower, but it is not a medication that is normally taken indefinitely.
Side effects are like phentermine (see phentermine), though due to the lower dose of phentermine in Qsymia, side effects are much milder.
Cost can be an issue (around $500/month), though the manufacturer does offer prescription assistance, and insurance coverage is often helpful.
Also, dosing can be approximated for the generics, phentermine and topiramate, bringing the cost down under $100/month.
This medication was initially developed as an anti-seizure drug and is also used to treat migraines. It has also been found to aid in weight loss, specifically when combined with other medications like phentermine, by reducing appetite and increasing feelings of fullness (See Qsymia).
Contrave combines bupropion and naltrexone to target the brain's reward system and control cravings. It can be particularly effective for emotional or binge eating.
This medication can be used long term for weight loss and typically results in gradual weight loss over time.
Bupropion is a commonly used antidepressant and is also used under the trade name Zyban to help people quit smoking.
Naltrexone is used to block opiates, so for anyone chronically taking opiates, Contrave is contraindicated, as it will block the effects of opioid pain medication, making them ineffective. By blocking opiate receptors, naltrexone helps dampen dopamine surges from stress eating (you basically won’t get the ’sugar high’ while taking Contrave because of the effects of naltrexone).
Patients with chronic pain, who take opioids, should not take Contrave, as the naltrexone will block the effects of narcotic medicines.
If you develop worsening depression or suicidal thoughts while on Contrave, you should stop the medication and call your doctor.
While every patient is different, and Dr. Pastorek tailors weight loss plans according to each individual patient’s needs, this is what most patients can expect at Pure Medicine.
Dr. Pastorek will get a thorough medical history, which will include ascertaining risks of heart disease/stroke/hypertension as well as talking through weight loss goals.
Basic labs will be ordered, and some patients will need an EKG and/or calcium score and/or blood pressure log before starting phentermine.
Most patients start on phentermine, while waiting for insurance approval/denial of Wegovy (or Ozempic for those with a diabetes diagnosis). If approved (and assuming there is no delay due to supply chain issues), the Wegovy/Ozempic is started, and the phentermine is eventually weaned off.
For those who cannot get insurance approval for Wegovy/Ozempic, Dr. Pastorek recommends compounded semaglutide, and phentermine is weaned off as compounded semaglutide dosing is titrated up.
While on phentermine, patients are seen monthly in office or via telemedicine visit to discuss progress, side-effects, and to monitor vital signs.
At Pure Medicine, Dr. Pastorek provides personalized care that considers your medical history, lifestyle, and weight loss goals. He understands that every patient is unique, and our team is here to help you navigate the world of medical weight loss. We will work closely with you to determine the most suitable medication, monitor your progress, and make any necessary adjustments to your treatment plan.
Embark on your journey to a healthier weight with the guidance and expertise of Pure Medicine. Contact us today to schedule your consultation and take the first step towards a healthier, happier you.
Your well-being is our priority, and we're committed to supporting you every step of the way.
4645 Avon Lane, Suite 200
Frisco, TX 75033
Phone: (469) 414-9660