Drugs for Weight Reduction
For those patients who may not lose weight on metformin or cannot tolerate it, there are other, albeit not equally good, alternatives. One option for the overweight patient with PCOS is to use medications designed to reduce weight. There are currently two classes of medications - the first, Orlistat, interferes with dietary fat absorption through the bowel, and the second works in the brain to reduce appetite. The latter is a relative of the seratonin receptor reuptake anti-depressants like Prozac, and its efficacy in real life has not lived up to its promise. The manufacturers of Orlistat advocate not combining it with metformin, for fear of exacerbating the bowel side effects.
Other weight-reducing medications are in the pipeline. A cannabis-like drug (Rimonabant) which is in clinical trials appears to be quite effective and its release for general use would be a welcome treat for insulin resistance.