Phentermine, Contrave® & Other Oral Weight-Loss Medications in Northern Virginia
Proven, affordable non-GLP-1 options prescribed by a bariatric surgeon
GLP-1 medications get the headlines — but they aren’t the right tool for every job. Insurance may not cover them, the cost may not be sustainable, or side effects and medical history may rule them out. Sometimes they can use a little help. The good news: There are several FDA-approved oral medications — phentermine, diethylpropion, Contrave®, and orlistat — that have a decades-long track record, much better affordability than the injectables, and can produce significant weight loss when they’re prescribed thoughtfully and paired with real support. At Virginia Bariatric Center in Herndon, Dr. Matthew Fitzer — a fellowship-trained, board-certified bariatric surgeon — has over two decades of experience prescribing the full range of weight-loss medications, so you get an experienced recommendation based on what fits your body, your health history, and your budget. We serve Herndon, Reston, Fairfax, Loudoun, Arlington, Alexandria, and the greater Washington, D.C. metro area, with telehealth visits available throughout Virginia, Maryland, and beyond.
Why consider a non-GLP-1 medication?
- Cost. All four medications on this page are available as inexpensive generics (or with manufacturer savings programs) — often under $30–$60 per month, versus hundreds for GLP-1s without coverage.
- Coverage. Many insurance plans that exclude semaglutide (Wegovy®) or tirzepatide (Zepbound®) still cover — or make affordable — the older oral options.
- Different mechanisms. Cravings-driven eating, portion-size struggles, and dietary-fat absorption are different problems, and different medications target each one.
Average weight loss with these medications is more modest than with GLP-1s — typically 3–8% of body weight versus 15–21% — and we’re up-front about that fact. For many patients, that’s exactly enough; for others, these medications are a starting point or a maintenance tool within a comprehensive program.
Also keep in mind that every patient responds to every medication differently – sometimes very differently. People’s responsiveness to weight loss medication falls somewhere on a bell curve. Being a low-responder to the injectables doesn’t mean you won’t be a high-responder to an alternative medication. Patients are often pleasantly surprised by their results with the older drugs.
Comparing your options at a glance
*Average results from clinical trials over 6–12 months, alongside diet and lifestyle changes; individual results vary.
| Medication | How it works | Typical results* | Best suited for |
|---|---|---|---|
| Phentermine (Adipex-P®, Lomaira®) | Stimulant-class appetite suppressant | ~5% of body weight | Strong hunger and portion-size struggles; budget-conscious patients |
| Diethylpropion (formerly Tenuate®) | Milder stimulant-class appetite suppressant | ~3–5% of body weight | Patients who need a gentler alternative to phentermine |
| Contrave® (naltrexone / bupropion) | Targets cravings and reward-driven eating in the brain | ~5–6% of body weight | Emotional eating, cravings, “food noise”; patients also managing low mood or quitting smoking |
| Orlistat (Xenical®, Alli® OTC) | Blocks absorption of ~25–30% of dietary fat in the gut | ~3–5% of body weight | Patients who can’t take stimulants or brain-acting medications; works locally in the gut |
Phentermine: the most-prescribed weight-loss medication in America
Phentermine has been FDA-approved since 1959 and remains the most widely prescribed weight-loss medication in the U.S. — because it works, and it’s inexpensive. It reduces appetite by stimulating the release of norepinephrine in the brain, making it easier to eat smaller portions without feeling deprived. It’s taken as a once-daily tablet or capsule, typically in the morning.
Phentermine is a controlled substance (Schedule IV) approved for short-term use, and while many physicians extend treatment off-label with close monitoring, it requires an in-person evaluation, blood-pressure checks, and regular follow-up. Common side effects include dry mouth, insomnia, and elevated heart rate or blood pressure — which is why it isn’t appropriate for patients with heart disease, uncontrolled hypertension, hyperthyroidism, glaucoma, or during pregnancy. This is a medication that rewards careful prescribing — exactly the kind of oversight a surgical weight-loss practice provides.
Diethylpropion: a gentler stimulant alternative
Diethylpropion is phentermine’s lesser-known cousin — an appetite suppressant from the same era and class, generally considered milder in both effect and side effects. For patients who feel jittery, wired, or sleepless on phentermine, diethylpropion (taken as a 75 mg extended-release tablet once daily, or 25 mg before meals) can deliver appetite control they can actually live with. It shares phentermine’s precautions: Schedule IV controlled substance, short-term approval, and unsuitability for patients with cardiovascular disease or uncontrolled blood pressure. Few practices in Northern Virginia offer it — we keep it in the toolkit because matching the medication to the patient beats forcing every patient onto the same drug.
Contrave®: for cravings and emotional eating
Contrave combines two long-established medications — naltrexone and bupropion — that together act on the brain’s hunger and reward pathways. Where phentermine blunts hunger, Contrave is often the better fit when the problem is cravings: eating in response to stress, boredom, or habit rather than physical hunger. In clinical trials, patients lost on average about 5–6% of body weight over a year, with roughly 1 in 3 losing 10% or more.
Contrave is not a controlled substance and is taken as tablets twice daily after a four-week ramp-up. It should not be used with opioid medications, in patients with seizure disorders or eating disorders, or with uncontrolled high blood pressure, and it carries bupropion’s standard boxed warning regarding mood changes — another reason physician follow-up matters. A manufacturer savings program keeps monthly costs reasonable for most patients even without insurance coverage.
Orlistat: weight loss without brain or stimulant effects
Orlistat works completely differently: it stays in your digestive tract and blocks the enzyme that digests fat, so roughly a quarter to a third of the fat you eat passes through unabsorbed. Because it doesn’t enter the bloodstream in meaningful amounts or act on the brain, it’s an option for patients who can’t take stimulants, antidepressant-class medications, or GLP-1s — and it’s the only medication on this page with an over-the-counter version (Alli®, at half the prescription dose).
The trade-off is predictable: eat a high-fat meal and you’ll know it — oily stools and urgency are the main side effects, and they’re also a surprisingly effective teacher of low-fat eating habits. We pair orlistat with dietitian guidance and a daily multivitamin (it can reduce absorption of vitamins A, D, E, and K, taken at a separate time of day).
How we choose the right medication for you
There’s no “best” weight-loss medication — there’s the best one for you. At your evaluation, we look at:
- Your eating pattern — constant hunger points one direction; evening cravings and stress-eating point another
- Your health history — blood pressure, heart health, medications, mental-health history, and prior weight-loss attempts
- Your coverage and budget — we find the most effective option you can actually sustain, whether that’s a $25 generic or a covered GLP-1
- Your goals — a patient seeking 10 pounds of loss and a patient with 100+ pounds to lose need different conversations, and we’re honest about when bariatric surgery or a GLP-1 medication would serve you better
Medications can also be sequenced or combined over time — for example, using an oral medication for maintenance after a GLP-1, or as a bridge while insurance authorization for another therapy is pending. Because Dr. Fitzer prescribes everything on this page and performs weight-loss surgery, you get one plan, not a sales pitch.
Cost and insurance
This is where the older medications shine. Generic phentermine, diethylpropion, and orlistat typically cost less than a streaming subscription each month at Northern Virginia pharmacies — with or without insurance — and Contrave’s savings program keeps it affordable for most patients. No prior-authorization battles, no shortages, no compounding-pharmacy risks. Your visit may also be covered by insurance even when a specific medication isn’t; see our insurance coverage guide or call us at (703) 709-9771 and we’ll help you sort it out before your first appointment.
Oral weight-loss medication FAQs
Is phentermine safe?
For appropriately selected patients under physician supervision, yes — it has been prescribed for over 60 years. It is not safe for patients with heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma, or during pregnancy, which is why we screen carefully, monitor blood pressure, and schedule regular follow-ups rather than simply refilling prescriptions.
How much weight can I lose on phentermine or Contrave?
In clinical studies, average weight loss is about 5% of body weight — roughly 12–15 pounds for a 250-pound patient — with some patients losing considerably more. Results depend heavily on pairing the medication with nutrition changes, which is why our program includes dietitian support rather than medication alone.
Do these medications work as well as Ozempic or Zepbound?
On average, no — GLP-1 medications produce roughly two to four times more weight loss in trials. But the older medications cost a fraction as much, are more often covered by insurance, and are sometimes the better medical fit. For many patients they deliver exactly the result they need; for others they're a starting point, and we can escalate if warranted.
What's the difference between phentermine and diethylpropion?
They work the same way — both are stimulant-class appetite suppressants — but diethylpropion is generally milder, with gentler effects on sleep, jitteriness, and heart rate. Phentermine is usually the first choice; diethylpropion is our go-to alternative when phentermine isn't well tolerated.
Can I just get phentermine from an online weight-loss site?
Be careful. Phentermine is a controlled substance, and legitimate prescribing requires a real medical evaluation, blood-pressure monitoring, and follow-up. A prescriber who has never examined you can't safely rule out the cardiovascular conditions that make stimulants dangerous. Our evaluations are thorough, and telehealth follow-ups keep ongoing care convenient.
Which weight-loss medication is right for me?
It depends on whether your challenge is hunger, cravings, or habits — and on your health history, insurance, and goals. That's a 30-minute conversation, not a quiz. Dr. Fitzer prescribes every FDA-approved weight-loss medication and performs bariatric surgery, so the recommendation you get is the one most likely to work for you.
Next steps: find the medication that fits your life
You don’t need to guess your way through weight-loss medications — and you don’t need a GLP-1 budget to get real results. Request an appointment or call (703) 709-9771 for an evaluation with Dr. Fitzer. Serving Herndon, Reston, Fairfax, Loudoun, Arlington, Alexandria, and the greater Washington, D.C. metro area — telehealth available throughout Virginia.