The Best Weight-Loss Pills for Women Over 50: Safe, Effective Options (2025)

Injectables like Ozempic may be grabbing headlines right now, but some of the best weight-loss pills are a more accessible and practical option for many women.

“These oral agents have been around for a long time and are approved by the FDA for obesity,” says Caroline Apovian, MD, a professor at Harvard Medical School and leading obesity medicine specialist. “They don’t get the same attention as the injectables, but they’re safe and effective—especially when combined with diet and exercise.” Here’s what to know about the top weight-loss drugs.

What to try if injectables like Ozempic aren’t an option

If injectables such as Ozempic or Wegovy aren’t covered by insurance, doctors may turn to off-label strategies to help you lose weight. That includes prescribing bupropion + naltrexone or phentermine + topiramate separately. But as Dr. Apovian notes, “It’s harder to match the effect exactly.”

Topiramate alone (25 to 50 mg) may help reduce evening cravings. Metformin, often used for type 2 diabetes, is another option. “It’s very safe and inexpensive,” she says, “but the weight loss tends to be modest—around four pounds.” (Learn more about metformin for weight loss here.)

Vyvanse, a stimulant used for binge eating disorder, is sometimes considered. But Dr. Apovian doesn’t recommend it for general weight loss. “It’s highly regulated and can raise blood pressure and heart rate. There are better and safer options.”

The best weight-loss pills for women over 50

When it comes to effective weight-loss pills, Dr. Apovian says these four options come out on top. Each has its own strengths:

Strongest prescription weight-loss pill: Qsymia

Qsymia combines phentermine, a stimulant that reduces appetite, with topiramate, a medication that helps quiet cravings—particularly those late-night urges that sabotage progress. It’s approved by the Food and Drug Administration for long-term use, and it’s been shown to help people lose about 10 percent of their body weight in one- and two-year clinical trials.

“Topiramate has been shown to help phentermine work in reducing cravings, specifically at night,” says Dr. Apovian, who is also Co-Director of the Center for Weight Management and Wellness (CWMW) in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital. She adds that Qsymia remains a highly-effective option for many women and is underused. “It’s still there, and it’s a great drug.”

The medication is taken daily, starting at low doses and gradually increasing. It’s generally well tolerated, with common side effects including dry mouth, tingling and constipation.

Qsymia is typically prescribed for people with a body mass index (BMI) of 30 or more, or a BMI of 27 and up with health problems such as high blood pressure or type 2 diabetes. Some doctors prescribe its ingredients separately to save money, but Dr. Apovian notes that the extended-release formulation in the branded version matters: “It’s harder to match the effect exactly, especially since the timing of the drug release matters.”

Best weight-loss pill for cravings & emotional eating: Contrave

Contrave combines bupropion, an antidepressant that promotes satiety, with naltrexone, a medication used to treat addiction. Together, they act on the brain’s reward system, helping to quiet the cravings that can lead to overeating.

“This combination works synergistically to activate the POMC neuron, which causes satiety,” says Dr. Apovian. In studies, users lost around 6 to 9 percent of their body weight, depending on lifestyle support. (See how one woman lost 97 pounds with Contrave.)

It’s taken twice daily after a slow, four-week ramp-up. Side effects may include nausea, insomnia or headache. The branded version is preferred for its extended-release formula.

Best short-term weight-loss pill: Phentermine

Approved in 1959, phentermine (Adipex) can be prescribed for weight loss, but it’s not for long-term use. “At the higher 37.5 mg dose, it’s only approved for short-term use—typically up to three months,” says Dr. Apovian.

Some women may respond better to lower doses, like Lomaira (8 mg), or half-tablets of Adipex. “That can be a better option for women who are more sensitive to stimulants,” she says.

Still, phentermine isn’t safe for everyone and must be used cautiously. “It can promote atrial fibrillation and other cardiovascular issues,” such as elevations in blood pressure and pulse, as well as insomnia and anxiety. Phentermine cannot be prescribed via telehealth visits alone—an in-person exam is required.

The best over-the-counter weight loss pill: Alli

Alli, the only over-the-counter pill that’s FDA-approved for weight loss, is a lower-dose version of Xenical. Both contain orlistat, which blocks your body from absorbing 25 to 30 percent of the fat you eat.

“This is a very safe medication,” says Dr. Apovian. “The side effects are mostly gastrointestinal, but they aren’t harmful.”

Xenical is 120 mg (prescription), whereas Alli is 60 mg (OTC). Both are taken with fat-containing meals. Weight loss is modest—around 3 to 5 percent—but consistent when combined with a low-fat diet.

What to ask your doctor about weight loss pills

If you’re curious about these medications, speak up. “The best thing people could do is to go to their doctor and say, ‘I want to talk about some of these agents for weight loss,’” says Dr. Apovian. “And if your doctor can’t do this, ask for an obesity medicine specialist.”

She emphasizes that no medication works on its own. “All these medications work only in conjunction with dietary and exercise recommendations,” she explains. “If you don’t exercise, you’re going to lose a lot of muscle. And if you don’t have the tools to know what healthy foods are, you’re probably not going to do it.”

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.