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Tesofensine

Triple Monoamine Reuptake Inhibitor | Weight Loss

Tesofensine (NS2330) is a triple monoamine reuptake inhibitor that blocks the reuptake of dopamine, norepinephrine, and serotonin. Originally developed for Parkinson's and Alzheimer's disease, it demonstrated significant weight loss effects in early trials, leading to its development as an anti-obesity agent. Phase 2 and 3 clinical trials have shown weight loss of 10-12% over 24 weeks, making it one of the more effective investigational weight loss compounds. It works primarily by suppressing appetite and increasing energy expenditure through central nervous system mechanisms.

Daily dose

0.25-0.5mg

Frequency

Once daily

Cycle length

12-24 weeks

Storage

Room temperature

Key benefits

Potent oral weight loss agent with 9-12% body weight reduction in clinical trials. Triple monoamine reuptake inhibitor offering a different mechanism than GLP-1 agonists. Once-daily dosing with long half-life for stable blood levels.

How it works

Blocks reuptake of dopamine, norepinephrine, and serotonin, increasing their levels in appetite-regulating brain regions. Silences GABAergic feeding neurons in the hypothalamus. May also increase resting energy expenditure through noradrenergic stimulation.

Dosage protocols

Goal

Weight Loss

Dose

0.5mg · Once daily

Route

Oral

Goal

Starting Dose

Dose

0.25mg · Once daily

Route

Oral

Research indications

weight Loss

Significant Weight ReductionPhase 2/3 trials show 9-12% weight loss over 24 weeks, superior to many approved medications
Appetite SuppressionPotent central appetite suppression through triple monoamine mechanism
Metabolic ImprovementsImprovements in triglycerides, insulin, and visceral fat in clinical trials

metabolic

Increased Energy ExpenditureMay boost resting metabolic rate through noradrenergic effects
Lipid ImprovementsReductions in VLDL cholesterol and triglycerides observed

Administration

oral

Interactions

Avoid Combination
SSRIs (Prozac, Zoloft, etc.)High risk of serotonin syndrome due to overlapping serotonergic activity. Both increase serotonin levels which can lead to dangerous accumulation.
Avoid Combination
SNRIs (Effexor, Cymbalta, etc.)Risk of serotonin syndrome and excessive norepinephrine stimulation. Combination may cause severe hypertension and cardiac effects.
Contraindicated
MAOIsAbsolutely contraindicated. Combination can cause life-threatening serotonin syndrome, hypertensive crisis, and death.
Avoid Combination
Stimulants (Adderall, Ritalin)Overlapping dopaminergic and noradrenergic effects may cause severe cardiovascular stress, hypertension, and increased abuse potential.
Avoid Combination
Bupropion (Wellbutrin)Both affect dopamine and norepinephrine reuptake. Combination increases risk of seizures, hypertension, and cardiac effects.
Insufficient Data
Semaglutide/TirzepatideNo clinical data on combination. Different mechanisms (GLP-1 vs monoamine) but combined use is not recommended without medical supervision.
Potentially Beneficial
Beta-Blockers (Metoprolol)Metoprolol may counteract tesofensine-induced heart rate and blood pressure increases while preserving appetite suppression. Studied in preclinical models.
Use Caution
CaffeineMay enhance stimulant-like effects and cardiovascular stress. Consider reducing caffeine intake while using tesofensine.

Safety notes

NOT FDA approved - investigational compound

Contraindicated with MAOIs, SSRIs, SNRIs, and stimulants

May modestly increase heart rate and blood pressure

Not for those with cardiovascular disease or uncontrolled hypertension

Can cause insomnia - morning dosing only

Long half-life (~9 days) means prolonged effects and side effects

Regular cardiovascular monitoring recommended

Research studies

TIPO-1 Phase IIB Trial (2008)

203 participants | 0.25-1.0mg daily | 24 weeks | Up to 10.6% weight loss

Landmark randomized, double-blind, placebo-controlled trial demonstrating dose-dependent weight loss. The 0.5mg dose showed 9.2% weight loss, approximately double that of FDA-approved obesity medications at the time.

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TIPO-4 Extension Trial (48 weeks)

140 participants | 0.5-1.0mg daily | 48 weeks | 13-14kg total weight loss

Open-label extension study showing sustained weight loss over 48 weeks of treatment, with participants maintaining 13-14kg weight reduction.

Viking Phase 3 Trial (2018)

372 participants | 0.25-0.5mg daily | 24 weeks | Significant weight loss

Phase 3 registration trial meeting primary and secondary endpoints. Demonstrated significant reductions in waist circumference, body fat, visceral fat, triglycerides, and insulin levels.

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GABAergic Hypothalamic Mechanism Study (2024)

Animal model | Various doses | Acute/chronic | Neuronal activity

Recent study revealing tesofensine silences GABAergic neurons in the lateral hypothalamus, providing mechanistic insight into its appetite-suppressing effects. Found synergy with 5-HTP for sustained weight loss.

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Appetite Suppression Mechanism Study

Rat model | 2mg/kg | 14 days | Alpha-1 and D1 receptor pathways

Demonstrated that tesofensine induces appetite suppression through indirect stimulation of alpha-1 adrenoceptor and dopamine D1 receptor pathways in diet-induced obese rats.

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