8 Best Phentermine Alternatives & Competitors (2026)

Mounjaro (tirzepatide) is Eli Lilly’s dual GIP/GLP-1 agonist that delivers greater weight reduction than semaglutide in head-to-head data. It acts centrally on appetite pathways rather than mitochondrial heat production. Equator’s preclinical mechanism could complement or differ from incretin drugs by targeting energy expenditure directly, though Mounjaro is already marketed while Equator remains pre-clinical.

Alli/Xenical (orlistat) is an OTC or prescription lipase inhibitor that reduces dietary fat absorption. It offers modest weight loss with GI tolerability issues and no impact on mitochondrial function. Equator’s thermogenic strategy aims for active calorie burning rather than passive malabsorption, representing a mechanistically distinct alternative for patients seeking sustained results.

Qsymia combines phentermine and topiramate for appetite suppression and satiety. It is an oral generic-option drug with cardiovascular monitoring requirements. Equator’s mitochondrial program targets energy expenditure biology instead of CNS appetite circuits, potentially avoiding stimulant-related side effects while addressing a different physiological lever.

Contrave pairs naltrexone and bupropion to modulate reward pathways and reduce cravings. Like other approved oral agents, it does not stimulate thermogenesis. Equator’s first-in-class mitochondrial activator could appeal to patients who have not responded to or tolerated existing CNS-acting weight-loss medications.

Metformin is the widely used first-line type 2 diabetes drug that modestly affects weight via hepatic glucose production. It has some mitochondrial effects but is not developed as a thermogenic agent. Equator’s targeted uncoupler program aims for more potent, selective activation of heat production than metformin’s indirect actions.

Rybelsus is the oral semaglutide tablet version of the GLP-1 class. It offers convenience over injectables but still relies on appetite suppression. Equator’s mitochondrial platform represents a non-incretin route that could be combined or used when GLP-1 efficacy plateaus or tolerability is poor.

Farxiga (dapagliflozin) is an SGLT2 inhibitor that promotes glucose excretion and modest weight loss. Its mechanism is renal rather than mitochondrial thermogenesis. Equator’s drug candidate targets a distinct calorie-burning pathway that may provide additive benefits in metabolic syndrome patients already on SGLT2 therapy.