Obesity and metabolic syndrome (MS) are risk factors for diabetes, cancer, some 
cardiovascular and musculoskeletal diseases. Pharmacotherapy should be used when 
the body mass index (BMI) exceeds 30 kg/m² or 27 kg/m² with comorbidity. 
Efficacy and safety of pharmacotherapy depend on the mechanism of action of 
drugs. In this context, drugs affecting the central and peripheral mediator 
systems such as cannabinoid receptor antagonists (Rimonabant), neuronal reuptake 
inhibitor of NE and 5 HT (Sibutramine), neuronal reuptake inhibitor of NE 5-HT 
DA (Tesofensine), agonist of 5 HT 2C receptors (Lorcaserin) have a high risk of 
side effects on the central nervous and cardiovascular systems when used for a 
long period. Apparently, the drugs design targeting obesity should screen safer 
drugs that affect fat absorption (Orlistat), activate energy metabolism 
(Adipokines), inhibit MetAP2 (Beloranib) and other peripheral metabolic 
processes. The use of synergies of anti-obesity drugs with different mechanisms 
of action is an effective approach for developing new combined pharmaceutical 
compositions (Contrave®, EmpaticTM, Qsymia et al). The purpose of this article 
is to review the currently available anti-obesity drugs and some new promising 
trends in development of anti-obesity therapy.