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Tesofensine (NS2330) — triple monoamine reuptake inhibitor
An INVESTIGATIONAL triple monoamine (noradrenaline / dopamine / serotonin) reuptake inhibitor developed for obesity. Originally trialled for Parkinson's and Alzheimer's disease, it failed there but produced unexpectedly large weight loss — and its phase-2 TIPO-1 trial (Astrup, Lancet 2008) delivered roughly twice the weight loss of the drugs approved at the time (~9-11% at 0.5-1.0 mg). Honest appraisal: it is NOT approved in any major market, the headline efficacy rests mainly on phase-2 data, the pivotal TIPO-1 paper carries a journal Expression of Concern, and the centrally-acting monoaminergic mechanism brings a real cardiovascular (heart-rate) and psychiatric (mood/anxiety, insomnia) trade-off. NOT a dietary supplement and NOT a longevity drug.
Prescription medication — not a dietary supplement
Tesofensine is a prescription (or investigational) drug, not a supplement. It is included here for reference because people research and discuss it (often used off-label) — not as a recommendation. Take it only under a qualified clinician's supervision and only as prescribed; do not source it from grey-market vendors, where identity, purity, and dosing are unverified. The evidence below reflects its clinical trials.
What the evidence says
Tesofensine doesn't have enough studies with structured effect-size data yet to pool a verdict. Browse the studies below for individual findings.
Most evidence is from high-quality meta-analyses and randomised trials published 2004–2024.
Based on 16 studies · 1 meta-analysis · 12 RCTs
Confidence
Moderate confidenceBy outcome
Phase-2 RCTs (TIPO-1) and a pooled meta-analysis show large, dose-dependent weight loss — roughly twice the approved drugs of its era — but tesofensine is investigational and unapproved, the flagship Lancet trial carries an Expression of Concern, there are no phase-3 outcome data, and the monoaminergic mechanism brings a real heart-rate and psychiatric trade-off, so it stays Emerging.
No trials currently enrolling · 11 completed on ClinicalTrials.gov
5 of the completed trials have posted results
Registered trials show research momentum for Tesofensine, not proof of effect — a registration is a plan, and posted results are sponsor-reported, not peer-reviewed. They are never counted toward the evidence rating above.
Browse these trials on ClinicalTrials.govClinicalTrials.gov · as of Nov 2026
Tesofensine (development code NS2330) is a centrally-acting triple monoamine reuptake inhibitor — it blocks the presynaptic reuptake of noradrenaline, dopamine, AND serotonin, enhancing the neurotransmission of all three monoamines in the brain.
It was originally developed by NeuroSearch as a treatment for Parkinson's and Alzheimer's disease; it failed to deliver in those neurological indications, but the trials surfaced a striking, dose-dependent side effect — weight loss — which redirected its development toward obesity.
Mechanistically the weight loss is driven centrally: tesofensine strengthens satiety and reduces appetite (the dominant mechanism in humans), with a smaller contribution from increased night-time energy expenditure and fat oxidation.
Newer preclinical work locates part of the action in lateral-hypothalamic GABAergic neurons, where tesofensine silences a feeding-promoting neuronal subset and blocks the weight rebound that usually follows weight loss.
The headline human evidence is the phase-2 TIPO-1 trial (Astrup et al., Lancet 2008; n=203): over 24 weeks on an energy-restricted diet, tesofensine produced mean total weight loss of ~4.5% (0.25 mg), ~9.2% (0.5 mg) and ~10.6% (1.0 mg) versus ~2% on diet plus placebo (i.e. roughly 2.5–8.6% placebo-subtracted) — about twice the weight loss of the obesity drugs approved at the time, which is why the compound drew so much attention.
A pooled meta-analysis of the earlier Parkinson's/Alzheimer's trials (Astrup et al., Obesity 2008) independently confirmed dose-dependent weight loss even without any diet program, and a mechanistic respiration-chamber RCT (Sjödin et al., Int J Obes 2010) showed the effect is driven mainly by enhanced satiety.
More recently, a combination of tesofensine with the beta-blocker metoprolol (Tesomet, intended to blunt the heart-rate rise) showed significant weight loss in a small phase-2 RCT in hypothalamic obesity (Huynh et al., Eur J Endocrinol 2022). The honest counterweight is substantial.
(1) Tesofensine is INVESTIGATIONAL — it is not approved as an anti-obesity medicine in the US, EU, or other major markets, and the pivotal efficacy data are phase-2, not phase-3 outcome data.
(2) The pivotal TIPO-1 Lancet paper carries a 2013 journal Expression of Concern, so even the flagship efficacy result should be read with caution.
(3) The mechanism carries a real cardiovascular trade-off: a monoaminergic (noradrenergic/dopaminergic) stimulant-like profile raised heart rate by ~6-7 bpm at the higher doses across the trials, echoing the class of centrally-acting appetite suppressants (sibutramine, fenfluramine, rimonabant) that were ultimately withdrawn for cardiovascular or psychiatric harm.
(4) Psychiatric and CNS effects — insomnia, mood changes, anxiety (a Tesomet-related serious adverse event was exacerbated pre-existing anxiety), dry mouth, nausea, constipation — are recognised, dose-dependent, and a reason that 'behavioural specificity and psychological side effects remain an issue.' It must never be sourced from grey-market / research-chemical vendors: it is an unapproved investigational drug, and off-trial product carries serious identity, dosing, and purity risks.
This is NOT a longevity drug and there are no lifespan or healthspan data.
Blocks presynaptic reuptake of noradrenaline, dopamine and serotonin simultaneously, enhancing neurotransmission of all three monoamines — the single upstream target that drives every downstream effect (and the cardiovascular/psychiatric trade-offs).
The dominant weight-loss mechanism in humans: tesofensine increases ratings of satiety and fullness and lowers prospective food intake. Preclinically it silences feeding-promoting GABAergic neurons in the lateral hypothalamus.
A smaller contribution: a respiration-chamber RCT showed modestly higher overnight energy expenditure and increased 24-h fat oxidation, complementing the appetite effect.
The same noradrenergic/dopaminergic stimulation that suppresses appetite raises heart rate (~6-7 bpm at higher doses) and can affect mood, anxiety and sleep — the central cardiovascular and psychiatric trade-off of the mechanism.
How Tesofensine works — from molecular targets to health outcomes. Click an edge to see supporting research.This visualization is in beta — pathways are being refined and expanded.
Avoid — the heart-rate rise is a central concern; this mechanism class saw sibutramine and fenfluramine withdrawn for cardiovascular harm.
Avoid — mood, anxiety and sleep effects are recognised; a serious anxiety event occurred in the Tesomet trial.
Contraindicated — weight loss and an investigational CNS drug are not appropriate in pregnancy.
Not appropriate — it is an unapproved investigational drug; off-trial sourcing carries serious identity, dosing, and purity risks.
As a serotonin reuptake inhibitor, combining tesofensine with other serotonergic drugs risks serotonin syndrome. Do not combine.
Additive noradrenergic/dopaminergic stimulation — compounding the heart-rate and blood-pressure effects.
The tachycardic effect may oppose rate-control therapy; Tesomet deliberately co-administered metoprolol to blunt the heart-rate rise.
Tip: Dose-dependent (~6-7 bpm at higher doses); the Tesomet combination added a beta-blocker specifically to blunt it. Cardiovascular monitoring is essential.
Tip: Stimulant-like mechanism; morning dosing helps. Common in the Tesomet trial (50% vs 13% placebo).
Tip: One of the most frequent effects across the trials; usually tolerable.
Tip: Dose-dependent; hydration and dietary adjustment help.
Tip: Psychiatric effects are a recognised concern of the central monoaminergic mechanism; a Tesomet serious adverse event was exacerbated pre-existing anxiety. Avoid in those with a psychiatric history.
Tesofensine has an evidence score of 4/10 — emerging evidence based on 16 indexed studies, including 1 meta-analysis. An INVESTIGATIONAL triple monoamine (noradrenaline / dopamine / serotonin) reuptake inhibitor developed for obesity. Originally trialled for Parkinson's and Alzheimer's disease, it failed there but produced unexpectedly large weight loss — and its phase-2 TIPO-1 trial (Astrup, Lancet 2008) delivered roughly twice the weight loss of the drugs approved at the time (~9-11% at 0.5-1.0 mg). Honest appraisal: it is NOT approved in any major market, the headline efficacy rests mainly on phase-2 data, the pivotal TIPO-1 paper carries a journal Expression of Concern, and the centrally-acting monoaminergic mechanism brings a real cardiovascular (heart-rate) and psychiatric (mood/anxiety, insomnia) trade-off. NOT a dietary supplement and NOT a longevity drug. Representative study: PMID 18356831.
Dosing for Tesofensine: SupStack does not provide a self-directed dosing protocol for Tesofensine. A dose used in a clinical trial does not establish a safe consumer dose. The phase-2 obesity trial (TIPO-1) gave once-daily oral tesofensine at 0.25, 0.5 and 1.0 mg, historical trial exposure rather than a safe dose: that trial is under a 2013 Lancet expression of concern, and its results have not been independently verified. Not for self-administration, only appropriate within a clinical trial. Individual needs vary, so check the right dose for you with a healthcare provider.
The best time to take Tesofensine is in the morning. It can be taken on an empty stomach. A long-half-life once-daily oral compound; morning dosing was used to limit the insomnia that the noradrenergic/dopaminergic mechanism can cause.
Tesofensine should be used with caution — talk to a healthcare provider before taking it. Reported side effects include increased heart rate, mood change / anxiety, insomnia / sleep disturbance. How often they occur is not established for all of them. Use caution if any of these apply to you: Not an approved medicine — only appropriate within a clinical trial; Cardiovascular disease, uncontrolled hypertension, arrhythmia or tachycardia (the heart-rate rise is a class concern); Psychiatric history — anxiety, mood disorders or insomnia (a Tesomet-related serious adverse event was exacerbated pre-existing anxiety).
Caffeine
Probably helpsBlocks adenosine receptors to boost alertness, reaction time, and endurance — an umbrella review of 21 meta-analyses found it ergogenic for endurance, strength and power.
Berberine
Likely helpsActivates AMPK to regulate blood sugar, improve insulin sensitivity, and support lipid metabolism. Its only head-to-head trial with metformin cited here was a 36-person pilot, which does not show it can replace metformin.
Orlistat
Mostly mechanism / observationalA gastrointestinal lipase inhibitor that blocks roughly 30% of dietary fat from being absorbed. It is the only weight-loss drug sold both on prescription (Xenical 120 mg) and over the counter (Alli 60 mg). The evidence base is large and old: across 16 long-term randomised trials it produces about 2.9 kg more weight loss than placebo, and in the 4-year XENDOS trial it cut new type 2 diabetes from 9.0% to 6.2%, though exploratory analysis found the effect was detectable ONLY in the ~21% of participants who already had impaired glucose tolerance. The trade-off is that the unabsorbed fat leaves in the stool — oily spotting, faecal urgency and steatorrhoea — and it measurably impairs fat-soluble vitamin absorption, which is what drives its real drug interactions (warfarin, levothyroxine, ciclosporin). Modest, unglamorous, and hard to stay on.
Bimagrumab
Too few graded studiesAn investigational monoclonal antibody that blocks the activin type II receptor (ActRII) — the receptor through which myostatin and activin restrain muscle — producing a striking body recomposition (fat DOWN, lean muscle UP) but NO proven functional benefit. In a phase 2 trial in adults with type 2 diabetes and obesity, bimagrumab caused a large loss of fat mass and a real gain in lean mass over 48 weeks, which is why it is now being developed as a metabolic / obesity drug. But the muscle-disease story is a cautionary one: its pivotal phase 2b trial in inclusion-body myositis (RESILIENT) added muscle yet FAILED its primary walking endpoint, and a 2025 systematic review concluded it had no effect on disease progression. It is NOT an approved drug, NOT a dietary supplement, and NOT a longevity drug — gaining muscle on a scan is not the same as moving or living better. It is described here to inform, not to recommend.
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Reviewed by Dr. Baher Al Hakim · Last reviewed June 2026 · evidence from 16 studies · how we score · editorial policy
This information is for educational purposes only. It is not a substitute for professional medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication.
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