II. Efficacy

  1. Results in 9 pounds weight loss more than Placebo in one year

III. Mechanism: Combination Agent

  1. Bupropion suppresses appetite
  2. Naltrexone decreases food cravings

IV. Dosing

  1. Contrave (90 mg Bupropion with 8 mg Naltrexone)
    1. Start: one tablet orally daily for 1 week
    2. Titrate gradually to 2 tablets twice daily over 4 weeks

V. Contraindications

  1. Seizure Disorder (due to Bupropion)
  2. Concurrent Opioid pain management (due to Naltrexone)
  3. Uncontrolled Hypertension

VI. Drug Interactions

  1. Opioids (due to Naltrexone)

VII. Adverse effects

  1. See Naltrexone and Bupropion
  2. Nausea is most common (up to 30% of patients)
  3. Up to 12% of patients stop due to adverse effects (only 50% of patients completed the first Contrave trial)
  4. Suicidality (FDA black box warning)

VIII. Disadvantages

  1. Expensive: $7 per day (or $210 per month) for an agent that is marginally better than Bupropion alone (see efficacy below)

IX. Efficacy

  1. Contrave (Bupropion and Naltrexone) results in 9 to 10.8 lb (up to 4.9 kg) weight loss more than Placebo in one year
  2. Bupropion alone results in 6 pounds weight loss more than Placebo in one year
  3. Contrast with Qsymia (Phentermine and Topiramate) which results in 20 pounds weight loss more than Placebo at 1 year
  4. Contrast with 250 calorie deficit per day results in 26 pounds weight loss per year

X. References

  1. (2014) Presc Lett 21(11): 62

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Cost: Medications

contrave (on 3/3/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CONTRAVE ER 8-90 MG TABLET $4.99 each