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Contrave

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Contrave, Naltrexone and Bupropion

  • Efficacy
  1. Results in 9 pounds weight loss more than Placebo in one year
  • Mechanism
  • Combination Agent
  1. Bupropion suppresses appetite
  2. Naltrexone decreases food cravings
  • 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
  • Contraindications
  1. Seizure disorder (due to Bupropion)
  2. Concurrent Opioid pain management (due to Naltrexone)
  3. Uncontrolled Hypertension
  • Drug Interactions
  1. Opioids (due to Naltrexone)
  • 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)
  • Disadvantages
  1. Expensive: $7 per day (or $210 per month) for an agent that is marginally better than Bupropion alone (see efficacy below)
  • 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
  • References
  1. (2014) Presc Lett 21(11): 62