Bupropion is commonly used to treat depression (Wellbutrin) and help with smoking cessation (Zyban). While it might cause mild weight loss alone, it's not primarily a weight loss drug. For more significant weight management, it's often combined with other medications. The most established combination for weight loss is with naltrexone, found in the brand-name medication Contrave.
The Primary Approved Combination: Naltrexone and Bupropion
Contrave, which combines extended-release naltrexone and bupropion, is the only FDA-approved medication that uses these two drugs together for weight management. It is prescribed for adults with a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition like high blood pressure or type 2 diabetes.
How the combination works
Naltrexone and bupropion work together to help with weight loss by affecting areas in the brain that control appetite and reward. Bupropion increases the activity of certain neurons in the brain that signal fullness and increase energy use. Naltrexone, which is typically used for alcohol and opioid dependence, blocks a natural opioid in the body that can interfere with these fullness signals. By blocking this, naltrexone enhances bupropion's effect, leading to better appetite control than either drug alone.
Dosage and administration
Contrave is an extended-release tablet that requires a gradual increase in dosage under medical supervision to help minimize side effects. The specific dosing schedule is determined by a healthcare provider.
Efficacy and outcomes
Studies show that patients using naltrexone/bupropion along with diet and exercise achieve greater weight loss compared to those taking a placebo. Doctors often look for at least a 5% body weight loss after 12 weeks to continue treatment. This weight loss can also improve some health markers related to heart and metabolism.
Other Potential Combinations and Off-Label Uses
Combining bupropion with other medications for weight loss has been explored. An investigational combination with zonisamide, an antiepileptic drug, showed promising results in trials but was not ultimately approved by the FDA for weight loss and its development was discontinued. While not an approved combination product, bupropion and topiramate are sometimes used together off-label for weight management, though the combination of phentermine/topiramate (Qsymia) is more commonly prescribed and approved. Any off-label use requires careful medical supervision due to potential risks and interactions.
Safety Considerations and Contraindications
Using bupropion with other medications needs careful evaluation by a doctor due to potential risks and interactions.
Important warnings
Bupropion can increase the risk of seizures, especially in individuals with a history of seizures, eating disorders, or those stopping alcohol or certain medications. Naltrexone blocks the effects of opioids, making it dangerous to use opioid pain medication while taking this combination. Using opioids during or shortly after treatment can also increase the risk of overdose. The combination can also raise heart rate and blood pressure, so caution is needed in patients with heart conditions. It's important not to take other medications containing bupropion or certain antidepressants called MAOIs with naltrexone/bupropion.
Comparison of Bupropion Combination Therapies
| Feature | Naltrexone/Bupropion (Contrave) | Zonisamide/Bupropion (Empatic) | Bupropion Alone (Off-label for weight loss) |
|---|---|---|---|
| Approval Status | FDA-approved for chronic weight management. | Discontinued; investigational. | Approved for depression/smoking cessation; minimal weight loss effect. |
| Mechanism | Targets hypothalamus (appetite) and mesolimbic system (reward) synergistically. | Involves anticonvulsant and antidepressant action; precise synergy unknown. | Mild effect on dopamine and norepinephrine; not a primary weight loss mechanism. |
| Efficacy | Clinically significant weight loss when combined with lifestyle changes. | Promising results in trials but development halted. | Modest, often temporary weight loss. |
| Common Side Effects | Nausea, constipation, headache, dizziness, dry mouth. | Anxiety, dizziness, insomnia, fatigue. | Insomnia, dry mouth, headache, increased heart rate. |
| Key Contraindications | Seizure disorders, eating disorders, opioid use, MAOIs, uncontrolled hypertension. | Seizure disorders, eating disorders, and interactions related to bupropion. | Seizure disorders, eating disorders, MAOIs. |
Conclusion
The only FDA-approved medication for chronic weight management that combines bupropion with another drug is naltrexone/bupropion, known as Contrave. This medication helps manage weight by affecting brain areas that control appetite and cravings. Other combinations, such as bupropion with zonisamide or topiramate, are not currently approved or have been discontinued for weight loss. Due to risks like seizures and interactions with other medications, including opioids, it is essential to consult a healthcare provider to determine if naltrexone/bupropion is suitable and to ensure safe and effective use.
Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before starting any new supplement regimen or medication.
