Naltrexone HCI/bupropion HCI for chronic weight management in obese adults: patient selection and perspectives

Abstract

Naltrexone, an opiate antagonist, and bupropion, a noradrenergic/dopaminergic antidepressant, have many effects on the reward systems of the brain. These medications impact eating behavior, presumably via their impact on food reward. However, only bupropion induces weight loss in obese individuals, while naltrexone does not have any appreciable effect. The combination of 32 mg of naltrexone and 360 mg of bupropion in a sustained-release combination pill form has been recently approved for obesity treatment. Studies have shown that the combination of these two medications is more effective in inducing weight loss, when combined with lifestyle intervention and calorie reduction, than each individual medicine alone. The naltrexone–bupropion combination, when combined with lifestyle intervention and modest calorie reduction, seems to be quite effective for 6-month and 1-year outcomes for clinically significant weight loss (over 5% of total body weight). These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. This paper reviews existing weight loss clinical trials with bupropion and the bupropion–naltrexone combination. Additionally, the rationale for the suggested patient selection and clinical strategies for special patient populations are discussed.

Validation of the Spanish Version of the Yale Food Addiction Scale 2.0 (YFAS 2.0) and Clinical Correlates in a Sample of Eating Disorder, Gambling Disorder, and Healthy Control Participants

“…However, more research is required to determine the efficacy of pharmacological and psychological approaches in individuals with food addiction. For example, naltrexone and bupropion have been used for chronic weight management in some obese adults, and, given that these medications are used in the treatment of other substance addictions, it could of interest to know whether patients who report more addictive-like symptoms respond differently ( 85 ). Psychological treatment could also have a positive impact on the cognitive processes involved in improving food addiction symptomatology.…”

Cardiovascular risk and obesity

“…α-MSH mediates the anorectic effect of POMC, whereas β-endorphin is responsible for autoinhibitory feedback, which inactivates the anorectic effect. Bupropion can be used to stimulate the POMC neurons, whereas naltrexone can be used to block the autoinhibitory feedback that is associated with a decline in weight reduction [57, 60, 71].…”

“…The recommended total daily dose is 32 mg naltrexone and 360 mg bupropion that should be initiated with one tablet of 8 mg naltrexone/90 mg bupropion a day, increased over 3 weeks to the maintenance dose of two tablets of 8 mg/90 mg twice a day. The 32 mg of naltrexone is the optimum dose [57, 60, 71, 72]. In the beginning of the treatment nausea is frequently reported, and seizures, elevated blood pressure or myocardial infarction are other side effects that have been observed [60].…”

A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome

“…It has recently been approved by the United States (US) Food and Drug Administration (FDA) for the management of alcohol and drug addiction. 128 Bupropion is an anti-depressant that is approved for the management of depression, seasonal affective disorder and to help with smoking cessation that acts by blocking dopamine reuptake. In clinical studies its main side effect was weight loss.…”