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Wednesday, March 16, 2016

Contrave- Diet medication

In June I plan to go back into practice to treat obesity with diet medications.  There was news today about Contrave.

These news articles should start with this news flash: 

 Obesity is chronic disease & must be treated 4 life w medicine

 The four new diet medications   are all indicated for long term treatment
 Two of these drugs are a combination of 2 drugs that has increased their efficacy.
 Contrave has 2 drugs and Qsymia has 2 drugs.

I myself realized I was on 5 diet medications. 

 Components of Contrave are Naltrexone 8mg & Bupropion 90mg 

These drugs have been on the market independently for many years.

Together they reduce food intake by acting on adrenergic and dopaminergic receptors in hypothalamus.

1-Naltrexone is an opioid antagonist. 
 "Concerns for liver toxicity initially arose from a study of non-addicted obese patients receiving 300 mg of naltrexone.[10] Subsequent studies have suggested limited toxicity in other patient populations." Wiki

2-Wellbutrin (Bupropion) is an anti-depressant that was used to help people stop smoking.
The dosing information when treating for depression is:
"A maximum of 450 mg per day, given in divided doses of not more than 150 mg each, may be considered for patients who show no clinical improvement after several weeks of treatment at 300 mg per day. Administer the 100‑mg tablet 4 times daily to not exceed the limit of 150 mg in a single dose."
Wellbutrin link  for bupropion 75mg per tablet

Slowly increase dose: (to prevent nausea)

First week: one tab each AM

Second week: one AM one PM

Third week:  2 AM one PM

Fourth week:  2AM 2 PM

Thus when taking Contrave for weight loss  the maximum dose of :

1-naltrexone is 4 x 8 mg= 32 mg

2-bupropion is 4 x 90 mg = 360 mg.

I am surprised that Contrave exceeds bupropion's advice on maximum single dose of bupropion.

Contrave must have new data?  It is probably because Contrave has an extended release formula of bupropion. 

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