The mechanism by which bupropion promotes weight loss is not entirely clear. Discover the benefits of Bupropion for healthy weight loss. Similarly, both the United States and European Union labelling recommend that the titration of NB dose occur over a 4‐week period following the initiation of treatment 14, 17. The three studies included in this analysis required that the escalation to the final dose of NB occur according to specific 4‐ or 5‐week protocols. Nausea lasting 1–2 weeks can be expected to occur in approximately one in three subjects during the initiation of NB therapy; however, it is almost always mild to moderate in severity and is transient in most subjects. Medications for the treatment of dyslipidemia and hypertension were also allowed in the COR-DM study. Fujioka et al. did not investigate the relationship between weight loss maintenance and initial weight loss with thresholds higher than the 5% threshold. The p-values are the significance level of the Log-Rank test for testing treatment differences in the overall risk of losing weight maintenance. The Kaplan-Meier estimates of weight loss maintenance are shown in Figure 3 (≥5% weight loss maintenance) and Figure 4 (≥10% weight loss maintenance). A 56-week, placebo-controlled trial of liraglutide 3 mg plus lifestyle intervention resulted in a mean weight loss of 8% compared with 2.6% in the placebo group.21 An escalation in dose also results in an increase in cost to the consumer (Table 1); however, if weight loss is acceptable, there is no need to escalate the dose and many patients achieve successful weight loss outcomes on low–mid doses. This article provides an update on pharmacotherapy for the management of overweight and obesity, highlighting the clinical efficacy, mechanism of action and considerations for use of each drug. It is therefore important to consider the cost of the treatment when selecting a drug, a combination of drugs and the doses to be used. In Australia, the two drugs can be prescribed separately.8 Liraglutide or semaglutide could be combined with phentermine and topiramate or the bupropion/ naltrexone combination. Observational and interventional studies written in English investigating the outcomes of obesity management with any of the aforementioned drugs that were published between 2012 and 2022 were included. Overweight individuals are those with a body mass index (BMI) greater than or equal to 25, while obesity is defined as a BMI of 30 or higher . Some individuals have reported weight loss as a side effect of taking bupropion SR 150 mg. Both contain the same active ingredient and have similar effects, including potential weight loss benefits. The mechanism of action behind the therapeutic effects and side effects of SSRIs have been well described. These are consistent with results from past studies Bouwer and Harvey, 1996; Deshmukh and Franco, 2003; Wise et al. 2006; Ranjbar et al. 2013. The average BMI increase was slight and similar on sertraline, citalopram, fluoxetine and duloxetine treatment. Methods of the study Initial Phase 2 studies in obese adults indicated that combined naltrexone and bupropion resulted in greater weight loss than the additive effects of the individual components (12). To examine the effects of naltrexone/bupropion (NB) combination therapy on weight and weight-related risk factors in overweight and obese participants. The 4% weight-loss cutoff to define clinical response was based on data showing that a weight loss of 4% or more prior to 16 weeks of treatment was the best predictor of 5% or more weight loss at 56 weeks,15 which is generally considered to be clinically significant. It is imperative to study the comedication effects of bupropion with individual antidepressants on BMI, as adverse weight changes can be a consequential health hazard. It also said that when supplying medicines used for weight management, the prescriber must independently verify the person’s weight, height and/or body mass index. People following the Weight Watchers weight-loss programme can expect to lose 1-2lb per week. Cheria lost 5st 5lb in 298 weeks, Lori lost 8st and 2lb in 614 weeks, Rachel lost 10lb in 10 weeks, and Franca lost 4st in 69 weeks. “Lasting weight health comes from evidence-based behaviour change. GLP-1 weight-loss medications change your weight. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Tell your healthcare provider if you are or plan to become pregnant. Tell your healthcare provider if you have any of the following. In addition, there could be an additive effect on the central nervous system when bupropion plus naltrexone is taken with alcohol.On the other hand, there is growing recognition that hindbrain signals may exert important effects on leptin signaling in the hypothalamus 36,47,48.The study found that CYP2C19 poor/intermediate metabolizers prescribed citalopram gained significantly more weight (2.6% total body weight gain) compared to normal or rapid/ultra-rapid metabolizers (0.4% and −0.1%, respectively) at six months.Naltrexone is indicated in alcohol and opioid dependence with a usual dose of 50 mg daily .When weight losses of over 10% were analyzed, 26 and 28% were found with the medications against 10 and 14% with the placebo .The majority of treatment studies have reported little weight loss,7 and the weight losses reported in studies of treatments for BED are less than those in obesity without BED.8 Of the medications for BED tested to date and available on the market, only 2 have been found to significantly reduce both binge eating and weight.This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Janux Therapeutics Secures Exclusive License Agreement with Bristol Myers Squibb, Potential Earnings Up to $800 Million The studies have been able to establish the efficacy, but data is lacking regarding long-term side effects. The side effects that resulted in discontinuation of treatment included blurry vision, headaches, insomnia, paresthesia, irritability, dizziness, anxiety, and depression . Lei et al. found phentermine-topiramate effective in the reduction of body weight as well as waist circumference, blood pressure, lipid levels, and plasma glucose levels . Weight-loss drugs can be expensive and aren't always paid for by insurance.This level of weight loss, although modest, is shown to improve medical outcomes if maintained in the long term.A healthcare provider can help you find the treatments and management strategies for your body and health.Packed with fibre and healthy fats, these super seeds promote satiety, making it easier to control your portions and avoid mid-morning hunger pangs.Clinicians should use this review to understand the varied uses of the drug and identify the situations and patient populations in which bupropion can lend its greatest benefit.They’ll use this complete profile to diagnose obesity and any related conditions you might have.Altogether, the use of bupropion in the treatment of ADHD should be limited to situations of first and second-line treatment failure, contraindicated concurrent medication use, or comorbidity.The major mechanism by which bupropion is metabolized to hydroxybupropion is through the CYP2B6 enzyme.15 Other drugs metabolized by this enzyme have the potential to competitively inhibit bupropion metabolism. The EDE comprises four subscales (dietary restraint, eating concern, weight concern, and shape concern) and a total global score. The Bupropion-SR 300 mg/day schedule consisted of Bupropion-SR 150 mg tablets taken once daily for the first 3 days, then taken twice daily for study days 4–56. Participants were instructed to continue eating in their typical pattern for the duration of the 8-week trial. Following the operational definition of smoking used in Healthy People 2010 , participants were classified as smokers if they reported smoking over 100 cigarettes in their lifetime. We stratified by smoking status since it is possible that smoking history/status could moderate treatment outcomes . Baseline characteristics were similar among treatment arms in each of the four studies.Even though it has not been directly compared to phentermine plus topiramate, bupropion plus naltrexone has a different safety profile.Naltrexone will induce opiate withdrawal in the setting of opiate analgesic use, a severe but nonfatal condition that still may require hospitalization.58 Chronic pain patients should be carefully screened for opiate pain medication use, prescribed or otherwise.A personalised approach must be used when selecting the appropriate weight loss drug for the patient.The studies showing increased efficacy of bupropion in preventing hospitalization and medication discontinuation in Taiwanese youth demonstrate that age may play a role the drugs success.Bupropion has shown some promise for treating obesity in two placebo-controlled trials 24, 26.It’s important to have an in-depth consultation with your doctor about whether Wellbutrin might work for you and your weight loss goals.The notice from the BMS suggests those using both oral HRT and GLP-1s switch to a higher dose or stronger form of progestin to preserve the protection the hormone provides against endometrial cancer. Semaglutide is a long-acting GLP-1 receptor agonist that is administered subcutaneously once weekly for the management of diabetes mellitus and has been shown to also induce weight loss . Patients can benefit greatly from the weight loss effects of liraglutide, and its use should be promoted in the appropriate patient population. Many clinicians are now comfortable prescribing liraglutide in overweight diabetic patients, but they seem to be hesitant to use it for obesity without diabetes. Liraglutide is especially beneficial in overweight or obese diabetic patients as it has also been established as an effective therapy for better glycemic control in type 2 diabetics as an adjunct to oral anti-diabetic medications and/or insulin . It’s a hot topic because who wouldn’t want to know if a medication might help them shed those pesky pounds or, on the flip side, add a few? When it comes to Wellbutrin, people often wonder about its impact on weight. If you’re considering starting Wellbutrin or are already on it, keeping a dialogue open with your healthcare provider can help you navigate these changes effectively. But remember, everyone’s body reacts differently, so it’s super important to keep an eye on what works best for you. Wellbutrin, cocaine, and amphetamines are all DRI drugs (dopamine reuptake inhibitors). Wellbutrin has found a significant presence in some city streets where it is known as “poor man’s cocaine” due to its euphoric and stimulating effects which are enhanced when snorted. Each client has a program aimed toward neurotransmitter rehabilitation, designed specifically for their needs and their health profile. Administering a safe and effective Wellbutrin tapering program must include helping to prevent a person’s symptoms from returning as the medication is being incrementally reduced. Some of these benefits might include more energy, a brighter mood, a better quality of sleep, more vitality overall, and therefore not needing the artificial stimulation of medication. Taking magnesium may cause side effects and other problems. These doses are the highest anyone should add to their diet. This indicates that the mineral may help reduce overall body fat. They're looking at whether magnesium supplements or IV treatments could ease symptoms. When your body doesn't have enough magnesium, stress can hit you harder. Our study reports an adverse weight gain on co-medication of escitalopram and bupropion, which warrants further validation studies. As shown in Tables 4 and 5, a majority of the panel voted that treatments for obesity should receive high or very high priority given the magnitude of the lifetime burden of the condition, and a majority believed that semaglutide’s impact on weight loss provides either a minor or a major positive effect on patients’ broader ability to meet their life goals. RCT evidence demonstrates that semaglutide, liraglutide, phentermine/topiramate, and bupropion/naltrexone all reduce body weight compared with placebo when added to standard lifestyle modification. Treatments promoting weight loss are broadly intended to prevent, treat, or reverse the complications of obesity, including its impact on quality of life.13-15 Observational studies support an association between weight loss and reductions in mortality.16 Given that treating obesity can improve health, screening adults for obesity is recommended by the US Preventive Services Task Force.17 When combined, phentermine/topiramate (7.5/46 mg or 15/92 mg) results in an estimated 8–10 kg bodyweight loss in 12 months; however, only 61% of participants completed treatment and we cannot assume the same efficacy when prescribed as combined, single agents.33 Further clinical trials with larger sample sizes should be done comparing AXS-05 to other first-line treatments of MDD. Also, if bupropion is a potential drug of choice for youth, further research needs to be done on the risk of abuse in this age group. Within the context of MDD, our investigation found that most evidence demonstrates bupropion is superior to placebo and non-inferior to SSRI’s such as escitalopram. Bupropion has also been studied as an agent for overweight and obese individuals due to its appetite suppressant effects. A 2013 meta-analysis observed bupropion demonstrated similar smoking cessation efficacy as nicotine replacement therapy compared to placebo.79 Weight gain is another common manifestation of nicotine withdrawal. Everyone’s body reacts differently to medications like Wellbutrin. It’s not just about the medication itself, but also about you—your lifestyle, body chemistry, and even your mental state! Ultimately, the effects of Wellbutrin on weight can vary from person to person. Life is too short to be discouraged by weight fluctuations. Don’t hesitate to consult your healthcare provider about any concerns you might have—this journey is best undertaken with guidance! From its role in treating depression to the varied experiences people have regarding weight gain or loss, we’ve unraveled quite a few truths. Always remember, your healthcare provider is there to support you and guide you through the process! Your mental wellbeing and physical health matter, and Wellbutrin could be just the right choice for you—with the right management plan. Along with behavior and dietary modifications, this medication decreased body weight by 5% to 15% and sustained weight loss; however, dietary and lifestyle changes should always remain the first-line treatment of obesity. The effects of naltrexone SR/bupropion SR (Contrave) may be beneficial in the long-term treatment of adult obesity, but further investigation of the drug’s safety profile is required before the FDA can grant approval. In bupropion clinical trials, the prevalence of somnolence in subjects taking bupropion was similar to that of placebo subjects and less than that seen with the tricyclic antidepressants and trazodone, which may be partly mediated by the latter drugs' effect on histamine and 5-HT2 receptors.28–31 Moreover, the somnolence rates were higher in SSRI-treated patients relative to bupropion (Figure 3).22,24–26 A slightly longer trial comparing orlistat to placebo when administered concurrently with a calorie-reduced diet found greater weight loss at 24 weeks for orlistat, but no differences in terms of binge eating frequency at post-treatment . That’s not surprising, worldwide obesity rates continue to climb. Weight loss is only of many possible Bupropion side effects. That means we don’t just treat a number on a scale—we treat the full story, with tailored medication plans, therapy, coaching, and lifestyle support. While not a magic bullet, it’s a well-studied option that works on both the body and the brain—and may be especially helpful when emotional eating, depression, or low drive are part of the picture. Together, they work on brain pathways involved in both physical hunger and emotional triggers, targeting the neurobiology of food cravings more effectively than either medication alone. However, given its unique mechanism of action, bupropion cannot be directly compared to other classes of pharmacotherapy (e.g., anticonvulsants, weight loss medications) that have shown some efficacy in reducing binge eating . However, it is unlikely that the brief length of the trial obscured potential effects on binge-eating given that response to antidepressant treatments to BED are generally quite rapid and observed by four weeks . For example, Wilfley et al. reported remission rates (defined as zero OBEs in the last two weeks of treatment) of 44% for sibutramine and 30% for placebo. What are the complications of obesity? I took his word for it and it's now been 5 weeks on this thing, and while it hasn't really improved my mood yet, it has helped in other ways. This is the 9th week on bupropion and I dread trying to get off of it because you can't divide the pills -- it is cold turkey or nothing. Gives energy boost to counteract the tiring effects of duloxetine Been on this combination for 8+years. First of all, as a healthcare professional, I want to say to these negative reviewers that all drugs are not for all people. I don't see any changes due to the medicine for two weeks. The relationship of greater blood pressure reduction with greater weight loss was evident for both treatment groups (Supporting Information Section 5). Mean systolic and diastolic blood pressure tended to remain within approximately 1 mm Hg of baseline values in both placebo- and NB-treated subjects throughout the study; mean blood pressure was slightly lower with placebo (Table 3 mITT-LOCF population and Table 4 safety population). The unweighted sensitivity analysis pooled all NB participants together for change from baseline to week 56 endpoint analyses regardless of re-randomization status. Importantly, using standard-release naltrexone rather than the sustained-release formulation available only in the branded combination medication is not a pharmacokinetic disadvantage.Other side effects were much less frequent, occurring in up to 5% of the cases, and included nasopharyngitis, headache, constipation, and diarrhea.Bupropion is generally considered to be a safe tool for weight loss when it is carefully prescribed by a knowledgeable healthcare provider in an individualized patient care plan.Talk to your doctor about the risks and benefits of taking bupropion.The finding that weight gain does not occur with bupropion helps confirm that this feature of the medication can be factored into risk–benefit decisions and can play a role in the selection of antidepressant medications.Pharmacogenomic treatment approaches to combat antidepressant-induced weight gain involve tailoring antidepressant therapy based on individual genetic profiles to minimize adverse effects such as weight gain.Additional considerations may include the efficacy profile of alternative medications and adverse effects other than weight gain.Approximately 52% of 468 participants completed 6 months of treatment and 48.7% titrated to the maximum dose of 4 tablets daily.As the regional director for clinical nutrition and weight management at a prominent healthcare organization in Southern California, Dr. Hashmi oversees the development and implementation of cutting-edge nutritional programs and weight management strategies. Stall N, Godwin J, Juurlink D. Bupropion abuse and overdose. Wilkes S. The use of bupropion SR in cigarette smoking cessation. Please contact us at Alternative to Meds Center so we can provide you with many more details about the various techniques and protocols that are used to help our clients meet their individual health goals. There is much more to learn about the programs delivered at Alternative to Meds Center and what they entail in terms of treatments and therapies that are available to our clients. Whether NDRI drugs were non-prescribed or prescribed, we strongly recommend seeking guidance to mitigate these risks. For instance, the anecdotal evidence of reduction in weight gain on addition of bupropion to weight inducing antidepressants like SSRIs and selective norepinephrine reuptake inhibitors (SNRIs) has not been elaborated Deshmukh and Franco, 2003; Demyttenaere and Jaspers, 2008. Considering the staggering statistics on antidepressant use, weight gain as an adverse effect of antidepressants can be a threatening public health hazard with serious consequences in chronic metabolic conditions. Six ANCOVA models were built to compare the short term effects on BMI, among monotherapy and co-medication groups. The effects of augmentation therapy involving multiple antidepressants, on weight changes needs to be adequately addressed. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Impact of Antidepressants on Weight Gain: Underlying Mechanisms and Mitigation Strategies Analysis of covariance (ANCOVA) was followed to compare the treatment cohorts as well as test the significance of the covariates. A paired t-test was conducted to test the difference between baseline and treatment BMI values. Problem name or, International Classification of Diseases 9 (ICD9) code or medication history, were used to extract the confounding factors. In order to account for potential confounding factors that may affect the BMI, other clinical and demographics information for each patient other than their baseline BMI values were extracted. Medications that induce CYP2B6, including lopinavir/ritonavir, rifampin, carbamazepine, phenytoin and phenobarbital, may decrease the effect of bupropion. Nausea, headache, dizziness, and vomiting were the most frequent adverse effects leading to discontinuation. The study designs, population characteristics, and results are displayed in table 2. Naltrexone/bupropion may also modulate food cravings through an effect on the dopamine reward pathway, as evidenced by improved responses to the question ‘generally, how difficult has it been to control your eating? As an opioid antagonist, naltrexone suppresses the negative feedback from β-endorphin. Researchers conducted a post hoc analysis of four phase 3 trials assessing extended-release naltrexone/bupropion among adults aged 18 years and older with obesity or overweight with hypertension, dyslipidemia or type 2 diabetes. Extended-release naltrexone/bupropion (Contrave, Currax Pharmaceuticals) was approved by the FDA in 2014 for chronic weight management in people with overweight or obesity. ATLANTA — Naltrexone/bupropion induced weight loss among adults with obesity and mild to moderate depression with no worsening of depression symptoms, according to data presented at ObesityWeek. By understanding bupropion’s mechanisms, potential side effects, contraindications, and optimal dosing, you and your healthcare provider can make informed decisions about your treatment. Additional research is needed to determine the drug’s full clinical potential, particularly in the areas of adolescent depression and combination therapy with varenicline or dextromethorphan. In the case of smoking cessation, bupropion is found to be an effective anti-smoking drug with synergistic benefits when used as a combination therapy. This investigation reviews the pharmacokinetic and pharmacodynamic effects of bupropion and its mechanisms of action and interactions with other drugs. The time for titration to the maintenance dose (which could have been fewer than 4 tablets/day) was longer, at an average of 77.9 (SD 56.5) days or 11.1 (SD 8.1) weeks (Table 4). However, 93% of the participants who completed the study were on the highest dose at the end of the study (Figure 1C). NB32 produced greater improvements in various cardiometabolic risk markers, participant-reported weight-related quality of life, and control of eating. You should check your blood sugar before you start treatment and while you are taking this medicine. This medicine may increase the risk of hypoglycemia (low blood sugar) in patients with diabetes. For these patients a 2.4 mg dose of semaglutide has been approved by the US Food and Drugs Administration (FDA) and is under consideration by the European authorities for the treatment of obesity. There are several drugs for weight loss available in Australia (see Table),6 however not all of them have an approved indication for obesity. Clinicians will assess your history and medical condition and may recommend Wellbutrin in combination with a healthy diet and exercise to support your weight loss outcomes. Weight loss of 5–15% has been shown to improve and/or prevent progression of obesity-related comorbidities, with greater weight loss resulting in more substantial improvements in complications and quality of life.5,6 The risks and benefits of pharmacotherapy for the management of overweight and obesity, including the additional benefits on cardiometabolic disease and its risk factors, should be considered prior to initiation of therapy.Monotherapy of all the SSRI/SNRI drugs showed significant weight increase, consistent with that of previous studies.However, the addition of orlistat is not contraindicated and is a valid option for treating obesity in these conditions.In the ≥10% responder population, the incidence of SAEs was 10.4% in the NB group (ranging from 0% in IGNITE to 20.5% in LIGHT) and 6.4% in the placebo group, with all SAEs occurring in the LIGHT trial.In conclusion, our systematic review suggests that naltrexone/bupropion treatment is effective in the accomplishment of weight loss amongst overweight subjects.It is a combination of two medicines that work in the brain to affect appetite. Study population The aforementioned studies suggest that the benefits outweigh the risks of adverse effects by causing weight loss and reduction of weight-related complications when used in an appropriate patient population. The combination of phentermine-topiramate allows minimal side effects with proven efficacy for weight loss. Grabarczyk performed a study with Veteran Health Administration (VHA) and found that after 20 weeks, phentermine-topiramate led to a 4.1% decrease in weight from baseline vs 3.6% for phentermine alone vs 2.1% for orlistat vs 1.6% in those on MOVE! A sixth drug, lorcaserin, was approved for weight loss but was later withdrawn, after being in clinical use for eight years, due to concerns of increased risk of cancer . PubMed database was searched using the keywords “pharmacotherapy”, “weight loss”, “FDA-approved”, “orlistat”, “phentermine-topiramate”, “naltrexone-bupropion”, “liraglutide”, and “semaglutide”. Anderson et al. reported that both 300mg/d and 400 mg/d bupropion dosing produced significantly greater weight loss than placebo when paired with a calorie deficit of 600 kcal/day. Studies of fluoxetine, fluvoxemine, sertraline, and citalopram have reported weight loss differences of approximately 0–3 kg compared to placebo, depending on the duration of the trial (see for summary and effect sizes across studies). As mentioned above, some clients may see weight loss within as little as 1-2 weeks, while for others it may take up to 8 weeks to see a noticeable reduction in weight. Furthermore, glucagon-like-peptide-1 (GLP-1) receptor agonists, such as liraglutide and exenatide, have been shown to be effective in mitigating weight gain 25,115. In addition to genetic predisposition, BMI is an important predictor of weight gain during antidepressant use. Furthermore, those on Bupropion were found to have a 15% decreased risk of gaining 5% of baseline weight when compared to other SSRIs. The mechanism of this weight gain is thought to be through antagonism of H1 and 5HTC receptors, which can lead to increased food intake . MAOIs are less commonly prescribed due to drug-drug interactions and dietary restrictions. Rates of discontinuation of treatment were similar between all naltrexone SR/bupropion SR groups. Additional endpoints were the proportion of participants with a decrease in body weight of 10% or more, a decrease of 15% or more, change in cardiometabolic risk factors, patient-reported measures of appetite, control of eating and food craving, depressive symptoms, and weight-related quality of life. Headache was reported more often in treatment groups (14% to 24% of participants) than in placebo groups. Pharmacological treatments can be beneficial in regulating food intake and body weight in those individuals. About half of patients who took naltrexone + bupropion experienced gastrointestinal disorders such as nausea, vomiting and constipation. Talk to your healthcare provider about your risks if you are in this age group. People who are 65 and older can be at greater risk for some side effects from Contrave. Do not take Contrave unless it has been prescribed to you by a healthcare provider. Tell your healthcare provider before you take Contrave if you have any of the following symptoms of opioid withdrawal. Before taking Contrave, be sure to tell your healthcare provider about any use of prescription and/or illicit opioids. In this meta-analysis, participants had at least 5% weight loss, with 55% taking naltrexone/bupropion. The study population consisted of adult patients undergoing naltrexone or naltrexone/bupropion treatment. The naltrexone/bupropion treatment was well tolerated by the patients, and side effects were rarely reported. Data were analysed from 33 subjects, 29 women and four men. If weight data were not available within this time frame, weight was used from the closest available office visit. The variability in response suggests obesity is a heterogeneous disease, for which we need a personalized approach accounting for individual differences in aetiological factors such as genetics.3 The safety and efficacy of naltrexone/bupropion in weight management is reviewed in this article. Further studies are necessary to determine the effect of naltrexone/bupropion on cardiovascular outcomes. In the published trials, the average weight loss is 6.8% from baseline and 4.3% placebo-subtracted from baseline. The effect of bupropion plus naltrexone has not been defined in special populations, such as patients with sleep apnea, osteoarthritis, and extreme BMIs (ie, above 40 kg/m2). While obesity is a disease, it doesn’t cause specific symptoms. It can affect your self-esteem and mental health. It’s a chronic (long-term) and complex disease that can affect your overall health and quality of life. Keep this medication in the container it came in, tightly closed, and out of reach of children. Call your doctor if you have any unusual problems while taking this medication. Do not take a double dose to make up for a missed one. Ultimately, understanding these factors can empower you on your weight management journey while on Wellbutrin. It’s quite fascinating how our minds can shape our physical health, don’t you think? Additionally, mental health is a huge factor. If you’re someone who was previously active and have now slowed down, that could lead to weight gain. The mechanism of action for the antiepileptic activity of this medication is not totally clear, but it is believed that it is linked of sodium and calcium channels blockage. Zonisamide has been used as an antiepileptic drug in Japan since 1989, being approved for such use in the United States (USA) and in some European countries in the early 2000s. There was no significantly higher incidence of adverse effects on the cardiovascular system, nor in relation to depressive disorders or suicidal ideation. The most commonly observed side effect was nausea, around 30%, compared to 5 and 6% in the placebo group. Additionally, some studies on rats have demonstrated that the ingestion of palatable foods (e.g., candies) leads to increased β-endorphin levels in the hypothalamus. A series of complementary binary logistic regression analyses tested the effects of bupropion vs. placebo on the categorical outcome of remission from binge eating.The use of ephedrine combined with caffeine and/or acetylsalicylic acid is approved as a combination therapy for the treatment of weight loss in many countries .Another study investigated the cortisol responses to naltrexone (increased on the naltrexone day) and nausea responses to naltrexone (mean level of nausea severity was 1.23 ±1.3) .In fact, a “new” version of this drug called “Contrave” (a combination of bupropion and naltrexone) hit the market in 2014 specifically marketed for weight loss in obese adults.10The most common adverse events with NB were nausea, constipation, and headache; these were generally mild or moderate and did not result in discontinuation in most participants.One of the newest medications is the combination of bupropion and naltrexone .If you have obesity, you may feel like there’s nothing you can do to manage your condition.The primary outcome was Kaplan-Meier-estimated weight loss maintenance in each study for up to 204 weeks. In the clinical trials, a predictable response to the combination product was determined if more than 5% of baseline weight occurred at 12 weeks. Patients were excluded from these trials if they had a diagnosis of diabetes mellitus, significant renal or hepatic impairment, condition-induced obesity, significant comorbidities, unstable weight over the previous 3 months, surgical interventions for obesity, contraindications, or drug-drug interactions with bupropion or naltrexone. Bupropion produced an average 3.4% placebo-subtracted weight loss over 6 to 12 months.15-17 In these trials, patients with a higher BMI at baseline and who were receiving 400 mg per day had a greater likelihood to achieve 5% weight loss from baseline.15-17 Based on this early evidence, it was theorized that bupropion could help with weight loss. Weight loss was significantly greater with NB than with placebo at month 2 but not at other time points. Of the 268 screened individuals, 40 were evaluated in person, and 22 met eligibility and were randomized to treatment. Least-squares means were estimated from all models and compared as necessary to explain significant effects in the models. Despite a short initial serum half-life, the pharmacologic activity of naltrexone is long lived, with an effective half-life of over 3 days, consistent with the terminal phase of plasma clearance.32 One advantage is the use of the extended-release formulation of bupropion, which allows for once-daily dosing. It is worth remembering that the suspension of the commercialization of these combinations was on account of side effects of one of their components and not due to any negative interaction between the drugs. It is worth noting that with regard to the drugs in initial studies, much of the information and clinical outcomes are from the pharmaceutical companies own websites, since they have not been yet submitted to peer-review in medical journals. Therefore, at the same time new drugs are being tested, it seems attractive to use different strategies, such as combination of medications. Antidepressants were the third largest prescription medication, majorly prescribed for depression, and their rate of use increased nearly 400% from 1988–1994 through 2005–2008 Pratt et al. 2011. The increase in BMI in the other five co-medication groups was not significantly different from their respective monotherapy groups. If you are a Mayo Clinic patient, we will only use your protected health information as outlined in our Notice of Privacy Practices. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Tachycardia occurred at a rate of 0.6% with naltrexone/bupropion and 0.2% with placebo. The between-group differences for SBP and DBP were the greatest after 8 weeks of treatment. Greater improvement in blood pressure and pulse were seen with placebo compared to naltrexone/bupropion . Two patients (0.06%) had a seizure while assigned to naltrexone/bupropion therapy. Build habits for weight loss with the #1 US doctor-recommended Points® programme – plus tools that make it easy. Cleveland Clinic providers work together to develop weight management plans that address the challenges you face while finding your healthy weight. If you think you may have obesity, talk to a healthcare provider. The German remains in pursuit of a title fight with Oleksandr Usyk, and with Tyson Fury being removed from the rankings due to inactivity, Kabayal moves one spot to No. 6 in ESPN's heavyweight rankings. Over in the heavyweight division, WBC interim champion Agit Kabayal secured a third-round stoppage of Damian Knyba in Germany. With the win, Smith jumps to the No. 3 slot in the junior welterweight rankings while Matias drops to No. 4. Matias had his moments and rattled off several hard combinations that appeared to hurt Smith. Take bupropion with food if the medication upsets your stomach. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with bupropion and each time you refill your prescription. The risk may be more likely with the first few months of treatment and when the dose is increased. Forest plot of randomized controlled trials investigating the effects of bupropion alone and… The random-effects model analysis was used to provide pooled weighted mean difference and 95% confidence intervals. A fixed-dose combination of these two drugs has received marketing authorisation in the European Union for obese patients and for over-weight patients with other cardiovascular risk factors. Data indicate that bupropion may be effective as a treatment for ADHD and in helping obese patients lose weight, although the use of bupropion in these conditions is not approved by the FDA, and additional studies are needed in both areas. In the long-term relapse prevention study, a greater weight loss was observed in patients with a greater body mass index at baseline.71 The safety databases for bupropion are extensive, comprising thousands of clinical trial subjects and over 40 million patients who have received bupropion clinically (data on file, GlaxoSmithKline, Research Triangle Park, N.C.). The most commonly reported adverse events (occurring more than 5% and more than placebo) during bupropion SR placebo-controlled trials (300-mg and 400-mg daily dosing) include headache, dry mouth, nausea, insomnia, constipation, and dizziness.63 Of these, dry mouth, nausea, and insomnia occurred at a statistically higher incidence with bupropion SR relative to placebo. A number of studies have evaluated bupropion for the treatment of attention-deficit/hyperactivity disorder (ADHD).54–57 Following initial open-label studies, a methylphenidate crossover study and 2 placebo-controlled studies, 1 in children and 1 in adults, were conducted.55–57 Both placebo-controlled studies provide evidence of efficacy for ADHD, while the crossover study indicated that the efficacy of bupropion was similar in magnitude to that of methylphenidate. Is it the medication or perhaps lifestyle changes that accompany its use? Others, however, spring into action and start to notice a gradual weight gain instead. Isn’t it fascinating how our bodies react differently to medications? When it comes to Wellbutrin, experiences with weight changes can be all over the map! From being mindful of your diet to staying active, you have the tools to steer your health in the right direction! At the first clinic appointment, prior to administration of the medication, all participants retrospectively self-reported the frequency of binge episodes occurring over the previous 7 days using EDE definitions.Beyond its proven ability to help with weight loss, growing research is uncovering GLP-1 drugs’ potential to address a range of other health conditions.There is significant association between obesity and depression.The assessments allowed for determination of diagnoses and eligibility, for characterization of baseline functioning and measurement of clinical changes, and for ongoing assessment of safety and compliance with treatment.Wait 2 weeks after stopping naltrexone and bupropion combination before you start taking a MAO inhibitor.Based on the data, bupropion plus naltrexone reduced the risk of major cardiovascular events by 41%, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular mortality.Following a 1-week placebo lead-in, 244 obese or overweight, nondiabetic received placebo subcutaneously (sc) tid, or pramlintide sc, 120 mcg tid, either isolatedly or in association with sibutramine, 10 mg/d, or phentermine, 37.5 mg/d, for 24 weeks.Skip the missed dose and continue your regular dosing schedule. Emerging research on pharmacogenomics and gut microbiota offers potential avenues for personalized treatment approaches. Mitigation strategies include switching to weight-neutral antidepressants, implementing pharmacological interventions such as metformin and GLP-1 receptor agonists, and integrating behavioral and lifestyle modifications. The underlying mechanisms involve complex interactions between serotonergic, dopaminergic, and metabolic pathways, with different antidepressant classes contributing to varying degrees of weight gain. Placebo-controlled trials of individual agents suggest that naltrexone/bupropion has greater weight loss efficacy than orlistat or lorcaserin, but is less effective than phentermine/topiramate. It is being developed as an adjunct to lifestyle modification for weight loss and maintenance in patients who are obese or have a BMI of ≥27 kg/m2 with obesity-related disease (e.g. diabetes, dyslipidemia, or hypertension). Hypertension was reported as an adverse event in 5.3% of patients assigned naltrexone/bupropion and 4.0% of those assigned placebo. Associated Data Around 1.4% of specialist physicians in US still use ephedrine with caffeine for treatment of obesity . In 1977, in Denmark, more than 70,000 patients used the combination of ephedrine with caffeine and even phenobarbital, which was withdrawn from the “formula” after reports of serious skin reactions. Ephedrine is a nonspecific beta-adrenergic agonist which promotes weight loss through increasing thermogenesis. Entrance criteria required that participants meet full DSM-IV-TR research criteria for BED, have a BMI 25–50, and be aged 18–65 years. Bupropion is an antidepressant which has been shown to be an efficacious treatment for smoking cessation 19–22. BED is distinct from the other eating disorders and obesity 3–5, and is more prevalent than the other eating disorders (anorexia and bulimia nervosa) . BED is defined by recurrent binge eating (eating unusually large quantities of food during which a subjective loss of control is experienced), marked distress about the binge eating, and the absence of inappropriate weight compensatory behaviors. When prescribed as combinations of their generic components, phentermine/topiramate appeared cost-saving, whereas bupropion/naltrexone was cost-effective. In the 1 head-to-head trial, semaglutide achieved greater weight loss than liraglutide.26 None of these drugs have assessed long-term outcomes in adults without preexisting diabetes mellitus, and thus there is uncertainty around long-term benefits, such as cardiovascular morbidity and mortality. Semaglutide and liraglutide are glucagon-like peptide-1 (GLP-1) receptor agonists that are also approved for diabetes mellitus and given by subcutaneous injection, whereas phentermine/topiramate and bupropion/naltrexone are combination oral agents that work via other mechanisms. Since most people do not achieve the desired weight loss with lifestyle modification, medications and surgical interventions are often considered. Some users report losing 1–2 pounds per week with a 300 mg Wellbutrin XL dosage for weight loss. Bupropion is a prescription antidepressant medication that can treat depressive symptoms as well as other conditions. All healthcare decisions should be made with your individual healthcare provider. There are many levels of care available, from intensive options like inpatient treatment to flexible outpatient options like intensive outpatient and partial hospitalization.You can also opt for a virtual treatment program like Within Health, which enables a more flexible treatment schedule. Table 2 summarizes BMI and the clinical measures at baseline and post-treatment (Week 8).Other clinical trial data shows that Wellbutrin can promote weight loss in obese patients.Diagnosed at baseline with hypertension or prescribed antihypertensive concomitant medications.ANCOVA, analysis of covariance; BMI, body mass index; SD, standard deviation.The treatment of these illnesses with antidepressants many times results in weight variation, depending on the drug class that is used 15,34,64,65.I don't see any changes due to the medicine for two weeks. Any study with evidence on bupropion or naltrexone monotherapy was not reviewed extensively in this article. Published Phase 3 clinical trials with primary endpoints related to weight loss were included and critiqued in this review. Although Contrave has not been approved for any indication other than chronic weight management, it may have an advantage over weight-loss medications in patients who are overweight and concomitantly suffer from major depressive disorder, seasonal affective disorder, or attention-deficit disorder or who want to quit smoking. The COR trial series provides adequate support for the efficacy of naltrexone/bupropion in chronic weight management, combined with lifestyle modifications. Moreover, in the COR-Diabetes trial, there was a clinically significant improvement in HbA1c and a lower portion of patients required rescue medications for glycemic control.24 In conclusion, our systematic review suggests that naltrexone/bupropion treatment is effective in the accomplishment of weight loss amongst overweight subjects. In one, the patients in the naltrexone/bupropion group had significant weight loss (–3.40 kg) compared with weight gain (+1.37 kg) in the patients in the placebo group . These studies focused on the effect of naltrexone on body weight in patients with anti-psychotic treatment. Regardless, several weeks may be required after the cessation of the naltrexone–bupropion combination before starting an opiate pain medication. Naltrexone has the potential to cause drug-induced hepatic damage and frequently elevates hepatic transaminases, which may or may not be clinically significant.50 Patients with hepatic disease were excluded from the abovementioned studies, and similarly, we do not recommend use of naltrexone–bupropion combination in this patient population. Your Guide to Ozempic and the New Weight-Loss Drugs: Top Experts + Real Women Tell All Opioid use can cause physical dependence, which means your body relies on the medicine. Ask your healthcare provider if you do not know if your blood pressure is under control. If you develop a rash, stop Contrave and call your healthcare provider right away. Tell your healthcare provider right away if you have any of the following symptoms of glaucoma. For all studies included in the analysis, study participants provided written informed consent, and the protocols were approved by an institutional review board. Included subjects were treated with NB 32 mg/360 mg or placebo, with baseline, week 16, and final time point data. It may take 4 weeks or longer before you feel the full benefit of bupropion. Combination treatment with sustained-release naltrexone and bupropion was developed to produce complementary actions in CNS pathways regulating bodyweight. Our study sheds light on the short-term comedication effects of bupropion in combination with six other antidepressants, based on EMR data. Although differences in pharmacological effects of the drug compounds may play a role in differing weight gain patterns Harvey and Bouwer, 2000; Serretti and Mandelli, 2010, it is difficult to explain the selective anomalous effect of the escitalopram and bupropion comedication. It is important to note that, duration, adherence to therapy, dosing of bupropion and other life style factors such as diet and exercise can also impact the degree of weight loss Croft et al. 2002; Jain et al. 2002; Fava et al. 2005; Calandra et al. 2012. Most studies have witnessed a higher weight loss effect on long-term use Harto-Truax et al. 1983; Gardner, 1985; Weisler et al. 1994; Settle et al. 1999; Croft et al. 2002; Jain et al. 2002. The preponderance of evidence suggests that antidepressant medication can have an adverse effect on body weight. Obesity is when you have excessive body fat. Treatments include changing what you eat, adding activity and mental health support. A BMI of 30 or higher is the usual benchmark for obesity in adults. In some cases, side effects may resolve on their own as your body adjusts to the medication. Unlike many SSRIs and SNRIs that are notorious for weight gain, Wellbutrin has the opposite effect and is actually FDA-approved in combination with naltrexone to treat binge eating disorder and to support weight management. Mochi Health is a virtual obesity medicine practice that connects you with medical providers, like licensed physicians and nurse practitioners, to help you optimize your weight loss journey. These GLP-1 medications are very effective for weight loss. Unfortunately, many street users have been harmed by overuse or overdose on stimulants including DRIs, SNRIs, and NDRIs. Those drugs are called SNRIs ( selective norepinephrine reuptake inhibitors ). Other prescription drugs that are stimulants, act by inhibiting the reuptake of norepinephrine (adrenaline). To compare effects, cocaine is a DRI, meaning it enhances the stimulating effects by Inhibiting the reuptake of dopamine. However, topiramate in combination with phentermine was approved for the treatment of obesity by the FDA in 2012.Those who took tirzepatide lost an average of 5.9% of their body weight after three months; 10.1% after six months; and 15.3% after 12 months.Lifestyle modification has long been the cornerstone of weight control 3; however, many individuals are not able to achieve or maintain weight loss with diet and exercise alone.The seizure rate with NB in this trial (0.1%) is consistent with what has been previously described with bupropion (0.1% with doses up to 300 mg) (11).It is inexpensive and generally well tolerated when attention is paid to its side effects and precautions.A 56-week, placebo-controlled trial of liraglutide 3 mg plus lifestyle intervention resulted in a mean weight loss of 8% compared with 2.6% in the placebo group.21I've been taking Bupropion SR for a few months to help with my mood, and while I haven't experienced significant weight loss, I have noticed some positive changes. At the end of 12 weeks, participants followed a down-titration protocol of 7 days of 150 mg of bupropion (active-treatment group) or placebo capsule (placebo group). The present double-blind pilot RCT evaluated the acute effects of NB delivered for 12 weeks and examined the longer-term effects through 6-month follow-up after the discontinuation of medication in patients with BED with obesity. The majority of treatment studies have reported little weight loss,7 and the weight losses reported in studies of treatments for BED are less than those in obesity without BED.8 Of the medications for BED tested to date and available on the market, only 2 have been found to significantly reduce both binge eating and weight. These medications have been shown to reduce body weight anywhere from 10-20%, depending on which GLP-1 agonist is used. Some are FDA-approved to treat obesity (Wegovy®, Saxenda), while others can be used off-label for weight loss (Mounjaro®, Ozempic®, Rybelsus, Victoza, Trulicity). Topiramate is an anti-seizure drug that can also help with weight loss by reducing appetite and increasing feelings of fullness. When you compare Bupropion to Contrave, it appears that bupropion has a more significant weight loss effect that was achieved in a shorter period of time. They gave the participants Contrave for 56 weeks, along with a calorie-restricted diet and regular exercise. Those were 5 weeks of hell. On 300 mg XL for 6 weeks now. Do not change your dose of Contrave without talking to your healthcare provider. These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. Naltrexone, an opiate antagonist, and bupropion, a noradrenergic/dopaminergic antidepressant, have many effects on the reward systems of the brain. Racial disparities in obesity and obesity treatment outcomes have been identified and reviewed extensively.34, 35, 36, 37 Therefore, this racial imbalance in the analyzed population renders the generalizability to other racial/ethnic groups unclear. Another limitation of this study is that the population analyzed consisted predominantly of Caucasians, with a limited representation of Black/African American patients and patients of other or unknown races. The strengths of our analysis are the large number of patients included and the well-defined and diverse methodologies and populations of the component studies. Based on the data, bupropion plus naltrexone reduced the risk of major cardiovascular events by 41%, including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular mortality. The study was halted after analysis of 50% of the preliminary data from the first 25% of patients, which showed no benefit and a possible increase in cardiovascular deaths. There were also positive effects on lipid concentrations, but the clinical relevance of the cardiovascular findings is unclear. Bupropion plus naltrexone should not be used among patients with uncontrolled hypertension. Week 56 data for NB32 are weighted as described in the Statistical analyses section. Greater improvements in IWQOL-Lite total score and subscale scores were maintained through week 56. In most cases, improvements in secondary endpoints were maintained at week 56. Unfortunately, many of the complications brought by obesity lead to death, which might be averted through a change in lifestyle. The World Health Organization (WHO) assessed that excessive weight is the cause of death of almost 3 million people and brings about disability amongst 35.8 million people annually . It is one of the greatest public health threats in Europe and the world . Initial responders to bupropion benefited further in the continuation phase. There was additional single-blind follow-up treatment for a total of 2 years. All subjects were prescribed a 1600 kcal/d balanced diet and compliance was monitored with food diaries. Factors like your lifestyle, diet, and even other medications could all play a role in how Wellbutrin affects your weight! Doctors might share that while some users experience weight loss on Wellbutrin, others might not be so lucky and can even gain a few pounds. Weight fluctuations can happen with many medications, and your unique health profile matters a ton! Unless otherwise specified, efficacy analyses were performed on a prespecified modified intent-to-treat (mITT) analysis population composed of all randomized participants with a baseline weight and ≥1 post-baseline weight on study drug (+1 day post-last dose). Exploratory analyses included percent change in weight from re-randomization and baseline to week 56 for participants re-randomized to NB32 or NB48.Safety assessments included evaluation of treatment-emergent adverse events, vital signs, electrocardiograms, and clinical laboratory measures. Here, we present the results of the Contrave® (proposed commercial name for NB) Obesity Research-II (COR-II) trial, a Phase 3 study conducted to evaluate the efficacy and safety of an SR formulation of NB for up to 56 weeks in overweight and obese participants. The Semaglutide Treatment Effect in People with Obesity (STEP1) trial assigned 1961 patients with obesity (without T2DM) to 68 weeks of treatment with 2.4 mg semaglutide or placebo plus lifestyle intervention. Compared to switching to placebo after 20 weeks, continued treatment with semaglutide can sustain weight loss.7 Numerous clinical trials have reported reduced body weight in patients taking Wellbutrin, indicating it may be an effective treatment for weight loss. In accordance with common practice, patients were not asked to discontinue treatment after 16 weeks due to insufficient weight loss. Stay informed and proactive about your health. ” Don’t shy away from sharing your personal goals too; letting your provider know that you’re focused on maintaining or adjusting your weight can shape the conversation. And if you’ve been feeling concerned about your weight while considering Wellbutrin, this conversation is a must. Your doctor will likely discuss the balance between the benefits and any potential side effects. After all, weight change can be as individual as your personality! Bupropion alone performed worse than placebo for 10% or more TBW loss; thus, NNT was negative (not shown in graph). Naltrexone 48 mg alone performed worse than placebo; thus, NNT was negative (not shown in graph). It increases blood levels of a range of medications through its inhibition of hepatic P450 cytochrome 2D6 enzyme. In addition, for all interventions, there is uncertainty about whether weight regain occurs over time despite continued therapy. A lack of direct comparisons among the medications and differences among the trials regarding their size, patient characteristics, concomitant lifestyle interventions, outcomes assessed, and duration of follow-up contribute to indirect analyses having more uncertainty. Serious adverse effects, which were very rare, included suicidal thoughts and seizures. Diane is an avid supporter and researcher of natural mental health strategies. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself. Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. FDA label Auvelity (dextromethorphan bromide/bupropion hydrochloride) approval 2022 cited 2024 July 11 Bupropion is generally considered to be a safe tool for weight loss when it is carefully prescribed by a knowledgeable healthcare provider in an individualized patient care plan. Like all medications, the use of bupropion comes with possible side effects and necessary considerations. There are certain patients who would likely not benefit from the use of bupropion or bupropion-naltrexone. Bupropion may be most beneficial for patients who have both depression and overweight or obesity, as it could offer dual benefits. If the patients are not on an opiate pain medication, the combination drug can be used with the caveat that it will block antinociceptive effects of opiates if they are required in future. Most patients with schizophrenia are obese due to the appetite-increasing effects of antipsychotic medications.55 While bupropion and naltrexone separately have been used safely in schizophrenia patients, bupropion has a documented side effect of psychosis in nonpsychotic patients.22,56,57 For schizophrenia spectrum patients, we recommend expert consultation and care. Bupropion by itself for example, induces much more weight loss in obesity treatment studies compared to analysis in depression studies, where weight loss is not the primary aim.23 Thus, results presented in Figures 1 and 2 should be interpreted by clinicians with these caveats in mind.