Dr. Sharon Orrange
Primary Care Physician
Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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LOCATION: Santa Monica, CA, USA
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AFFILIATIONS:
  • Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California
YEARS IN PRACTICE: 11
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A New Medication for Weight Loss
42
Posted in ADHD / ADD by Dr. Sharon Orrange on Jun 27, 2009

I save prescribing the weight loss medications, like Meridia of Xenical, for those who have made a good faith effort at serious diet and lifestyle changes. This is true for me because many of the weight loss medications carry risks and side effects and don't have sustainable results. Well, there is a new kid in town to report on, which is actually a combination of two fairly well known medications.A new pill which combines naltrexone and bupropion (wellbutrin) produced clinically meaningful weight loss at 56 weeks, results from a recent multicenter phase III trial showed.

What is it? Bupropion is a norepinephrine-dopamine reuptake inhibitor that is used for the treatment of depression and smoking cessation, while naltrexone is an opioid antagonist that is approved for alcohol and opioid dependence.

The new combined pill is known as Contrave.

How does it work? The combination of these two drugs target hunger, fullness, and reward centers in the brain that control the balance of food intake and energy expenditure.

Does it work and do the results last? The study results recently published involved 793 patients with a body mass index between 27 kg/m2 and 45 kg/m2 at nine sites in the United States. Of the 793 patients (90% female), 591 were randomized to the study drug, which consisted of 32 mg of naltrexone and 360 mg bupropion per day, while 202 were randomized to placebo. The measured end points were percentage change in body weight and the proportion of patients who achieved a 5% loss of weight.

Results: At 56 weeks, results showed that patients in the medication treatment group lost 9.3% of their body weight, compared with a loss of 5.1% in the placebo patients, a difference that was statistically significant.

In addition, significantly more patients in the medication group than in the placebo group achieved a weight loss of 5% or more.

Is Contrave well tolerated? Well, sort of . The discontinuation rate due to adverse events was 26% in the medication treatment group, compared with 13% in the placebo group. The most frequent side effect was nausea (34% in the medication treatment group vs. 11% in the placebo group), headache (24% vs. 18%), and constipation (24% vs. 14%).

A word about the nausea:  In this study, nausea had a fairly rapid onset in people, was generally mild or moderate, and tended to resolve in the first 4 weeks. I tend to think this is from the Buproprion (Wellbutrin) as many experience nausea on that medication even when used alone.

If other trials go as well as this, expect to see the drug company to ask for approval in 2010.

Also NO, I do not have a stake in any pharmaceutical companies including the ones that make this medication...

Thoughts?

Dr O.


CATEGORIES: News
CONDITIONS AND COMMUNITIES: ADHD / ADD  •  Agoraphobia & Social Anxiety  •  Alcoholism  •  Anxiety  •  Bipolar Disorder  •  Body Modification  •  Celiac Disease  •  Chronic Fatigue Syndrome  •  Chronic Pain  •  Depression  •  Diabetes Type 2  •  Diets & Weight Maintenance  •  Endometriosis  •  Fatty Liver Disease  •  Fibromyalgia  •  Food Addiction  •  Gastric Bypass Surgery  •  GERD & Heartburn  •  Gout  •  Healthy Eating  •  High Blood Pressure  •  High Cholesterol  •  Hypothyroidism  •  Irritable Bowel Syndrome (IBS)  •  Obesity  •  Polycystic Ovarian Syndrome (PCOS)  •  Post Partum Depression  •  Seasonal Affective Disorder  •  Sleep Apnea  •  Smoking Addiction & Recovery
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Displaying comments 42-23 of 42
42
how could i become one you could try it on to see im a 100lbs overweight e-mail loiskritnersanchez@yahoo.com
By lois36  Oct 15, 2009
41
I juice and try to eat healthy because I have severe FMS. Before FMS I was very thin, now I am considered severly obese. I am very interested in hearing more about this new weight loss medication. I will be keeping an ear open for further news. Thanks Dr. O!
By theklineklan  Oct 14, 2009
40
WOW! I want to try this, sounds like this actually might help people!
By luvinmomhood  Aug 04, 2009
39
ive been taking xenical since feb 09 .. lost 93lbs combining this with eating well and exercise..
i'll be interested to see how this drug works.
By KiiRahh  Jul 29, 2009
38
Was told that I couldn't take Alli and Zoloft together, any reason why.. Want to loose weight and dont want to take met. Any suggestions. I was diagnosed with PCOS in 2000.
By 2angelsinmo  Jul 28, 2009
37
I'm very CONCERNED that you DID NOT MENTION all the other SIDE EFFECTS that this drug could have, as WELLBUTRIN and other medications have! Your article is too positive and gives too much hope!!! while you don't consider the SIDE EFFECTS. A very 'doctor'- like thing to do. Please please consider your audience.
By chris2345  Jul 24, 2009
36
I generally disaprove of weightloss drugs...however there might be a silver lining to this one.
By Shamrock593  Jul 20, 2009
35
Any diet drug scares me! Having been one who took Redux (after Phen Fen -- or was it FenPhen? -- was pulled and we were all told, by the FDA, that Redux was safe), I wouldn't touch a diet med ever again! I had aortic valve replacement surgery because of it!
The pharmaceutical company admitted fault/liability in some way, because I got a load of money for it. It's never enough to compensate for what I have been through, however. I would rather have my good heart back, not one with a replacement valve. I am grateful I have the replacement valve, don't misunderstand, but if I could go back and UNdo the damage? You bet I would!

And as Pepper commented.. it certainly doesn't deal with the food addiction and the reasons behind the overweight, overeating cycle, does it? Isn't it like taking cough medicine and analgesics for TB? Covering the symptoms? Like "AcuJordan" said, treat the root cause...

Diet Drugs? NOT A CHANCE!
By YamaBlonde  Jul 20, 2009
34
I already take that and have been on it for about 10 years. It does not help us to not want to eat. Pepper
By pepper09mos  Jul 11, 2009
33
I was diagnosed Welbutrin for depression about 9 years ago.
I am already slender and while on this drug, I quickly lost 30 lbs, which made me absolutely skinny and gaunt. It also gave me a mild form of OCD tendencies - I had a really really clean house.
It seemed to help the depression but my doctor became so concerned about the lack of appetite I experienced that he quickly switched me to another anti depressant.
People on pain medication for chronic pain should avoid meds containing naltrexone as it might precipitate abrupt unwanted withdrawal symptoms.
By PDXRuthie  Jul 10, 2009
32
Oh, I forgot to state that I have only lost 40 lbs post op..... :(
By Humminbrd22  Jul 08, 2009
31
Would you prescribe these meds to a GBS patient if they are over a yr out and has not lost any weight since the 4th month ???
Please respond..I am Desperate and so disappointed...
TY,
Donna
By Humminbrd22  Jul 08, 2009
30
There is a time and a place for medications, no doubt. Determining that is an individual decision that should be weighed after doing as much research and self-educating as you can coupled with sound medical advice. Weight loss is a challenging issue to deal with. It involves life-style adjustments-- the hardest to affect in my patients-- psycho-emotional issues -- depression, body image, addiction--, and very real physiological health concerns with more than one diagnosed condition. Where does one begin? When I see patients one either multiple medications or multiple supplements, the first question I ask after reviewing their health history is why are they taking what they are taking. And do they understand what interactions may be taking place. It is a very slippery slope when you start chasing sympotms with meds. Stacking them one at a time leads to its own health problems. This is where consulting your primary care physician comes into play. Ask them to help you coordinate your regimen. It also helps to get a complemtnary perspective from another discipline that is focuses on seeing the whole of a person, as we are more than just the some of our symptoms. I find that as an acupuncturist, my patients appreciate this Chinese Medicine can offer a different context for their dizzying array of symptoms, that can at times tie many of them together into a more understandable pattern of imbalance. "Treating the root," we say. And this is no more true than with the complex pattern of weight loss.

Be well,

Jordan Hoffman, L.Ac., Dipl. OM
"AcuJordan"
By AcuJordan  Jul 05, 2009
29
Dr. O, what pharmaceutical company will make Contrave? Is there a link to follow its progress through final FDA-approval?
By NewYorkNY2009  Jul 05, 2009
28
I am worry about my day by day increase weight.i searching a safe and easy way to loss weight.when i read your article i think that i search is complete.i follow your tips and i hope i get a good result.

http://ezinearticles.com/?Dont-Buy...
By sophiedrick  Jul 02, 2009
27
I have been on Buproprion (Wellbutrin) for years to help with depression and stopping smoking in 2001. I really need to lose 100#. I go to Curves 3x a week and I walk the mall 2-3 times a week. I also go to Weight Watchers, but I have many medical issues. I need help. My doctors just say "You need to lose weight." They are no help. Thanks for listening. Any suggestions, please email me @ pepper09mos@yahoo.com Thanks in advance. Pepper09mos
By pepper09mos  Jul 02, 2009
26
I have been using Wellbutrin to control my appetite for 6 months and it generally works well. It seems to stop the "lack of impulse control" which my pdoc says is characteristic of bipolar disorder. I lost about 20 lbs, but part of that was because I had surgery and couldn't walk, so I couldn't walk to the kitchen to overeat at night. However, I was actually much worse without the Wellbutrin, eating all day, instead of just at night. Mind you, I only take 1/4 of a tab, sustained release, which apparently still works a bit, but not like it should. Unfortunately, the minimum dose of 150 mg SR, keeps me awake all night, which is too dangerous for a bipolar with a history of sleep deprivation induced psychosis. LOL

I am beginning to think part of my issue with food is body image. I simply don't really want to be thin again. I am average now - after losing 70 lbs 2 years ago. But I can't lose that last 20 lbs, let alone get down the to 50 less lbs I was during my 20's and 30's. I don't think I really want to be thin and attractive. Just healthy.

Oh ya - I exercise 6 days a week weights and riding bike for an hour despite RA, and feet deformities, and now reconstructive surgery. I eat an organic vegetarian diet, no junk - but even home made, no sugar, no salt, organic ground muffins can put on weight if you eat enought of them! Yikes!

Someone also mentioned Wellbutrin for menopause symptoms. That was the first thing I noticed when I went off of it - the hot flashes stopped after 5 years. My pdoc said there is an actual physiological mechanism involved. Also my body temp is below normal, and the Wellbutrin somehow stimulates circulation, and brings it to almost normal. A wonderful thing when you live in a cold, northern climate, with 7 months of brutal winter this year. I don't think I would ever go off Wellbutrin, kind of wondering what the combination would do to help me lose those last pounds, and whether it affects the liver - mine has been messed up by Tylenol, Reactine, and methotrexate for the RA.
By Angela53510  Jul 02, 2009
25
will this help someone like me who has fibromyalgia, cfs, anxiety, depression, liden factor 5 diffieciency, and severe crohns? i dont eat much or often to begin with but i also cant spend much energy on exercise walking around the block wears me out for hours and i have severe arthritis in both feet both hips and my rib, my docs dont understand why i'm gaining wieght they say i should have a problem gaining keep testing my thyroid levels which is always within normal range please any help would be apreciated!
By sickntiredmom  Jul 01, 2009
24
I would like to try it. "Contrave"
Since, AS hitting my knees...I am not moving as much and have gained weight. I've not gained a lot, but feel that my knees would be happier if I lost some weight.

I'm recovering from left knee/scope and hope to be dancing soon.
By sunshinehopeful  Jul 01, 2009
23
Scorpiogirl73: Its a great point, certain lifestyles do not make it easy to follow a strict diet and exercise regimen...but I don't agree about most physicians wanting patients to follow their "orders"..we just want a good result for you. Period.
By DrOrrange  Jul 01, 2009
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