Bupropion vs Contrave vs Naltrexone

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When it comes to weight loss medications, three options that often come up are Bupropion, Naltrexone, and Contrave. Let’s break them down and see how they stack up in the battle against obesity.

Bupropion

Bupropion is typically known for treating major depressive disorder, but what’s interesting is its potential for helping with weight loss. Unlike many other antidepressants, Bupropion is considered weight-neutral, and for some, it may even lead to weight loss. This is good news, especially for those trying to quit smoking, as Bupropion is also approved to help with smoking cessation.

The exact way Bupropion influences weight is not fully understood, but it’s believed to impact neurotransmitters like norepinephrine and dopamine, which play roles in regulating appetite and reward pathways. By preventing the removal of these neurotransmitters, Bupropion contributes to reduced appetite, less psychological cravings, and possibly increased energy expenditure.

Research suggests that Bupropion can lead to a weight loss of around 7-10% of body weight. However, when compared to a placebo, the actual weight loss attributed to Bupropion is closer to 2-5% total body weight. It’s important to note that the effects may take some time to show, with noticeable changes often appearing around 24 weeks.

Bupropion seems to be more effective in addressing the emotional aspects of weight loss, such as food addiction and emotional eating, rather than simply suppressing appetite. So, while it may not curb overall appetite as much as some other drugs, it can be beneficial for those struggling with the psychological aspects of weight management.

Naltrexone

Naltrexone is a medication primarily used to assist individuals in managing opioid and alcohol dependence. It works as an opioid receptor antagonist, blocking the effects of opioids and aiding in the treatment of opioid addiction by curbing cravings. Additionally, naltrexone has shown effectiveness in addressing alcohol use disorder by reducing both alcohol cravings and the pleasurable effects of drinking.

While the precise mechanisms linking naltrexone to weight loss are not entirely understood, it is believed to involve adjustments to brain pathways related to appetite regulation and reward. Acting as an opioid receptor antagonist, naltrexone may influence the brain’s reward system, diminishing the pleasure associated with eating. This, in turn, can lead to decreased cravings and a reduced inclination to overeat.

It’s important to note that naltrexone alone doesn’t directly impact weight, making it less likely to be a standalone solution for weight loss. However, when combined with bupropion, it appears to be particularly beneficial in enhancing bupropion’s ability to reduce cravings, especially in individuals dealing with obesity and struggling with emotional or binge eating patterns.

Contrave

Contrave is a medication that combines bupropion and naltrexone to help with weight loss. Unlike using bupropion alone, Contrave allows for significant weight loss with lower doses of both medications.

When bupropion is used by itself, it usually requires a minimum of 400 mg per day to be effective. Even slightly lower doses, like 300 mg, are not as impactful. Naltrexone, on the other hand, doesn’t show noticeable effects on weight even at 100 mg.

In the case of Contrave, only 90 mg of bupropion and 8 mg of naltrexone are needed to achieve significant weight loss. Using these lower doses reduces the chances of experiencing side effects, making Contrave a safer long-term option compared to using bupropion alone.

Studies have shown that Contrave can lead to a weight loss of around 11-22 lbs, which is roughly 5% of body weight when compared to a placebo effect. This means that using Contrave can provide an additional 5% weight loss on top of any weight loss achieved through dietary or lifestyle changes.

Comparison

So, how do these three drugs stack up when it comes to weight loss? Let’s break it down.

Firstly, only Contrave has the official nod for weight loss. Bupropion might have some impact on shedding pounds, but it doesn’t have the official green light for weight loss. When it comes to your wallet, bupropion and naltrexone are available in generic forms, making them a more budget-friendly option compared to Contrave, which doesn’t have a generic version.

Bupropion goes by the brand names Aplenzin, Wellbutrin, and Zyban, while naltrexone can be found under ReVia, Vivitrol, and Depade. Quick note: the brand name drug Narcan is not naltrexone; it’s naloxone. Both naloxone and naltrexone counteract opioid receptors, but Narcan (naloxone) is for emergencies, rapidly reversing opioid overdoses. On the flip side, naltrexone is for ongoing management in opioid addiction.

Now, let’s talk dosage. Contrave takes a clever approach by using lower doses since it combines both drugs synergistically. And finally, their impact on weight loss and the research backing them up vary. Bupropion has mild to moderate effects, especially helpful for those wrestling with emotional eating or food addiction. Naltrexone, on its own, doesn’t contribute much to shedding pounds. Meanwhile, Contrave shows moderate to strong effects on weight loss, depending on the person, and boasts extensive research supporting its long-term use for tackling obesity.

Generic Contrave?

People often ask me if they can take bupropion and naltrexone separately to get the same effects as Contrave. The answer is technically yes. Contrave is essentially a sustained-release combination of both. “Sustained-release” means the medicine is released slowly over time. Unlike quick-release methods that dissolve right away in the stomach, providing an instant dose, sustained-release formulations release the drug gradually. This helps maintain a steady and lasting effect, often requiring fewer doses and potentially causing fewer side effects.

If your healthcare provider suggests taking them individually, perhaps to save costs or due to availability issues, you can combine a 100 mg dose of sustained-release bupropion with a regular 50 mg naltrexone tablet split in half. While it won’t be an exact match, as this combo provides 100 mg of sustained-release bupropion with 25 mg of instant-release naltrexone, compared to Contrave’s 90 mg sustained-release bupropion with 8 mg sustained-release naltrexone, it’s a pretty close approximation. Will it be as effective as Contrave? It’s challenging to say for sure since there haven’t been direct comparisons, but for most people, it’s likely to be good enough.

Should you try them?

So, the big question: Should you give these medications a try? It’s crucial to understand that these drugs mainly work by influencing the reward pathways in your brain, which suggests they might be more effective at tackling emotional eating and snacking rather than being a super-effective appetite suppressant. Research indicates that their overall impact on weight loss might not be as robust when compared to potent appetite suppressants like Qsymia, Ozempic, or Mounjaro.

However, it’s important to know that both bupropion and Contrave also strongly influence mood, and they do come with their fair share of side effects and contraindications. Common side effects include things like dry mouth, insomnia, headaches, and nausea. Some folks might experience dizziness or blurred vision, and in certain cases, there might be an uptick in blood pressure.

Bupropion has also been linked to a risk of seizures. Plus, there’s a possibility of mental health-related side effects such as anxiety, agitation, and mood changes, which should be addressed promptly with medical attention. So, using these medications isn’t risk-free. If you’re thinking about giving them a shot, it’s crucial to get evaluated by a doctor first.

Learn more about

• What to Expect With Contrave
• Other weight loss medications

See also

• 
  Comparing Weight Loss Drugs in 2024
  Ozempic and Mounjaro are highly effective at treating obesity, however there are many other approved and off-label options that also work.
• 
  Bupropion vs Contrave vs Naltrexone
  Contrave is a synergistic combination of buproprion and naltrexone, which can be replicated to some degree using the generics individually.
• 
  New Obesity Drugs in 2024
  New obesity drugs target more than just GLP-1 and do much more than suppress appetite for a more nuanced approach to weight loss.
• 
  Mounjaro: Who Loses the Most Weight?
  White or Asian younger women who use metformin and have lower sugar and lipid levels tend to experience more weight loss with Mounjaro.
• 
  How does Oforglipron compare?
  Orforglipron, Semaglutide, and Danuglipron are oral GLP-1 agonists that are all similar enough that cost may end up being the winning factor.