Thursday, December 16, 2010

A New Combination Medicine for Weight Loss: Naltrexone + Wellbutrin

     I have already treated a couple of patients with a combination of Naltrexone and Bupropion (Wellbutrin) for weight loss, and the results have been quite impressive.  Now an FDA panel has given its recommendation for the approval of a new combination pill containing Naltrexone with Bupropion (Wellbutrin).  It is becoming more apparent that combination's of drugs can be more powerful when they are given together rather than just using each of them alone.  There is good reason to think that combining Naltrexone with Wellbutrin would be useful to help patients with weight loss.
     Naltrexone is, of course, quite a powerful drug used to treat addictive disorders.  We use Naltrexone Implants as part of our routine treatment for opiate and alcohol dependencies.  Our experience with Naltrexone Implants in opiate addicts is that over 50% of these patients report virtually no cravings.  In a similar way our alcoholic patients treated with Naltrexone implants usually report much reduced cravings.  A recent newsletter article of mine reviewed studies that showed that Naltrexone can greatly reduce the memories of getting pleasure from using drugs and alcohol.  But when it comes to food addiction or obesity, the evidence shows that Naltrexone, either pills or implants, is a lot less powerful.
     Bupropion (Wellbutrin ) is an antidepressant that has been in use for many years.  It is not in the SSRI family like most antidepressants such as Prozac and Zoloft.  It acts more on the dopamine system, which is also the neurotransmitter that is related to addiction (although in a different part of the brain).  Because it acts on dopamine, a number of physicians have tried using it for addictive diseases.  It has been approved by the FDA for tobacco dependence and it has showed some benefit.  Unfortunately, it has been tried for cocaine and other addictions but has not shown a lot of usefulness.  So, Bupropion clearly has some effect in some addictive diseases, just not a very strong effect.
     Combining these two medicines makes sense.  By targeting two separate pieces of the addiction puzzle, it makes sense that there could be an additive effect.  The results of the clinical trials are positive but not overwhelming.  The studies show that patients taking the combination for 12 months achieved about a 5% weight loss. This is better than placebo and better than many other treatments for obesity.  There is some concern about side effects but both of these drugs have been used for many years and have been found to be very safe.
     As mentioned earlier, I have treated a couple of patients with this combination.  One patient reported her cravings for food were virtually gone and she had never had such a powerful effect from any other weight loss treatment.  She lost over 10 pounds in a couple of months!  We are open to trying these medicines if patients want to try to see if this combination will work for them.  Similar to our experience with alcoholics and opiate addicts, it may be that the Naltrexone Implant will be more powerful than the oral tablets.  Like all other addictions, we believe that medicines alone are not enough.  We believe that the best recovery from addiction requires a holistic approach including other treatments such as the 12 steps, individual/group counseling, as well as inpatient/outpatient aftercare.  
Dr. Peter Coleman


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