The FDA has approved a new weight-management drug called Contrave. This is the third new medication approved in the past 2 years for adults with a body mass index (BMI) of at least 30 (or 27 and up, with an associated comorbidity like high blood pressure, diabetes or high cholesterol). The other two are Qysmia and Belviq. All of these drugs work to decrease the feeling of hunger and promote feeling “full” via different mechanisms in the brain.
Contrave is a combination of two medications (naltrexone and bupropion) in an extended-release formulation. The two drugs have been used in the past for different purposes. Naltrexone was originally created to treat patients with alcohol and opioid dependence. Bupropion, commonly known as Wellbutrin, is indicated for the treatment of depression, seasonal affective disorder and smoking cessation.
Physicians have already been prescribing bupropion for its weight-loss side effects. This prompted research on a combination formulation of bupropion and naltrexone, since pharmacotherapy aimed at targeting multiple hunger pathways in the brain appears to be more effective in overall appetite suppression.
Bupropion works by stimulating specific neurons in the hypothalamus that are responsible for food intake and energy regulation. Stimulation of this area promotes weight loss by decreasing hunger and increasing energy expenditure. Naltrexone indirectly stimulates the same hypothalamic neurons. So the naltrexone/bupropion combination decreases hunger by stimulating the reward pathways or “feel-good” signals in the brain.
Contrave Use and Trial Results
Clinical trials included about 4,500 patients who were either overweight or obese. Participants were randomly assigned to received the investigational drug or a placebo for one year. About 42% of patients lost at least 5% of their body weight compared to 17% in the placebo group, according to the FDA. Specifically, patients who took the drug had approximately a 4% greater weight loss when compared to the placebo group.
No medication alone will effectively promote weight loss — especially in the long term. Like any weight-loss medication, Contrave should be used with a healthy eating and exercise plan.
Common side effects of Contrave include nausea, headaches, dizziness, insomnia, dry mouth or changes in bowel movements. More serious side effects can include seizures and patients with a history of seizure disorder should not use the drug. Also, as with any medication that works on the brain, caution is advisable for patients with a history of mood or psychiatric disorders, since Contrave can potentially affect cognitive processes and psychiatric behavior.
Lastly, even though current studies have not shown any adverse effect on heart health or incidence of stroke, it would be preferable to avoid using this medication for those who have had a recent stroke, heart attack, life-threatening arrhythmia or heart failure.
A future possibility may be liraglutide (brand name Victoza). Liraglutide is used for diabetes management and works by increasing the efficacy of insulin to promote satiety. Currently being studied, it is too early to say if the FDA will approve liraglutide as a weight-loss aid.