The Next Weight Loss Pill - Contrave

Recently, the US Food and Drug Administration (FDA) gave its stamp of approval for a new combination pill that may help in the fight against severe obesity. The pill is called “Contrave” and contains 2 different drugs:

1. Bupropion
2. Naltrexone

Bupropion, a well known antidepressant medication, is also used to help people quit smoking. You may ask why an antidepressant is being used for weight loss. Well, the basic idea is that some of the neurotransmitters in our brain that are in charge of controlling appetite and that feeling of fullness after we eat, may not be functioning properly when we become morbidly obese. Those neurotransmitters are either not being regulated correctly or not working properly. Bupropion may help in boosting the signal and making sure the brain listens to the signals coming from the rest of the body, that you have eaten enough and that you are not feeling hungry anymore.

Naltrexone is a drug that is used for helping people who are alcohol or narcotic dependant. It’s a great de-addiction medicine. Again, you’d be right in asking why such a drug would help you with weight loss. To understand this, we have to understand a little about the reward centers in our brain.

Deep inside the brain there are a few structures that form the reward pathway of the brain. For people with a technical bent of mind and those who want to read more, I’m referring to the prefrontal cortex, the nucleus accumbens and the ventral tegmental area.

This reward center has the job of reinforcing any behavior which the body enjoys. When you do something that makes you happy, the reward center becomes active and makes sure the memory of that event is always associated with a feeling of happiness and fulfilment. Narcotics and other such drugs work by over stimulating the reward center. However, foods and sugars do the same thing, just to a lesser degree. When you feel good after eating that chocolate cake, it’s because your brain is being manipulated like it is on heroin.

Naltrexone is supposed to break this reward cycle. It interferes with the reward center and doesn’t let it get over stimulated. Therefore, Naltrexone is used to break the basic addiction to food.

The FDA has approved Contrave for treating obese (body mass index > 30) and overweight adults (body mass index from 27 to 30). In the case of overweight adults, the drug is to be used in cases where the individual has other weight related diseases affecting them such as high blood pressure, type 2 diabetes or elevated cholesterol levels.

In a clinical trial conducted by Sanofi, the manufacturer of Contrave, significant weight loss (5% weight loss) was achieved by 42% of people who received Contrave  and 17% of people who received placebo. In a trial of people with type 2 diabetes, 36% of patients taking Contrave and 18% of patients taking placebo had significant weight loss of at least 5% of body weight.

The intake of Contrave has to be evaluated often. It cannot be taken forever. Twelve weeks is the recommended duration of treatment. If you haven’t lost at least 5% of the weight that you need to lose, it’s probably not going to help you at all. You have to remember too, that these drugs are not magic pills. If you really want to lose weight and keep it off, then you need to have a healthy and sustainable exercise and diet routine as a part of your lifestyle.

Bupropion has some pretty nasty side effects that are associated with all antidepressants. Suicidal thoughts and behaviors are a risk factor here. If you are on Bupropion / Contrave and you notice such symptoms, contact your doctor immediately.

Bupropion can also cause seizures. It’s a complete no-no for people with seizure disorders. If you have uncontrolled hypertension, it needs to be controlled before consuming Contrave.

There are more tests and trials being done to evaluate the safety of this drug, especially in heart patients and the pediatric population. For now, if you are an obese or overweight adult with no heart problems, you can talk to your doctor about adding Contrave to your exercise and dietary weight loss plan.