Obesity Treatment

Association of BUPROPION + NALTREXONE

In an era of substantial increase in the prevalence of obesity worldwide and with an

increasingly limited supply of available mechanisms for its treatment, which often
achieve satisfactory results, the combination of one or more drugs is being tested, as
occurs in the treatment of other chronic diseases such as hypertension and diabetes.
There may be a risk of interactions and the cost of treatment may be higher, but the
combination can bring additive or synergistic effects to weight.

Two drugs with different effects may have the potential to offer an even greater result
than the sum of using the two drugs individually. Researchers have thus raised the
hypothesis that the use of Bupropion in combination with Naltrexone could have a
significant effect on weight, although they have low efficacy when used separately.

These researchers arrived at this reasoning due to the fact that Bupropion, an
antidepressant related to phenethylamines and used in the treatment of nicotine
withdrawal, works by inhibiting the reuptake of dopamine and norepinephrine, thus
increasing the concentration of these neurotransmitters in the central nervous system.
This increase signals the POMC (pro-opiomelanocortin) producing neurons, which
when released are quickly cleaved into alpha MSH and beta-endorphins. Alpha-MSH is
an anorexigenic substance that also increases energy expenditure. However, the effect
of Bupropion on weight is not very relevant because when beta-endorphin is produced,
it inhibits POMC, so Bupropion alone cannot achieve the anorexigenic effect.

Naltrexone, an opioid antagonist used in the treatment of opioid and alcohol withdrawal,
inhibits beta-endorphins as an opioid antagonist, allowing Bupropion to have its
anorexigenic effect.

Recommended dosage: Adverse effects: Nausea, constipation,

Bupropion : 150 a 360mg
Naltrexone: 12 a 32mg
headache, dizziness, vomiting, and dry mouth. A
serious side effect may occur, but only in
patients with a history of seizures. Bupropion
lowers the seizure threshold, so it is not
recommended for patients with a history of
seizures."

References

Greenway, FL, Fujioka, K, Plodkowski, RA, et al. Effect of naltrexone plus bupropion
on weight loss in overweight and obese adults (COR-I): a multicentre,
 randomized, double-blind, placebo-controlled, phase III trial. Lancet 2010,
376:595-605.

Greenway, FL, Whitehouse, MJ, Guttadauria, M, et al. Rational design of a combination

medication for the treatment of obesity. Obesity. 2009 17: 30-39

Halpern, B, Faria AM, Halpern, A. Bupropion/Naltrexone fixed dose for the tratament
of obesity. Drugs of Today, 2011

Halpern, B, Oliveira, ESL, Faria, AM, et al. Combination of drugs in the treatment of
obesity. Pharmaceuticals. 2010, 3, 2398-2415

Wadden, TA, Foreyt,JP, Foster, GD, et al. Weight loss with Naltrexone SR/Bupropion
SR combination therapy as an adjunct to behavior modification: the Cor-BMOD
trial. Obesity, 2011 19: 110-120.