Contrave Contrived to Confuse

Contrave is marketed as a prescription weight-loss drug made from a combination of naltrexone HCL and bupropion HCL. Bupropion is an antidepressant, also marketed as Wellbutrin and Zyban for smoking cessation. Naltrexone is used to counteract alcohol and opioid addiction. (See our previous newsletter on Contrave.)

We’re not sure how this drug has anything to do with weight loss, except that the FDA allows it to be prescribed for that. We’re guessing it has something to do with calling obesity an addiction similar to smoking, and it’s another way to make money off of a drug by expanding its potential client base. The DSM-5 has a mental diagnosis called “Overweight or obesity.”

Naltrexone is not used extensively because the retention rate of patients is very low, so this use gives it additional life.

Bupropion increases the amount of the neurotransmitter dopamine in the brain. The most common side effects associated with bupropion are agitation, dry mouth, insomnia, headache, nausea, constipation, and tremor. It can also cause mania, hallucinations, seizures, suicidal thoughts and behavior, anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, and severe restlessness. Additional adverse events of the Contrave combination are loss of consciousness and abuse of the drug.

Bupropion can also cause unusual weight loss or gain. We guess the doctor is betting on the former. The exact neurochemical effects of Contrave are not fully understood. What we fully understand is that the doctor is gambling that users will experience weight loss as a side effect of the drug.

Contrave has a boxed warning to alert health care professionals and patients to the increased risk of suicidal thoughts and behaviors associated with antidepressant drugs. The warning also notes that serious neuropsychiatric events have been reported in patients taking bupropion.

Contrave is a trademark of Orexigen Therapeutics, Inc. and is distributed by Takeda Pharmaceuticals. Shares of Orexigen (NASDAQ:OREX), collapsed 72% in 2015, based on its long-term cardiovascular-outcomes study for Contrave. The FDA chastised Orexigen for releasing immature data from a study where the analysis was incomplete, requiring Orexigen to run an additional long-term study.

Just for completeness, these are are inactive ingredients in Contrave: microcrystalline cellulose, hydroxypropyl cellulose, lactose anhydrous, L-cysteine hydrochloride, crospovidone, magnesium stearate, hypromellose, edetate disodium, lactose monohydrate, colloidal silicon dioxide, Opadry II Blue and FD&C Blue #2 aluminum lake. (With apologies to your dictionary, which may or may not help with some of these strange ingredients.)

The FDA approved Wellbutrin as an antidepressant in 1985 but because of the significant incidence of seizures at the originally recommended dose (400-600 mg), the drug was withdrawn in 1986. It was reintroduced in 1989 with a maximum dose of 450 mg per day.The current recommended dose for Contrave is no more than 4 tablets per day; each tablet has 90 mg bupropion HCL for a total of 360 mg per day. In Contrave clinical trials, 24% of subjects discontinued treatment because of an adverse event.

The cost of Contrave varies from about $55/month to over $200/month depending on dose, location, and insurance coverage.

We can contrive several less dangerous and cheaper alternatives for losing unwanted weight, without Contrave.

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