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Bupropion for Weight Loss

writtenByWritten by: Tessa Chatham Registered Nurse
Tessa Chatham Registered Nurse

Tessa Chatham Registered Nurse

Tessa is a MSN prepared Registered Nurse with 10 years of critical care experience in healthcare. When not practicing clinical nursing, she enjoys academic writing and is passionate about helping those affected by medical aliments live healthy lives.

Read more posts by this author.
reviewBy Reviewed by: Linda Anegawa
Reviewer

Linda Anegawa

Dr. Anegawa graduated from Univ. of Pennsylvania School of Medicine & completed her residency at Stanford. Linda has over 15 yrs of practice and currently specializes in weight management & diabetes.

May 17, 2021 Read Time - 6 minutes

What is Bupropion?

Bupropion (Wellbutrin) is used to treat depression but is used as an off-label medication for weight loss. Besides depression, Bupropion is also used to treat seasonal affective disorder, smoking cessation, and attention deficit hyperactivity disorder (ADHD) and works by balancing levels of certain types of chemicals called neurotransmitters in the brain. 

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Is Bupropion Used for Weight Loss?

Decreased appetite and weight loss has been observed in 10 to 28% of people who take Bupropion. After discovering this effect, Bupropion was added to Naltrexone to form a different FDA-approved drug for weight loss. The brand name of this combination drug of Bupropion and Naltrexone is Contrave. Contrave works through the combination of these two medications that together reduce hunger and control cravings. Both medications are well established by the FDA as safe and effective. Both medications have been prescribed by doctors for other conditions for more than 30 years; however, the combination drug came to market in 2014.

On average, those who took Contrave for 6 months combined with a weight management program were able to lose up to 25 pounds compared to the placebo group. 

On its own, bupropion may not be prescribed solely for weight loss, but for one of the other uses above, and the weight loss is seen as an added benefit for those who have been trying to lose weight unsuccessfully.

How Does Bupropion Work?

Bupropion, as well as the combination of Naltrexone and Bupropion, are believed to work together on the hunger center and reward system of the brain to reduce appetite and control cravings. They do this by enhancing levels of the chemicals norepinephrine and serotonin and modifying opiate receptor signaling.  

Bupropion Side Effects

Prescription medications often cause side effects; however, risk vs. benefit should be discussed with your physician. Some common side effects of Bupropion with or without Naltrexone may include:

  • Headache
  • Constipation
  • Vomiting
  • High blood pressure
  • Heart palpitations
  • Dizziness
  • Insomnia
  • Hot flashes
  • Drowsiness
  • Anxiety
  • Excitement
  • Dry mouth
  • Nausea
  • Stomach pain
  • Excessive sweating
  • Ringing in the ears
  • Changes in your sense of taste
  • Frequent urination
  • Sore throat

You should stop taking Bupropion or Buproprion-Naltrexone and notify your physician right away if you have serious side effects, including:

  • Thoughts of suicide or dying
  • Attempts to commit suicide
  • New or worsening depression
  • New or worsening anxiety
  • Elevated blood pressures
  • Feeling agitated or restless
  • Panic attacks
  • New or worse irritability
  • Acting aggressive, being angry or violent
  • Acting on dangerous impulses
  • An extreme increase in activity and talking (mania)
  • Other unusual changes in mood or behavior
  • Trouble sleeping (insomnia)

Bupropion Warnings

When taking Bupropion or Bupropion with Naltrexone, you or your family members should pay close attention to sudden changes in mood, behaviors, thoughts, or feelings. This is most important when you first start taking these medications or with dose changes. Rare but serious adverse effects may include:

  • Suicidal thoughts
  • Seizures
  • Confusion
  • Hallucinating (seeing or hearing things that do not exist)
  • Irrational fears
  • Muscle or joint pain
  • Rapid heartbeat

Make sure to keep your follow up visits with your physician as scheduled. Call your doctor  between visits if you have questions or have concerns about your symptoms.

Bupropion Dosages

Bupropion prescribed for weight management is taken orally and the dosing and formulations are variable: immediate release and extended release forms of the drug are available. For bupropion-naltrexone, a low dose is initially begun and slowly increased over 4 weeks as needed. 

The following are standard Contrave (naltrexone/bupropion) dosages:

  • 8mg/90mg daily in the morning for the first week
  • 8mg/90 mg twice daily for the second week
  • 8mg/90mg twice daily and 1 tablet in the evening for the third week
  • 8mg/90mg increase to 2 tablets, twice daily in the morning and evening during the fourth week and onward.
Morning DoseEvening Dose
Week 11 tabletNone
Week 21 tablet1 tablet
Week 32 tablets 1 tablet
Week 42 tablets2 tablets

While the most common dosage is 16 mg/180 mg twice daily, many people get a good effect from a lower dose. The maximum dose is 32 mg/ 360 mg daily. 

Bupropion is available inexpensively as a generic drug, and is covered by most insurances.  Unfortunately, the combination weight loss drug Contrave is not covered by most insurances. If you have an insurance plan that does not cover the cost of Contrave, then you may submit an appeal. Without insurance, Contrave costs about $99-$250 per month. Your doctor may discuss with you prescribing bupropion and naltrexone individually to save money. This is known as ‘off label’ prescribing.

Bupropion should be taken in the morning and in the evening; do not administer with high-fat meals as this can lead to an unsafe build-up of levels. Do not cut, chew or crush tablets. Significant drug interactions exist and may require dose and frequency adjustment or avoidance all together, so be sure to inform your physician of all medications that you take, whether prescription or over-the-counter.

Bupropion Interactions 

Bupropion or Bupropion-Naltrexone for weight loss can have interactions with other medications that increase or decrease the serum concentration levels. This can be dangerous because medication taken will not work as intended. The following are concerns related to bupropion/naltrexone:

  • Suicidal thinking/behavior (*black box warning*)
  • Accidental opioid overdose- opioid build up from drug interactions can lead to life-threatening opiate intoxication.
  • May elevate heart rate, blood pressure, and is contraindicated for patients with uncontrolled hypertension.
  • Liver damage (hepatotoxicity).
  • Seizures- bupropion may cause dose-related risk of seizures, so patients with a history of seizure disorder should not take this medication.
  • Avoid alcohol when taking Bupropion for weight loss, as both alcohol and bupropion together can lower the threshold for seizures in the brain.

Heart medication such as carvedilol interacts with bupropion by increasing carvedilol’s effectiveness. Other medications that Bupropion increases the effectiveness of include:

  • Dextromethorphan (Robitussin)
  • Digoxin
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Metoprolol
  • Sertraline (Zoloft)
  • Tamsulosin (Flomax)

Information related to the use of this combination (naltrexone/bupropion) in pregnancy is limited, and due to the lack of clinical studies, Bupropion or Contrave should be discontinued once pregnancy is detected. Contrave is not recommended for breastfeeding women.

  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

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Can You Buy Bupropion Online?

Bupropion is available online with a prescription from a medical doctor. If you are overweight and are looking for alternative treatments to add to diet and exercise, then Bupropion or Bupropion-Naltrexone (Contrave) may be right for you. Make an appointment today to speak with a board-certified physician about weight loss medication options.


Read More About Bupropion for Weight Loss


Sources:

PlushCare is dedicated to providing you with accurate and trustworthy health information.

Early, J., Whitten, J. Naltrexone/Bupropion (Contrave) for weight loss. American Family Physician Journal. Accessed on April 10, 2021 from https://www.aafp.org/afp/2015/0415/p554.html

MedLinePlus. Bupropion. Accessed on April 10, 2021 from https://medlineplus.gov/druginfo/meds/a695033.html 

MedLinePlus. Naltrexone and Bupropion. Accessed on April 10, 2021 from https://medlineplus.gov/druginfo/meds/a619020.html 

National Library of Medicine. Bupropion SR vs. placebo for weight loss in obese patients with depressive symptoms. Accessed on April 10, 2021 from https://pubmed.ncbi.nlm.nih.gov/12376586/

Most PlushCare articles are reviewed by M.D.s, Ph.Ds, N.P.s, nutritionists and other healthcare professionals. Click here to learn more and meet some of the professionals behind our blog. The PlushCare blog, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. For more information click here.

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