Naltrexone with bupropion

How it works

The two agents act centrally on appetite-regulating pathways, with bupropion stimulating hypothalamic neurones and naltrexone blocking an opioid-mediated feedback loop, together reducing appetite and food intake.

Prescribing in practice

• Because bupropion lowers the seizure threshold, the combination is contraindicated in epilepsy or conditions predisposing to seizures, and must not be used with opioids or in opioid dependence owing to the naltrexone component.
• It is contraindicated with monoamine oxidase inhibitors and in uncontrolled hypertension, and can raise blood pressure and heart rate.
• Review for adequate weight loss after an initial period and discontinue if the response is insufficient, while monitoring mood given bupropion's psychiatric effects.

Monitoring

Monitor blood pressure and heart rate, weight response, and mood or behavioural changes including any suicidal ideation.

Counselling the patient

• Swallow the tablets whole with the dose built up gradually, and do not take with a high-fat meal.
• Do not take any opioid painkillers while on this medicine and tell healthcare staff you take it before any procedure.
• Report low mood, agitation or thoughts of self-harm.

Evidence & guidelines

Naltrexone-bupropion is licensed for weight management as an adjunct to lifestyle measures, with trials showing modest additional weight loss; NICE has appraised its place in therapy.