Naltrexone, an
opiate antagonist, and
bupropion, a noradrenergic/dopaminergic
antidepressant, have many effects on the reward systems of the brain. These medications impact eating behavior, presumably via their impact on food reward. However, only
bupropion induces
weight loss in obese individuals, while
naltrexone does not have any appreciable effect. The combination of 32 mg of
naltrexone and 360 mg of
bupropion in a sustained-release combination pill form has been recently approved for
obesity treatment. Studies have shown that the combination of these two medications is more effective in inducing
weight loss, when combined with lifestyle intervention and calorie reduction, than each individual medicine alone. The
naltrexone-bupropion combination, when combined with lifestyle intervention and modest calorie reduction, seems to be quite effective for 6-month and 1-year outcomes for clinically significant
weight loss (over 5% of total
body weight). These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. This paper reviews existing
weight loss clinical trials with
bupropion and the
bupropion-
naltrexone combination. Additionally, the rationale for the suggested patient selection and clinical strategies for special patient populations are discussed.