From the Guidelines
A seizure disorder is a contraindication for taking Contrave (bupropion and naltrexone), but phentermine's interaction with seizure disorders is not explicitly stated as a contraindication in the provided evidence. According to the American Gastroenterological Association clinical practice guideline on pharmacological interventions for adults with obesity 1, naltrexone-bupropion ER, the combination found in Contrave, should be avoided in patients with seizure disorders due to the risk associated with bupropion. This is because bupropion carries a dose-related risk of seizures, and its use is cautioned against in patients at risk of seizures.
Key Considerations for Phentermine and Contrave
- Phentermine-topiramate ER is suggested for use with lifestyle modifications in adults with obesity or overweight with weight-related complications, with specific considerations for patients with comorbid migraines or those at risk of teratogenic effects 1.
- Naltrexone-bupropion ER, or Contrave, is suggested for use with lifestyle modifications, with specific considerations for patients attempting smoking cessation, those with depression, and importantly, those with seizure disorders, in whom it should be avoided 1.
- The primary concern with Contrave in patients with seizure disorders stems from the bupropion component, which has a known risk of inducing seizures, particularly in individuals with a history of seizure disorders.
Clinical Implications
Given the information from the AGA clinical practice guideline 1, patients with seizure disorders should avoid Contrave due to the bupropion component. While phentermine's direct interaction with seizure disorders is not explicitly contraindicated in the provided evidence, caution is always advised when considering medications that could potentially lower the seizure threshold or interact with anti-seizure medications. Patients with seizure disorders should discuss alternative weight management strategies with their healthcare provider to minimize risks and optimize outcomes.
From the Research
Seizure Disorder and Phentermine or Contrave
- A seizure disorder may be a concern for patients taking phentermine or Contrave (bupropion and naltrexone) due to potential interactions and side effects 2.
- The combination of fenfluramine-phentermine has been associated with seizures in some cases, suggesting a possible link between phentermine and seizure activity 2.
- However, the current evidence does not provide a clear contraindication for phentermine or Contrave in patients with seizure disorders 3, 4, 5, 6.
- It is essential to consider the individual patient's medical history and potential drug interactions when prescribing phentermine or Contrave, especially in patients with a history of seizure disorders.
- The FDA-approved medications for obesity management, including phentermine and Contrave, should be prescribed with caution and under close monitoring, especially in patients with underlying medical conditions such as seizure disorders 3, 4, 5, 6.