Can patients with Ehlers-Danlos Syndrome take Wellbutrin (bupropion) for weight loss?

Wellbutrin (Bupropion) for Weight Loss in Patients with Ehlers-Danlos Syndrome

Bupropion (Wellbutrin) is not recommended for weight loss in patients with Ehlers-Danlos Syndrome due to safety concerns and lack of evidence supporting its use in this specific population. 1

Rationale for Not Recommending Bupropion in EDS

The American Academy of Sleep Medicine explicitly recommends against using bupropion for the treatment of restless legs syndrome, which is relevant as many patients with EDS experience similar neurological symptoms 1. This recommendation is based on moderate certainty of evidence, suggesting potential harm outweighs benefits.

While bupropion (as part of Contrave - bupropion/naltrexone combination) is FDA-approved for weight management in the general population, several concerns make it unsuitable for EDS patients:

• Patients with EDS often have cardiovascular manifestations including tissue fragility, which may increase vulnerability to bupropion's cardiovascular effects 2
• EDS patients frequently experience comorbid conditions including chronic pain, depression, and anxiety that require careful medication management 3, 4
• Bupropion can cause modest increases in blood pressure, particularly in the first 8 weeks of treatment 5

Safer Weight Loss Alternatives for EDS Patients

Non-Pharmacological Approaches (First-Line)

• Structured lifestyle modifications with regular follow-up through personal office visits, phone calls, or digital communication 1
• Moderate physical activity with appropriate joint protection strategies given the joint hypermobility in EDS 1, 4
• Dietary intervention focusing on caloric restriction for weight stabilization or reduction 1

Pharmacological Alternatives (If Non-Pharmacological Approaches Fail)

For patients with EDS who require medication for weight management:

• Orlistat may be safer as it works through a peripheral mechanism (lipase inhibition) with minimal systemic effects 1
• Lorcaserin (where available) has a better cardiovascular safety profile than sympathomimetic agents 1

Special Considerations in EDS

1. Cardiovascular Risk: EDS patients, especially those with vascular type, have increased arterial fragility 2. Medications that increase blood pressure or heart rate should be avoided.

2. Tissue Fragility: The connective tissue disorder in EDS affects multiple organ systems, potentially altering drug metabolism and effects 6.

3. Multisystem Complications: EDS patients often require multiple medications for comorbid conditions, increasing the risk of drug interactions 4.

4. Surgical Considerations: If weight loss is being pursued to qualify for surgery, note that EDS patients have higher surgical complications and may require specialized approaches 7.

Monitoring and Follow-up

If weight management is essential for an EDS patient:

• Focus on non-pharmacological approaches first
• Consider referral to specialists familiar with EDS for comprehensive management
• Monitor for joint stability issues during exercise programs
• Evaluate for comorbid conditions that may contribute to weight gain

In conclusion, the risks of bupropion for weight loss in EDS patients outweigh potential benefits, and safer alternatives should be pursued under close medical supervision.