Can Contrave (bupropion/naltrexone) impact eyesight?

Contrave (Naltrexone/Bupropion) and Eyesight: Potential Impacts

Contrave (naltrexone/bupropion) can potentially impact eyesight, primarily due to the bupropion component which may cause angle-closure glaucoma in susceptible individuals and other visual disturbances.

Mechanism and Risk

Bupropion, one of the active ingredients in Contrave, has been associated with specific ocular effects:

• Angle-closure glaucoma: Bupropion can cause mild pupillary dilation, which in susceptible individuals (particularly those with anatomically narrow angles) can trigger an episode of angle-closure glaucoma 1
• Visual disturbances: Bupropion may affect cognitive and motor skills, which can impact visual perception and performance 1

The FDA label for bupropion specifically mentions angle-closure glaucoma as a potential adverse effect requiring patient counseling 1.

Risk Factors and Susceptibility

Certain patients are at higher risk for developing visual side effects:

• Patients with pre-existing narrow-angle anatomy
• Patients with undiagnosed glaucoma
• Those with a family history of glaucoma

It's important to note that pre-existing open-angle glaucoma is not a risk factor for angle-closure glaucoma 1.

Other Potential Visual Effects

While the FDA label specifically mentions angle-closure glaucoma, research on psychotropic medications (the class to which bupropion belongs) suggests other potential ocular effects:

• Accommodation interference: May cause transient blurred vision 2
• Eye movement disorders: Potentially affecting various eye movements 2
• Neuropsychiatric effects: Cognitive impairment and dizziness that may indirectly affect visual perception 3

Monitoring and Prevention

For patients taking Contrave:

1. Pre-treatment assessment: Consider an eye examination to determine susceptibility to angle closure
2. Prophylactic measures: Susceptible individuals may benefit from prophylactic procedures (e.g., iridectomy) 1
3. Patient education: Inform patients about potential visual symptoms that require immediate attention
4. Regular monitoring: Watch for symptoms such as:
   • Eye pain
   • Changes in vision
   • Redness of the eye
   • Swelling around the eye

Clinical Implications

The American Gastroenterological Association lists the common side effects of Contrave, which include dizziness and headache that may indirectly affect vision, but does not specifically list direct visual disturbances as common adverse effects 4.

Management of Visual Side Effects

If visual disturbances occur while taking Contrave:

• Discontinue the medication and seek immediate medical attention for severe symptoms
• Consider ophthalmologic evaluation, particularly if symptoms suggest angle-closure glaucoma
• Discuss alternative weight management options with your healthcare provider

Conclusion

While Contrave is not associated with retinopathy or permanent visual damage like some medications (e.g., chloroquine and hydroxychloroquine 4), the bupropion component carries a specific risk for angle-closure glaucoma in susceptible individuals. Patients should be informed of this risk and monitored appropriately.