What is the difference between Levitricram and Contrave (bupropion and naltrexone) for weight loss?

Naltrexone-Bupropion (Contrave) vs. Levitricram for Weight Loss

Naltrexone-bupropion (Contrave) is FDA-approved for weight loss with an average weight reduction of 3-6% of total body weight, while "Levitricram" is not a recognized medication for weight management. 1

Mechanism of Action and Efficacy

Naltrexone-Bupropion (Contrave)

• Mechanism: Bupropion stimulates hypothalamic proopiomelanocortin neurons while naltrexone blocks opioid-mediated autoinhibition, reducing food cue reactivity and improving eating control 1
• Efficacy:
  • Produces moderate weight loss of approximately 3-6% compared to placebo (1%) at 56 weeks 1
  • Mean percentage total body weight loss (TBWL) of 3.01% according to American Gastroenterological Association (AGA) guidelines 1
  • Clinical trials showed significant weight loss with 32/360 mg/d dosing compared to placebo 1, 2

Levitricram

• Not an FDA-approved medication for weight loss
• No evidence in medical literature supporting its existence as a weight loss medication
• The term may be a confusion or misspelling of another medication

Administration and Dosing

Naltrexone-Bupropion (Contrave)

• Starting dose: Gradual titration over 4 weeks to minimize gastrointestinal side effects 3
• Maintenance dose: Naltrexone SR/bupropion SR 32/360 mg daily (usually divided as two tablets twice daily) 1, 3
• Administration: Oral tablets taken with food to reduce gastrointestinal side effects

Side Effects and Safety Profile

Naltrexone-Bupropion (Contrave)

• Common side effects: Nausea (most common), constipation, headache, dizziness, insomnia, dry mouth, vomiting 1, 3, 2
• Serious concerns:
  • Increased treatment discontinuation due to adverse events (RR 2.39) compared to placebo 1
  • Neuropsychiatric effects including risk of depression and suicidal ideation 4
  • Modest increase in blood pressure and heart rate 4, 2
  • Contraindicated with opioid use, seizure disorders, uncontrolled hypertension, and during pregnancy 3
  • Should not be used within 14 days of MAOIs 1, 3

Monitoring and Follow-up

Naltrexone-Bupropion

• Efficacy assessment: If less than 5% weight loss after 12 weeks at maintenance dose, discontinue treatment 3
• Discontinuation: Gradual tapering recommended to minimize withdrawal symptoms 3
  1. Weeks 1-2: Reduce to 1 tablet twice daily
  2. Weeks 3-4: Reduce to 1 tablet daily
  3. Week 5: Complete discontinuation
• Monitoring: Regular assessment of blood pressure, heart rate, and mood changes 3

Comparative Efficacy with Other Weight Loss Medications

Naltrexone-bupropion produces less weight loss than newer medications:

• Less effective than semaglutide (10.76% TBWL) 1
• Less effective than liraglutide (4.81% TBWL) 1
• Less effective than phentermine-topiramate (8.45% TBWL) 1
• More effective than orlistat (2.8-4.8% weight loss) 1

Special Considerations

Potential Benefits Beyond Weight Loss

• May be particularly beneficial for patients with:
  • Comorbid depression (bupropion component) 1
  • Alcohol use disorders (naltrexone component) 1
  • Smoking cessation needs (bupropion component) 1

Contraindications

• Absolute contraindications include:
  • Concurrent opioid use
  • Seizure disorders
  • Uncontrolled hypertension
  • Use of MAOIs within 14 days
  • Pregnancy 3

Clinical Decision Algorithm

1. Patient Selection:

   • BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities
   • No contraindications (seizure disorders, uncontrolled hypertension, opioid use)
   • Consider for patients with comorbid depression or alcohol use disorder

2. Treatment Initiation:

   • Start with gradual dose titration over 4 weeks
   • Combine with comprehensive lifestyle intervention

3. Monitoring:

   • Assess efficacy and safety monthly for first 3 months
   • Continue only if ≥5% weight loss achieved at 12 weeks
   • Monitor blood pressure, heart rate, and mood regularly

4. Discontinuation:

   • If <5% weight loss after 12 weeks at full dose
   • If intolerable side effects develop
   • Use gradual tapering schedule when discontinuing

In conclusion, naltrexone-bupropion (Contrave) is a moderately effective FDA-approved medication for weight loss with specific benefits for certain patient populations, while Levitricram is not a recognized weight loss medication.