Bupropion Dosing for Obesity Management
For obesity treatment, bupropion is used in combination with naltrexone as naltrexone/bupropion ER, with a typical maintenance dose of 16 mg naltrexone/180 mg bupropion twice daily after a 4-week titration period. 1
Dose Titration Schedule
The medication requires gradual dose escalation to minimize side effects: 1
- Week 1: 8 mg naltrexone/90 mg bupropion once daily in the morning
- Week 2: 8 mg naltrexone/90 mg bupropion twice daily (morning and evening)
- Week 3: 16 mg naltrexone/180 mg bupropion in the morning, 8 mg naltrexone/90 mg bupropion in the evening
- Week 4 and beyond: 16 mg naltrexone/180 mg bupropion twice daily (maintenance dose)
Expected Weight Loss Outcomes
Clinical trials demonstrate the following weight loss results with the maintenance dose: 1
- COR-I trial: 6.1% weight loss versus 1.3% with placebo
- COR-II trial: 6.4% weight loss versus 1.8% with placebo
- COR-DIABETES trial: 5.1% weight loss in diabetic patients
Ideal Patient Selection
This medication works particularly well for patients with: 1
- Food cravings or addictive eating behaviors
- Concomitant depression (bupropion component provides antidepressant effects)
- Desire to quit smoking or reduce alcohol intake
- Preference for non-controlled substances and oral (non-injectable) medications
Critical Contraindications
Absolute contraindications include: 1
- Uncontrolled hypertension
- History of seizures or conditions predisposing to seizures
- Anorexia nervosa or bulimia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- Recent MAOI use (within 14 days)
- Uncontrolled pain requiring chronic opioid therapy
Important Safety Monitoring
Patients require close monitoring for mood changes, particularly in the first few months of treatment, though phase 3 studies reported no evidence of suicidality. 1 Blood pressure should be monitored regularly given the potential for hypertensive effects.