From the Guidelines
Bupropion combined with oral naltrexone is not a recommended treatment option for methamphetamine use disorder based on the provided evidence. The study by 1 focuses on the combination of pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders, but it does not specifically address the use of bupropion and oral naltrexone for methamphetamine use disorder.
Key Points to Consider
- The study 1 highlights the importance of combined pharmacological and behavioral interventions for substance use disorders, but it does not provide evidence for the specific combination of bupropion and oral naltrexone for methamphetamine use disorder.
- Cognitive behavioral therapy (CBT) is a first-line behavioral approach for treating substance use disorders, including methamphetamine use disorder, and should be considered as part of a comprehensive treatment program.
- The mechanism of action of bupropion and naltrexone, as well as potential side effects, should be carefully considered when evaluating treatment options for methamphetamine use disorder.
- A comprehensive treatment program that includes behavioral therapy, counseling, and support groups is essential for addressing the psychological aspects of addiction.
Treatment Approach
Given the lack of evidence for the specific combination of bupropion and oral naltrexone for methamphetamine use disorder, treatment should focus on established behavioral therapies, such as CBT, and other evidence-based interventions. Pharmacotherapy options should be carefully evaluated based on individual patient needs and the latest clinical guidelines.
From the Research
Bupropion and Oral Naltrexone in Methamphetamine Use Disorder
- The use of bupropion and naltrexone to treat methamphetamine use disorder has been studied in several clinical trials 2, 3.
- A multisite, double-blind, two-stage, placebo-controlled trial found that the combination of extended-release injectable naltrexone and oral extended-release bupropion was effective in reducing methamphetamine use in adults with moderate or severe methamphetamine use disorder 2.
- The trial found that 13.6% of participants in the naltrexone-bupropion group had a response, defined as at least three methamphetamine-negative urine samples out of four, compared to 2.5% in the placebo group 2.
- Another study found that the combination of naltrexone and bupropion was safe and potentially effective in reducing methamphetamine use in a small sample of participants 3.
- However, a systematic review and meta-analysis found that the addition of bupropion to cognitive behavioral therapy did not reduce the risk of relapse compared to cognitive behavioral therapy alone 4.
Adverse Events and Safety
- The combination of naltrexone and bupropion was associated with adverse events such as gastrointestinal disorders, tremor, malaise, hyperhidrosis, and anorexia 2.
- Serious adverse events occurred in 3.6% of participants who received naltrexone-bupropion during the trial 2.
Comparison to Other Treatments
- Cognitive behavioral therapy and contingency management have been found to be effective in reducing methamphetamine use, but the evidence for pharmacologic treatments is limited 5, 6.
- A review of the neurobiology and clinical presentation of methamphetamine use disorder found that there is a need to develop interventions aimed at novel biological targets and to better understand the complex neurobiology of the disorder 6.