Medication is the strategic tool

Appetite suppressants are indicated for patients with a BMI of >30 or >27 with  one or more weight-related comorbidity (high blood pressure, high cholesterol, etc).  They are contraindicated in pregnant patients. Bupropion/naltrexone is contraindicated in those who have uncontrolled hypertension, liver disease, history of seizures, eating disorders such as anorexia and bulimia, chronic opioid use, and MAOI use. Zonisamide is contraindicated in those with sulfonamide allergies.

Bupropion/naltrexone side effects include nausea, headache, constipation, dizziness, and insomnia. Zonisamide side effects include nausea, dizziness, fatigue, dry mouth, concentration difficulties, numbness and tingling. Topiramate side effects include dizzines, dry mouth, numbness and tingling, concentration difficulties, altered taste.

Patients who took bupropion/naltrexone on average lost 8% of their body weight at 52 weeks compared to placebo, according to this study. In fact, a majority of the weight loss occurs in the first 16 weeks of therapy. Patients who took 400 mg of zonisamide on average lost 7% of their body weight at 52 weeks compared to placebo, according to this study. Patients who took 384 mg of topiramate daily lost 6% of their body weight at 24 weeks compared to placebo, according to this study.

If you choose to use insurance for medication, pricing will vary based on your specific plan and formulary. Our team assists with prior authorizations when applicable, though approval cannot be guaranteed. Contrave® (naltrexone/bupropion) is available through a partnered mail-order pharmacy for approximately $99 per month with self-pay. In some cases, the individual generic components (bupropion and naltrexone) may be prescribed separately, which can be a lower-cost option when paying out of pocket. Topiramate and zonisamide are available as generic medications and are typically low cost.

Contrave® (naltrexone/bupropion) is available through a manufacturer-partnered delivery pharmacy or can be prescribed to a local commercial pharmacy. The individual generic components — bupropion and naltrexone — as well as zonisamide and topiramate, may also be prescribed and filled at most retail pharmacies.

Contrave® (naltrexone/bupropion) is a capsule that is taken twice daily. Generic bupropion and naltrexone are tablets that are taken once or twice daily. Topiramate comes in capsule or tablet form that is taken twice daily. Zonisamide is a capsule that is taken daily.