As if the push for natural weight loss supplements was not bad enough, Big Pharma is at it again. This time with weight loss pills. It is not bad enough that they pick at your wallet, they pick at your pride.

“New” Weight Loss Pills Are Really “Old”

I still remember when I first saw the commercial for Contrave back in 2016. Weight loss pills are all the rage on the television with audiences hoping for a quick fix, and this ad was no different. I watched it with curiosity, skeptical as always about these Big Pharma ads, and then exploded with disgust at the end of it.

Contrave is a combination of two drugs, naltrexone and bupropion. Each of these drugs is available in generic form and has been available for years. Together in one pill, however, the medication is now brand-name only, and therefore much more expensive.

According to GoodRx, the lowest out of pocket cost for a 30-day supply of the drug is $515. The cost of comparable doses of naltrexone and bupropion, again without insurance, only average $99 and $20 per month, respectively, for a grand total of $119. That’s a difference of $396 for the very same medications used in brand-name form.

Ouch, or as Big Pharma would say, cha-ching.

What You Need to Know about Naltrexone and Bupropion

Naltrexone is a drug first patented in 1967 with clinical trials started in 1973. As you can see, it has been around quite a long time. The drug has been FDA approved to treat alcohol dependence and opioid addiction at doses of 50mg daily (Contrave only offers up 32mg daily). The medication is NOT a cure for substance use disorders but if taken consistently can help to decrease the risk of relapse once someone is sober.

The idea is that naltrexone decreases the craving for alcohol and opioids by blocking opioid receptors. Could it also decrease your craving for food? Could it cut down on binge-eating? The data is not all that impressive. The drug may help with weight loss more from its side effects of anorexia and nausea. The problem, however, is that naltrexone increases your risk for depression and suicide too.

This is why they added the second ingredient, bupropion.

Bupropion is a medication used to treat major depressive disorder and seasonal affective disorder. A brand-name version of the drug, Zyban, is approved by the FDA for use in smoking cessation. The maximal recommended dose is 450mg per day and Contrave gets relatively close to that at 360mg per day.

The risk of seizure with the medication increases as the dose gets higher. Using bupropion with alcohol or with medical conditions that increase seizure activity can also put you at risk. This is the reason why Contrave is contraindicated for people with eating disorders. Interestingly, those with binge eating disorders are the ones who would theoretically respond best to the naltrexone.

There are many side effects to consider when you take bupropion. Interestingly, some of the side effects of bupropion are changes in appetite (anorexia OR increased appetite), weight loss, or weight GAIN. Yes, you read that right. The very problem Contrave aims to treat could be a possible side effect of the medication.

Manipulating the Dose of Combination Pills

Cost and side effects are not the only reason I have an issue with Contrave or most drug combination pills for that matter. The issue that drives me most crazy is dosage.

The truth is that Big Pharma is after profit margins more than bettering your health (why else would it be spending big bucks to repurpose old drugs than to develop new ones?). To get at the big bucks, they manipulate how they perform their clinical trials. Instead of using doses of naltrexone or bupropion that are currently available on the market, they used obscure doses in their studies. The FDA then approved the drugs for the treatment of obesity but only at those very specific doses.

Why did they do this? Because your doctor cannot prescribe you the generic medications if those doses are not available.

Why else did they do this? Because by performing clinical trials at doses lower than the available generic medications, they make it look like prescribing the available generic drugs might be overkill, literally a possible overdose.

All this gameplay keeps the money with the brand-name product and out of the hands of generic manufacturers. Again, cha-ching.

The FDA and Big Pharma

It amazes me that the FDA lets Big Pharma get away with it. The FDA could help to curtail drug costs by requiring companies that perform studies on long-standing generic medications to do one of the following:

• Require them to include an arm in their study with doses that already exist in the current market
• Require them to manufacture generic versions of each drug at the doses used in their study

These measures would not only allow the FDA to see if available doses would be safe for use but would promote cost controls by making generics available for the same indication. The cost of American pharmaceuticals is sky-rocketing. It is time to take action. Instead, Big Pharma can charge exorbitant prices for the privilege of being the only drug with that FDA-approved indication.

The pharmaceutical companies try to look like good guys by offering discount coupons to those who cannot afford it, but in the end, that just ends up shifting costs to the insurance companies for those who do have coverage. The insurance companies then take it out on us, often with higher deductibles and premiums. In the end, we all pay.

Do Weight Loss Pills Even Work?

The argument for Contrave would be more compelling if these weight loss pills even worked. The results are modest at best. According to a summary report from Consumer Reports, the average person who used Contrave lost 12 pounds over a year compared to a 3-pound weight loss with a placebo. People who had diabetes and used Contrave lost less weight, only 9 pounds compared to 4 pounds with a placebo.

Is so little weight loss worth all those side effects?

Your money may be better spent on other activities, experiences, or items that can promote health and wellness.

 

Bupropion. GoodRx. https://www.goodrx.com/bupropion

Contrave. GoodRx. https://www.goodrx.com/contrave

Is Contrave Worth Trying If You Want to Lose Weight? (2016). Consumer Reports. https://www.consumerreports.org/drugs/is-contrave-worth-trying-to-lose-weight/

Naltrexone. GoodRx. https://www.goodrx.com/naltrexone