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Naltrexone HCI/bupropion HCI for chronic weight management in obese adults: patient selection and perspectives

机译：纳曲酮盐酸盐/安非他酮盐酸盐用于肥胖成人的慢性体重管理：患者选择和观点

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Naltrexone, an opiate antagonist, and bupropion, a noradrenergic/dopaminergic antidepressant, have many effects on the reward systems of the brain. These medications impact eating behavior, presumably via their impact on food reward. However, only bupropion induces weight loss in obese individuals, while naltrexone does not have any appreciable effect. The combination of 32 mg of naltrexone and 360 mg of bupropion in a sustained-release combination pill form has been recently approved for obesity treatment. Studies have shown that the combination of these two medications is more effective in inducing weight loss, when combined with lifestyle intervention and calorie reduction, than each individual medicine alone. The naltrexone–bupropion combination, when combined with lifestyle intervention and modest calorie reduction, seems to be quite effective for 6-month and 1-year outcomes for clinically significant weight loss (over 5% of total body weight). These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. This paper reviews existing weight loss clinical trials with bupropion and the bupropion–naltrexone combination. Additionally, the rationale for the suggested patient selection and clinical strategies for special patient populations are discussed.
机译：阿片拮抗剂纳曲酮和去甲肾上腺素/多巴胺能抗抑郁药安非他酮对大脑的奖励系统有许多影响。这些药物可能通过影响食物报酬而影响饮食行为。然而，仅安非他酮可引起肥胖者的体重减轻，而纳曲酮则无明显作用。最近已批准将32毫克纳曲酮和360毫克安非他酮以缓释组合药的形式联合用于肥胖症治疗。研究表明，与生活方式干预和减少卡路里结合使用时，这两种药物的组合比单独使用每种药物更有效地诱导体重减轻。纳曲酮-安非他酮的组合与生活方式干预和适度的卡路里减少相结合，对于临床上显着的体重减轻（超过总体重的5％）而言，对于6个月和1年的结局似乎非常有效。这些药物并非没有严重的副作用，但是，仔细的患者选择可以减少严重的并发症并增加阳性结果。本文回顾了使用安非他酮和安非他酮-纳曲酮组合的现有减肥临床试验。此外，还讨论了针对特殊患者人群的建议患者选择依据和临床策略。

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