Qnexa and Contrave – appetite suppression and craving control

Qnexa and Contrave – appetite suppression and craving control

Qnexa was recently approved by the FDA and Contrave is likely going to be approved in December. These 2
drugs aren’t new, but they are combinations of safe and effective medications that can be used to help weight
loss. Qnexa is a combination of phentermine and Topemax. Phentermine is a controlled appetite suppressant
and Topemax is a migraine medication. When these medications are used in combination, there can be excellent
appetite suppression and a decrease in carbohydrate cravings. The problem is that Qnexa is a fixed dose of both
phentermine and Topemax. Standard medical practice is to start most patients on 25-50mg of Topemax a day,
and gradually increase the dose until there is good therapeutic control of carbohydrate cravings. With Qnexa, I
can’t do that. The same problem exists with Contrave, which is a combination of the antidepressant Wellbutrin
and the narcotic-craving inhibitor Naltrexone. I generally start patients on 150-300mg of Wellbutrin, and may
increase the dose to 450mg. Naltrexone is started at 25-50mg a day, and the dose must be carefully adjusted to
avoid nausea and upset stomach. I like the combination of Wellbutrin and Naltrexone for weight loss.
Wellbutrin is the only antidepressant that can actually cause weight loss, and by adding Naltrexone, carbohydrate
cravings can significantly diminish. But I don’t like fixed medications like Contrave, because I can’t adjust the
doseage to maximize effectiveness and minimize side effects.