Naltrexone & Weight Loss! General Question's About Drug Therapy!

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In order to understand how important Naltrexone has been to my weight loss practice, I need to say a few words about the bane of every dieter--the plateau.  The most likely explanation for plateaus is the set point theory.  That is, the set point acts as a weight thermostat.  Most people can lose somewhere between 10 to 20% of their body weight without too much difficulty.  Beyond that however, the weight thermostat kicks in and then your body fights you for every ounce.  (So when you hit your plateau and your diet starts to fail, it is not really your fault).

Even with the traditional appetite suppressants (eg Phentermine), once you hit that plateau the going gets very tough.  Phentermine works on one neurologic pathway that suppresses appetite; the body's weight thermostat has at least three pathways that make you hungry, very hungry.  One of these pathways is regulated by beta-endorphin.  The other two are regulated by leptin and ghrelin respectively.

Naltrexone blocks the beta-endorphin dependent pathway.  I usually start my patients on a phentermine-type appetite suppressant and then, when they hit the plateau, add Naltrexone.  The Naltrexone has exceeded all of my expectations.  The medicine is very safe and has very few side effects.  Granted, the weight loss is slow but if you have ever been stuck at your plateau weight for five months just seeing the scale move again is reason for celebration.

I got the idea to try Naltrexone after reading the very impressive results of the phase III clinical trials for a medicine called Contave.  Contrave is a combination of Bupropion and Naltrexone.  I tend to combine the Naltrexone with Phentermine because my patients are already on Phentermine.  Bupropion and Phentermine work along a similar neurologic pathway.  In any case, here is what jumped out at me from the Contrave study: the subjects kept losing weight at a steady pace--no plateau.  Every other study of a weight loss drug shows that subjects lose weight rapidly for eight to twelve weeks and then they hit a "wall".

N.B.  You cannot take Naltrexone if you take opiates for pain or recreationally.  Chronic opiate users could have a dangerous opiate withdrawl if they were to take Naltrexone.  Patients who use opiates occasionally would not gain pain relief.  Otherwise Naltrexone is very safe and well-tolerated.