Bupropion for Weight Loss
Are you struggling with depression or trying to quit cigarettes and need help with managing your weight? Scroll down to see if Bupropion (Aplenzin/Wellbutrin) is right for you.
What is Bupropion?
Bupropion is an antidepressant medication sold under the brand names Aplenzin and Wellbutrin. It is used to treat depression and help people with quitting cigarette smoking. It can also be used off-label or in conjunction with managing depression to help people lose weight. The difference between Aplenzin and Wellbutrin is how it is dosed. Otherwise, they all use the same active ingredient and are used to similar conditions.
How Does Bupropion Work?
The mechanism by which bupropion promotes weight loss is not entirely clear. Still, it is believed to work by affecting the levels of certain neurotransmitters in the brain, including dopamine and norepinephrine. These neurotransmitters regulate appetite, food cravings, and energy metabolism.
Bupropion may help to reduce appetite and food cravings, which can lead to a decrease in overall calorie intake. It may also increase energy expenditure by increasing the body's metabolic rate, although the exact mechanisms still need to be fully understood.
Who Qualifies for Bupropion?
Wellbutrin and Aplenzin are all FDA-approved for the treatment of depression. However, only Wellbutrin is approved for the management of smoking cessation. If you are currently diagnosed with Major Depressive Disorder (MDD) or Seasonal Affective Disorder (SAD), you may be eligible to start on Wellbutrin or Aplenzin. You are also eligible for Wellbutrin if you are an active cigarette smoker and wish to quit.
Wellbutrin and Aplenzin can also be used off-label for weight loss. If you have a BMI greater than or equal to 30 or a BMI greater than 27 with at least one other weight-related condition (diabetes, high blood pressure, high cholesterol), you may be eligible for this medication.
Can Bupropion Be Used For Weight Loss?
In a study published in 2012, researchers examined the weight loss effects of bupropion in patients struggling with obesity (1). The participants were given different doses of bupropion in combination with a calorie-restricted diet and regular exercise for 24 weeks. The results showed that people taking bupropion in combination with diet and exercise lost around 7-10% of their initial body weight. This tells us that bupropion can benefit people with obesity.
It must be noted that bupropion and any prescription weight loss medication should be taken with dieting and regular exercise.
Bupropion vs Other Prescription Weight Loss Medications
Bupropion vs Contrave
Contrave is an FDA-approved prescription weight loss medication that can be used for people struggling with obesity. It is a combination of two medications: Naltrexone and Bupropion.
In the COR-II trial published in 2013, researchers studied the weight loss effects of Contrave for people struggling with obesity (2). They gave the participants Contrave for 56 weeks, along with a calorie-restricted diet and regular exercise. They found that people taking Contrave lost around 6% of their body weight after 56 weeks. They also saw that Contrave reduced certain cardiometabolic risk factors, such as LDL cholesterol levels, fasting insulin levels, and waist circumference.
When you compare Bupropion to Contrave, it appears that bupropion has a more significant weight loss effect that was achieved in a shorter period of time. However, Contrave is FDA-approved for weight loss which may make it easier to qualify if you do not have depression or are not currently smoking cigarettes. Bupropion may also be better for patients with a history of opioid use disorder or who use opioids chronically since Contrave should be avoided for these patients. Though it contains bupropion, Contrave cannot be prescribed to treat depression. Therefore, for those struggling with depression, bupropion may be the better option.
Bupropion vs Qsymia
Qsymia is a prescription weight loss medication that contains a combination of two drugs: phentermine and topiramate. Phentermine is an appetite suppressant that affects the central nervous system and helps to reduce food cravings. Topiramate is an anti-seizure drug that can also help with weight loss by reducing appetite and increasing feelings of fullness. It also increases the effects of phentermine.
In the CONQUER Trial published in 2011, researchers examined how effective Qsymia was at treating obesity. The study was done over a 52-week period where participants took different doses of Qsymia. Depending on the dose, people on Qsymia lost around 8-10 kg (18-22 lbs). They also saw that around 68% of people noticed at least a 5% reduction in weight after one year (3).
Based on these results, Qsymia seems more effective at reducing body weight. It is also FDA-approved for managing obesity, so getting approval from your insurance provider may be easier.
Bupropion vs GLP-1 medications
The GLP-1 agonist medications were all made to treat type 2 diabetes. They mimic the effects of the naturally produced hormone, GLP-1, released from cells in the gut to regulate blood sugar and slow food movement through the gut. There are many different kinds of GLP-1 agonist medications on the market today. Some are FDA-approved to treat obesity (Wegovy, Saxenda), while others can be used off-label for weight loss (Mounjaro, Ozempic, Rybelsus, Victoza, Trulicity).
These medications have been shown to reduce body weight anywhere from 10-20%, depending on which GLP-1 agonist is used. This is seen especially when a GLP-1 agonist is used with diet and regular exercise. For example, in the SURMOUNT-1 Trial, people taking Mounjaro over 72 weeks noticed an average reduction in body weight of 15% (4).
These GLP-1 medications are very effective for weight loss. However, they often cost substantially more than bupropion. Though there may be potential benefits of GLP-1 medications for depression and anxiety, these medications are not used to treat depression. Bupropion may still be the better medication for those who are also suffering from depression and want to lose weight.
Bupropion Side Effects
The side effects when taking bupropion may vary. The most common side effects include:
- Insomnia (45%)
- Vivid Dreams (~13%)
- Decreased libido or sexual drive (~10%)
- Dry Mouth (27%)
- Constipation (26%)
- Nausea and vomiting (22%)
- Headache (34%)
- Seditation (20%)
- Dizziness (22%)
Bupropion Dosage and Administration
As mentioned, Bupropion is sold under the brand names Alpenzin and Wellbutrin. These medications are given at different doses.
Wellbutrin is given as a twice-daily tablet started at a dose of 100mg (200mg per day). After three days, the dose is increased to 300mg per day (three 100mg tablets per day taken six hours apart). The maximum dosage for Wellbutrin is 450 mg per day.
Alpenzin may be given a different dosing schedule depending on what is being treated (MDD or SAD). For MDD, Alpenzin is started at 174mg once per day. After four days, the dose is increased to 348mg, which you would remain on. For SAD, Aplenzin is also started at 174mg. However, after seven days, the dose is increased to 348mg and continued throughout the winter. Alpenzin can then be slowly tapered and discontinued in the spring.
Bupropion Contraindications and Warnings
Severe Allergic Reaction
You may experience a severe allergic reaction to Bupropion when first taking it. Signs of a severe allergic reaction include swelling of your face, lips, tongue, or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat. Let your provider know immediately if you have experienced this when taking Bupropion in the past.
History of Seizures
Bupropion can potentially increase the risk of seizures depending on the dose. This is particularly dangerous for those who have a history of seizure disorders. If you have had seizures in the past, notify your provider before starting Bupropion.
Anorexia or Bulimia
People suffering from eating disorders like Bulimia and Anorexia may be at a higher risk for seizures when taking Bupropion.
Suicidal Thoughts and Psychiatric Symptoms
Bupropion can potentially worsen suicidal thoughts or thoughts of self-harm. It may also induce psychosis in those at high risk of developing psychiatric disorders such as Bipolar Disorder or Schizophrenia. Make sure to see your provider regularly to monitor any drastic changes in your behavior or the appearance of thoughts of suicide.
Drug Interactions
You should not take bupropion if you are on other bupropion-containing products (Contrave, Wellbutrin, Aplenzin) or are currently taking Monoamine Oxidase Inhibitors (Marplan, Nardil, Emsam, Parnate).
Bupropion Coverage and Cost
Wellbutrin is significantly less expensive than Aplenzin and will probably be the best option. Wellbutrin can cost around $6-$13 for a month’s supply. Payment assistance programs are also available depending on your income or Medicare status to help further reduce the costs.
Aplenzin can cost upwards of $2500 for a month's supply! There are also no generic versions of it available to switch to. However, most pharmacies believe that it is the same as Wellbutrin. Depending on your insurance plan, you may be eligible for an Aplenzin CoPay Coupon to help reduce costs. With this, you can pay as low as $5 per prescription. However, if you do not qualify, then Wellbutrin is likely a better option.
Where Can I Get Bupropion?
If you would like to learn more about Bupropion or want to see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!
Mochi Health is a virtual obesity medicine practice that connects you with medical providers, like licensed physicians and nurse practitioners, to help you optimize your weight loss journey. We provide monthly video chats with actual medical providers to provide guidance about weight management and to get you started on prescription weight loss medications to supplement your weight loss plan.
References
- Anderson, J.W., Greenway, F.L., Fujioka, K., Gadde, K.M., McKenney, J. and O'Neil, P.M. (2002), Bupropion SR Enhances Weight Loss: A 48-Week Double-Blind, Placebo- Controlled Trial. Obesity Research, 10: 633-641. https://doi.org/10.1038/oby.2002.86
- Apovian, C.M., Aronne, L., Rubino, D., Still, C., Wyatt, H., Burns, C., Kim, D., Dunayevich, E. and (2013), A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity, 21: 935-943. https://doi.org/10.1002/oby.20309
- Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, Day WW. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Apr 16;377(9774):1341-52. doi: 10.1016/S0140-6736(11)60205-5. Epub 2011 Apr 8. Erratum in: Lancet. 2011 Apr 30;377(9776):1494. PMID: 21481449.
- Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038. Epub 2022 Jun 4. PMID: 35658024