Naltrexon/Bupropion in der Adipositastherapie

M. Blüher

doi:10.1055/s-0038-1654051

Adipositas - Ursachen, Folgeerkrankungen, Therapie, Table of Contents

Adipositas - Ursachen, Folgeerkrankungen, Therapie 2018; 12(02): 60-67
DOI: 10.1055/s-0038-1654051

Übersichtsarbeit

Schattauer GmbH

Naltrexon/Bupropion in der Adipositastherapie

Naltrexone/Bupropion for chronic weight management

M. Blüher

¹Universität Leipzig

› Author Affiliations

Abstract

Zusammenfassung

In der Therapie der Adipositas reichen häufig konservative Basistherapiemaßnahmen wie eine energiereduzierte Mischkost, eine Erhöhung der körperlichen Aktivität sowie eine Verhaltensmodifikation nicht aus, um die individuellen Gesundheitsziele langfristig zu erreichen. Eine medikamentöse Therapie kann bei nicht ausreichendem Erfolg in Kombination mit dem Basisprogramm erwogen werden. Seit Januar 2018 ist mit Naltrexon 32mg/Bupropion 360mg eine neue Pharmakotherapie der Adipositas in Deutschland eingeführt. Naltrexon ist ein _-Opioidrezeptor- Antagonist und Bupropion ein schwacher Inhibitor der neuronalen Dopamin- und Noradrenalin- Wiederaufnahme die zusammen über die Wirkung auf den Nucleus arcuatus des Hypothalamus und das mesolimbische dopaminerge Belohnungssystem zu einer Verringerung der Nahrungsaufnahme beitragen. Die Wirksamkeit und Sicherheit von Naltrexon/Bupropion wurde zusätzlich zur Basistherapie in vier doppelblinden Placebo-kontrollierten Phase III-Studien bei 4 536 Personen mit Adipositas oder Übergewicht über einen Zeitraum von 56 Wochen untersucht (COR-I, COR-II, CORBMOD, COR-Diabetes). Unter Naltrexon/Bupropion wurde in der COR-I Studie eine durchschnittliche prozentuale Gewichtsabnahme von 5,4% im Vergleich zu 1,3% in der Placebogruppe erzielt. Zu den häufigsten Nebenwirkungen von Naltrexon/Bupropion zählen Übelkeit, Erbrechen, Obstipation, Durchfall, Schlaflosigkeit, Kopfschmerzen, Schwindel und Mundtrockenheit.

Summary

Obesity treatment with caloric restriction, increased physical activity and behavior modification are frequently not effective to achieve individual weight loss or health goals in the long term. Pharmacotherapy may be considered if these basic conservative therapies are not sufficient. Since January 2018, a proprietary formulation of extended release Naltrexone 32mg/Bupropion 360mg is available for the pharmacotherapy of obesity in Germany. Naltrexone is a _-opioid receptor antagonist and Bupropion a noradrenergic/dopaminergic antidepressant, which together have effects on the Nucleus arcuatus in the hypothalamus and the mesolimbic dopaminergic reward system to reduce food intake. Efficacy and safety of Naltrexone/Bupropion (NB) has been investigated in combination with behavior modification in four double blind, placebo-controlled phase III clinical trials in 4,536 individuals with obesity or overweight for 56 weeks outcomes (COR-I, COR-II, COR-BMOD, COR-Diabetes). In the COR-I trial, Naltrexone/ Bupropion led to a mean weight loss of 5.4% compared to 1.3% in the placebo group. Common adverse effects of Naltrexone/Bupropion include nausea, vomiting, constipation, diarrhea, headache, dizziness, insomnia and dry mouth.

Schlüsselwörter

Adipositas - Naltrexon/Bupropion - BMI - Gewichtsreduktion

Keywords

Obesity - Naltrexone/Bupropion - BMI - weight management

Full Text

References

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