Pediatric Healthy Lifestyles & Nutrition Toolkit | Page 49

Obesity Pharmacotherapy

c.
Follow-up:
i.
See patient monthly x 3, at least to start
ii.
Increase by 10 mg increments every 1-2 months
iii. For adolescents with BED: start at 20-30 mg QAM x 1 week, then increase by 10-20 mg
increments every 7 days until optimal response obtained. May increase to 70mg QAM as needed
to decrease frequency of binge eating.
iv. In growing youth, monitor height
v.
Consider adding topiramate for patients whose weight loss has reached a plateau
d.
Discontinue:
i.
If unable to tolerate
ii.
If BMI continues to increase
9. Buproprion / Naltrexone ER( Contrave)( mean change in BMI: 5 %) a.
Patient Selection i. FDA-approval:
1. Adults ≥18 years old with BMI ≥30 kg / m2 or BMI ≥27 kg / m2 in presence of at least 1 weight-related comorbidity
2. Consider for patients with a. Strong hunger ii.
b.
Depression
CONTRAINDICATIONS
1.
Uncontrolled hypertension
2.
Seizure disorder or history of seizures
3.
Anorexia or bulimia
4.
undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and
antiepileptic drugs
5.
Use of other bupropion-containing agents
6.
Within 14 days or current use of monoamine oxidase inhibitors
7.
Known allergy to any of the ingredients in Contrave
iii. USE CAUTION
1.
Substance abuse
2.
Glaucoma
3.
High blood pressure
4.
Hepatic or renal impairment( dose adjustments recommended)
5.
Depression, suicidal ideation
6.
Patients at high risk for pregnancy
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