Oral medication plan

If prescribed, most patients will start with bupropion and Naltrexone as the foundation of their oral weight Management treatment plan. If appropriate, your provider may also recommend adding metformin and/or topiramate to your treatment plan.

You may notice a change in your weight in the first few months of treatment. However, for most people, it can take a few months to notice a change in weight. Consistency is key! Taking the medications, eating a healthy diet, and incorporating physical activity into your lifestyle are all crucial steps to achieving results. 

Bupropion and Naltrexone are not magic. To get the best results with these medications, you need to combine them with a healthy diet and regular exercise. It’s also important to have regular check-ins with your Nurx provider to track your progress and adjust your treatment if needed.

The most common side effects of bupropion and naltrexone include nausea, constipation, headache, vomiting, dizziness, insomnia, anxiety and dry mouth. Although rare, serious side effects may occur including seizures, suicidal thoughts, opiate overdose (if taken WITH opioids), increases in blood pressure, liver toxicity, and angle-closure glaucoma.

The most common side effects of metformin are diarrhea, nausea, vomiting, flatulence, abdominal discomfort, loss of appetite, and metallic taste. Rarely, metformin can cause  lactic acidosis, a life-threatening medical emergency that may lead to death and requires hospital treatment. Symptoms of lactic acidosis may include tiredness, weakness, nausea, vomiting, stomach pain, decreased appetite, rapid breathing, dizziness, muscle pain, or feeling cold in your hands or feet. If you experience these symptoms, stop taking metformin and seek medical care immediately. Most people with lactic acidosis with metformin have other conditions that, combined with metformin, lead to lactic acidosis.

The most common side effects of topiramate include somnolence (feeling tired), difficulty concentrating, tingling sensations, dizziness, difficulty sleeping, and depression. Although rare, serious side effects may occur including metabolic acidosis, kidney stones, decreased sweating leading to hyperthermia, and acute angle-closure glaucoma.

We are here to help you manage side effects. If you experience side effects, be sure to let your provider know as they can provide personalized guidance and educational content. They may even be able to prescribe treatment to help you manage these concerns.

For any serious or severe side effects, please seek immediate in-person medical care.

It's important to have open and honest communication with your healthcare provider before taking any medication, especially if you have certain health conditions or if you are taking other medications. Be sure to talk to your healthcare provider before starting these medications if you have depression, other mental illness, diabetes, or are 65 years or older.  

 
• Bupropion may cause changes in your mood or behavior. Stop taking Bupropion and let your healthcare provider know immediately if you develop agitation, hostility, depressed mood, or changes in thinking/behavior that are not typical for you.
    
• Naltrexone can increase the risk of an opioid overdose if you take opioid medications while using it. Do not take this medication if there is a chance you will take opioid pain medication. This medication may increase your blood pressure or cause hypertension. Do not start this medication if you have been diagnosed with coronary artery disease. 
• Metformin is safe for most people. However, you should get metformin from an in-person provider if you have liver or kidney disease, heart failure, low blood pressure, alcohol dependence, or a history of lactic acidosis. Do not take this medication if you are pregnant, breastfeeding, or plan to become pregnant. Additionally, metformin is safe to use with most medications but it's a good idea to talk to your primary care provider before combining metformin with fenofibrate or colchicine as the combination may increase your risk for muscle damage. Additionally, medication such as topiramate, zonisamide, and valproic acid may increase the risk of lactic acidosis.
• Topiramate is safe for most people. However, you SHOULD NOT take topiramate if you have kidney or liver disease, history of glaucoma, history of kidney stones, serious depression. If you have history of depression and/or suicide, reach out to your care provider before starting topiramate. Do NOT get pregnant or breastfeed while taking this medication, as studies show that it can be associated with birth defects. Additionally, topiramate may cause your birth control to be less effective. We recommend touching base with your provider to discuss alternatives and/or strategies to prevent pregnancy while using this.

The medical consult fee is a one time charge of $39. Patients will also be charged an ongoing care fee of $59/month. If you are prescribed oral medication, you may be able to use insurance. If you use cash, your treatment plan will cost $60-105/month depending on your medications.