title: Safety assessment of combination therapies in the treatment of obesity: focus on naltrexone/bupropion extended release and phentermine-topiramate extended release.
abstract: Few studies on combination therapies for the treatment of obesity had been conducted until recently, when two fixed-dose combinations, bupropion-naltrexone ER fixed-dose combination and phentermine-topiramate ER titrated-dose combinations were evaluated in clinical studies that ultimately led to FDA approval. Areas covered: In this review, we discuss safety concerns about both combinations, the rationale and history of combination therapies for obesity (including phentermine plus fenfluramine), and possible future new combinations. Expert opinion: Combination therapies are a promising new area in obesity treatment, similar to what occurs with diabetes and hypertension. Safety assessment is highly important due to the high number of potential users on a chronic basis.
authors.affiliation: a Obesity Unit, Department of Endocrinology, Hospital das Clínicas , University of São Paulo (USP) , São Paulo , Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Halpern
authors.affiliation: a Obesity Unit, Department of Endocrinology, Hospital das Clínicas , University of São Paulo (USP) , São Paulo , Brazil.
authors.forename: Marcio C
authors.initials: MC
authors.lastname: Mancini
mesh_terms: D000818:Animals; D019440:Anti-Obesity Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016642:Bupropion / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D009271:Naltrexone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009765:Obesity / Q000188:drug therapy*; D010645:Phentermine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077236:Topiramate
chemical_list: D019440:Anti-Obesity Agents; D003692:Delayed-Action Preparations; D004338:Drug Combinations; C000591595:bupropion hydrochloride, naltrexone hydrochoride drug combination; D016642:Bupropion; D000077236:Topiramate; D005632:Fructose; D009271:Naltrexone; D010645:Phentermine
keywords: Obesity pharmacotherapy; bupropion/naltrexone; cardiovascular safety; combination therapy; nephrolithiasis; phentermine/topiramate; psychiatric safety; seizures