Orlistat and Contrave after Bariatric Surgery
Have you wondered about Orlistat (Xenical) or Contrave (Buproprion and Naltrexone) after bariatric surgery? If you’re not as familiar with these medications as the newer Wegovy or Zepbound GLP1s, keep reading. There are OTHER medications for Obesity management!
Find out about all 7 FDA approved medications for Obesity here!
There is a lot of information to overwhelm yourself with regarding medication management. Instead, stick with me and I will tell you what you need to know about medications like Orlistat and Contrave after surgery.
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While the newer GLP1s have made a big splash, the truth is, we have other medications. And we have for quite some time.
Orlistat (Xenical) was FDA approved in 1999 for Obesity management. Contrave was approved in 2014 and I personally remember this moment as a Dietitian working in Obesity treatment. Woah, they are making new medications? What I didn’t know was coming next!
By the way, two more medications are showing to be quite promising in stage 3 FDA trials right now: CagriSema and Retatrutide. Medication for Obesity is here to stay.
If you’re looking for help managing weight after bariatric surgery, you’re in the right place! Grab my free 10 Day Habit Refresh tracker and the corresponding blog posts!
What is Orlistat?
The active ingredient in Orlistat is Xenical. The primary mechanism for this medication is fat malabsorption.
The medication is taken orally three times a day (120 mg each dose). That is a drawback for many to have to remember to take the medication before each meal of the day.
Patients who take Orlistat have said it keeps them accountable to not eat high fat foods when taking the medication so they can minimize the side effects of malabsortion. In this way, the medication can help in both food decisions and the malabsorption inhibiting some calories being absorbed into the body.
When or why use a medication like Orlistat after bariatric surgery?
Bariatric surgery continues to be the most effective treatment to the disease of obesity. It’s super exciting that we also have medication options to add to the toolbox because weight reoccurrence after the first year post-op can be a common part of the journey. What we don’t know is how much. Everyone is different.
A medication like Orlistat after bariatric surgery is safe and effective and can help continue to manage Obesity and Obesity-related diseases in the long run.
The GLP1 medications are more effective, but the cost is a huge hindrance for many. If you do not have diabetes and you can’t afford out of pocket costs for Zepbound, Wegovy or Saxenda without insurance coverage, Orlistat is another option.
The average weight loss results with Xenical is 4% weight loss. Some lose more, some lose less. To put that into perspective, if someone weighs 200 pounds when they start medication, they might lose 8 pounds. Seems like a small amount but some may have better results especially if they reduce fat intake to avoid side effects and it helps manage further weight reoccurance.
Side effects and contraindications of taking Orlistat after bariatric surgery?
As you might image, the side effects to a prescription medication taken three times a day that malabsorbs fats in your foods leads to fatty stools.
The unpleasant side of this medication is related to bathroom discomforts. Flatulence, fecal urgency, oily stools as well as fat-soluble vitamin or drug malabsorption.
Like I mentioned, some patients find they limit fat in their food choices to limit side effects.
Who should not take Orlistat? Those with a history of an organ transplant, oxalate kidney stones or cholestasis.
What is Contrave?
Contrave is a FDA approved prescription medication for Obesity that combines two active ingredients: Naltrexone and Buproprion.
Naltrexone is used to help patients who struggle with addiction to narcotics or alcohol. It doesn’t cure an addiction but it can help someone who has stopped to stay off drugs or alcohol.
Buproprion is used to treat Major Depressive Disorder or to prevent Seasonal Affective Disorder. Together, these two ingredients have shown to help suppress appetite and reduce cravings.
When or why use a medication like Contrave after bariatric surgery?
Contrave is a medication that may be pursed if someone struggles with strong food cravings. The ingredients in Contrave work together and may help those with stress related eating triggers.
Medications are indicated for those with a BMI over 30, or over 27 with a weight related co-morbidity. After bariatric surgery, medications may be discussed after 12 months post-op if you’re having an extended platuea or weight reoccurance.
The average weight loss results with Contrave is 4-6% weight loss. Some lose more, some lose less. To put that into perspective, if someone weighs 200 pounds when they start medication, they might lose 8-12 pounds. Seems like a small amount but some may have better results especially if the cravings are reduced or weight reoccurance is stopped.
Side effects and contraindications of taking Contrave after bariatric surgery?
The medication is taken orally twice a day. Potential side effects include nausea, vomiting, diarrhea, constipation, headache, agitation/mood changes, fatigue, insomnia, dry mouth and blurred vision.
As with other medications, some will tolerate it well and see results. Others will tolerate it and not see as much result. While others will not tolerate it and pursue other options.
Who shouldn’t take Contrave? Those with a seizure risk, uncontrolled hypertension or chronic opioid use.
Estimated cost of Orlistat and Contrave
These medications are significantly less than GLP1 medications Zepbound, Wegovy and Saxenda. Those medications can be $500-$1200 a month out of pocket.
While not “cheap” Orlistat is less expensive at around $280 a month. That is from the GoodRx website with their coupon. The bottle is 90 capsules and you take three per day.
Contrave has a lower ticket price of around $99 a month. Depending on insurance coverage, you could pay less.
Where to go for prescription and monitoring?
This is a sticky area, especially in light of cost and supply. When it comes to healthcare, you do want to make sure you are working with qualified experts. Obestiy specialized providers are knowledgeable on all 7 FDA approved medication and will know when to layer medication, change dosage or change prescriptions as needed.
I recommend contacting your surgical team to ask if they offer medical management of obesity. If you don’t have access to your team, visit obesitymedicine.org and use the Find a Provider option. These are obesity medicine experts who know medications and the disease very well.
What happens when you stop taking the medication?
I get this question all the time. I’ve even been asked by other dietitians what happens when someone stops taking the medication. How do we teach them to maintain the weight loss?
The short answer is that we don’t. This is a medication treating a chronic disease. It’s not about teaching someone to keep weight off. While some patients may be able to maintain weight when the medicine is titrated down, the vast majority will experience weight relapse when the medicine isn’t present.
That’s a hard pill to swallow (or injection to take). The medications are indicated for long-term use and that means cost and management are long-term.
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