Yolanda called to ask if we could compound a version of a new prescription drug on the market called CONTRAVE.

CONTRAVE is a combination of Naltrexone and Bupropion that “may help some obese or overweight adults, who also have weight related medical problems, lose weight and keep the weight off” (directly from CONTRAVE marketing material). It costs approximately $225 for 120 doses. There is a graduated dosing schedule that begins at 1 tablet daily, increasing to 4 daily. After the ramping up of dosing, the bottle of 120 doses will last one month, at a cost of approximately $2,700 per year.

It is obviously expensive and Yolanda is hoping to get her hands on the drug for less.

One thing to understand is that compounding pharmacists are not permitted to duplicate a commercial drug (that’s been FDA approved) unless there is a significant clinical reason to do so.

Wanting a lower cost is not clinically relevant. That immediately removes the compounder from legally duplicating the product.

Well, suggested Yolanda, couldn’t the pharmacist just make an 8mg dose of Naltrexone – in slow release formulation – so she can get a cheaper prescription for bupropion (Wellbutrin is one trade name product)?

Technically, the answer is yes. However, knowing that the most common doses of naltrexone are in the 3.0mg to 4.5mg range (and they’re not slow release) would lead any reasonable person to conclude that Yolanda was using the slow release 8 mg dose in combination with Wellbutrin only to reduce her costs for the drug. Because we’d know what she was intending, we’d be complicit in her plan – making it an illegal activity on our part.

There is no clinical rationale for making this dose of naltrexone and, therefore, no legitimate reason to make it.

Why would anyone want to take CONTRAVE? The drug maker’s advertising says, “CONTRAVE should be used with a reduced-calorie diet and increased physical activity”. They fail to mention that those two things will result in weight loss without their drug and without the risk of side effects.

The most common side effects of CONTRAVE include: nausea, constipation, headache, vomiting, dizziness, trouble sleeping, dry mouth, diarrhea, severe allergic reactions, increased blood pressure or heart rate, liver damage or hepatitis, glaucoma, low blood sugar, thoughts about suicide or dying, attempts to commit suicide, depression, anxiety, feeling very agitated or restless, panic attacks, irritability, acting aggressive, being angry or violent, acting on dangerous impulses, an extreme increase in activity and talking (mania), and other unusual changes in behavior or mood.

There has to be something seriously out of balance for a person to even think it reasonable to take this combination of drugs to lose weight – especially as the instructions for using it say to reduce calories and increase daily activity, which can be done for no cost and with no risk of serious side effects.

This incident clearly demonstrates how far from the idea of health we’ve fallen in this country – probably other places as well. I conclude that the drug is an insane product, made by companies who care far more about their bottom lines than helping people. It will be purchased by equally delusional patients who honestly believe a pill will help them drop the pounds. Yes, delusional.

Sorry, Yolanda, we can’t and won’t help you commit an illegal act, defraud a drug company, and potentially kill your self. Regardless of your reason behind wanting to use it, CONTRAVE is not a rational solution.