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Comment by swyx | Hacker News Reader

for those who are interested in a cheaper, partially generic, pill based option for weight loss, i was just referred by a friend to the naltrexone + bupropion + metformin solution offered by hims (not linking because their website is terrible for learning anything without giving all your health info). he lost 30lbs in 3 months on it. i've just started so i cant vouch but just sharing that non GLP1 appetite suppression solutions that work exist.

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Naltrexone in high doses takes away all pleasure by blocking opioid receptors (low doses do too, but it is different when only a few hours). So there is no reward for drinking or eating if that is why you are eating. If this is not why you eat it will be less effective.

Bupropion acts as a norepinephrine–dopamine reuptake inhibitor. Importantly it doesn't directly raise your serotonin. If you are a night owl, have trouble falling asleep etc you might have low serotonin to start and this could be bad for you.

Both of these are associated with suicidal thoughts. There is a reason HIMS requires your health info before suggesting drugs. I would flag the parent as providing dangerous information.

i mean your comments are helpful and useful context but no need to go censoring information just knowing about the existence of things?

I've never heard of combining metformin with the other two drugs. The naltrexone/bupropion combination is sold under the brand name Contrave. As with any weight loss drug, I recommend a healthy amount of scepticism. Contrave's history includes an initial FDA disapproval and two prematurely terminated studies, and the drug changed hands a couple of times.

https://en.wikipedia.org/wiki/Naltrexone/bupropion#History

This is sold as Contrave / MySimba, albeit adding metformin to the mix is a little unusual

https://en.m.wikipedia.org/wiki/Naltrexone/bupropion

For those not aware: Metformin is a popular (unapproved?) nootropic.

My guess is metformin is here because of its effects on blood sugar. It is available as a prescription drug for this purpose.

Some people who come off the GLP-1 meds (acheiving goal weight) are recommended by their docs to take metformin as a maintenance drug to stabilize weight.

I had an endo suggest that to me. In addition there's been a flurry of Peter Thiel types mentioning it as a life-extension wonderdrug.

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