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The black box on Contrave warns that this drug may cause suicidal thinking and behavior in young adults, whether or not patients are taking medicines used to treat depression

Metabolic rate increase and thermogenesis How tesofensine boosts metabolism: Norepinephrine stimulates beta-adrenergic receptors Activates thermogenesis in brown and white fat Increases basal metabolic rate 5-10% Enhanced fat oxidation (preferential fat burning) Similar to ephedrine effects but stronger Energy expenditure studies: Clinical trials showed increased resting energy expenditure 24-hour metabolic rate elevated 5-10% Translates to ~100-200 extra calories burned daily Combined with appetite suppression = larger deficit Thermogenesis mechanism: Why metabolism boost matters: Creates deficit even without appetite changes Counteracts metabolic adaptation Preserves lean mass better Enhanced fat loss vs muscle loss Different advantage vs GLP-1 agonists Cardiovascular cost: Increased metabolism = increased heart rate Blood pressure elevation Cardiac workload increased Major safety concern Why FDA rejected despite efficacy See best peptides for energy and fat loss peptides

Multidisciplinary collaboration between diabetes specialists, rheumatologists, gastroenterologists, or other relevant specialists is advisable to ensure coordinated care and appropriate monitoring

Prevalence and Correlates of Coronary Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: PROMIS-HFpEF

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