Synergy Bella Weight Loss Caps with E-visit EMPOWER PHARMACY

THIS ITEM REQUIRES A PRESCRIPTION FROM DR.K. NEW PATIENTS MUST PAY THE NEW PATIENT FEE AND BE SENT AN *APPROVAL MESSAGE* PRIOR TO ORDERING. DO NOT ORDER PRIOR TO THIS OR YOUR ORDER WILL BE CANCELLED MINUS A 5% PROCESSING FEE. RETURNING PATIENTS MAY PLACE AN ORDER WHEN READY AND DO NOT NEED PERMISSION PRIOR TO PLACING A NEW ORDER.

These products ship to all my patients!

*MN: Empower is temporarily shipping STERILE ITEMS ONLY to MN (no creams or oral medications).

WI: Empower has temporarily suspended shipping of all products to the state of WI due to licensing delays.

These products ship from EMPOWER PHARMACY. Please allow 10-14 days for shipping.

These amazing SYNERGY Bella capsules combine some of the awesome ingredients found in brand named Contrave (bupropion/naltrexone) and Qysemia (topiramate), along with some other popular ingredients that can help with weight loss, appetite suppression, and weight loss!

These capsules may be used alone or with your weight loss and/or peptide injections! The only exception to this is tesofensine.

WHO WOULD BENEFIT FROM THESE CAPSULES?

• Patients that want to add an oral medication instead of increasing their dose of an injectable medication due to cost, side effects, etc
• Patients that have stalled and want to "jumpstart" their weight-loss
• Patients that have maxed out their injectable medication dosage but still have not reached their weight loss goals
• Patients that have a starting BMI that is too low to qualify for tirzepatide or semaglutide. If your starting BMI is 27 or above, you will be eligible for these medications

AVAILABLE OPTIONS

These capsules are available in six different formulations. Please take time to read ALL information about each ingredient and pay attention to the warnings. Please let us know if you have any questions about which formulation to order! Also, please make sure we have a complete and updated list of your current medications in your Push Health account.

1) Synergy Bella REGULAR Caps: Bupropion HCL/Naltrexone HCL/Topiramate 65mg/8mg/15mg

2) Synergy Bella PLUS Caps: Bupropion HCL/Naltrexone HCL/Topiramate/Caffeine/Oxytocin/B12 (Methylcobalamin) 65mg/8mg/15mg/20mg/100IU/1mg

3) Synergy Bella PLUS DECAF Caps: Bupropion HCL/Naltrexone HCL/Topiramate/Oxytocin/B12 (Methylcobalamin) 65mg/8mg/15mg/100IU/1mg

4) Synergy Bella SUPER MET Caps (PLUS Caps + METFORMIN): Metfomin/Bupropion HCL/Naltrexone HCL/Topiramate/Caffeine/Oxytocin/B12 (Methylcobalamin) 250mg/65mg/8mg/15mg/20mg/100IU/1mg

5) Synergy Bella SUPER MET DECAF Caps: Metfomin/Bupropion HCL/Naltrexone HCL/Topiramate/Oxytocin/B12 (Methylcobalamin) 250mg/65mg/8mg/15mg/100IU/1mg

6) Synergy Bella SUPER MET BF (Bupropion-Free) Caps: Metfomin/Naltrexone HCL/Topiramate/Caffeine/Oxytocin/B12 (Methylcobalamin) 250mg/8mg/15mg/20ng/100IU/1mg ***THIS VERSION OF THE MEDICATION WAS DISCONTINUED BY EMPOWER PHARMACY AND IS NOT CURRENTLY AVAILABLE WITHOUT THE BUPROPION. I AM LEAVING IT HERE SO THAT CURRENT USERS OF THIS MEDICATION CAN VIEW INFORMATION.***

*The amount of caffeine in these caps is only 20mg. In comparison, a 12-ounce can of Dr. Pepper has 27mg and a Coke has 34mg of caffeine. The SUPER MET BF caps are NOT available in a DECAF form.

**Patients currently taking other medications that also inhibit the uptake of norepinephrine and/or dopamine (SNRIs like Pristiq, Cymbalta, and Effexor; or NDRIs like Focalin, Ritalin, and Wellbutrin) should use the SUPER MET BF (Bupropion-Free) capsules (NOT CURRENTLY AVAILABLE, SEE ABOVE).

***Patients with a history of uncontrolled high blood pressure, seizures, severe depression, a history of suicidal ideations, or mania should also use the SUPER MET BF (Bupropion-Free) capsules (NOT CURRENTLY AVAILABLE, SEE ABOVE).

****Patients taking chronic opiates (including tramadol) would not want to use any of these due to the LDN found in the capsules.

BUPROPION

Unlike the antidepressants that are selective serotonin reuptake inhibitors (SSRIs), which medical professionals believe work by upping serotonin levels in the brain, bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI).

NDRIs work similarly to SSRIs in that they block the reuptake of chemical messengers, but instead of serotonin, they inhibit the reuptake (or reabsorption) of norepinephrine and dopamine. Sometimes, these two important chemical messengers can malfunction, and this can cause mood disorders like depression and anxiety. Buprpion leads to increased norepinephrine and dopamine, which can help with depressive episodes.

Dopamine and norepinephrine affect appetite and the feeling of fullness (satiety). Listening to hunger cues and controlling the urge to eat can be more difficult for people with overweight or obesity. But bupropion leads to increased dopamine levels, which may help those with obesity experience fewer cravings.

Bupropion may also help reduce body mass by improving energy levels. This can lead to feeling more energetic and being able to do light to moderate physical activity.

When combines with naltrexone, it is uniquely designed to reduce hunger and control cravings, so you can lose weight and keep it off when combined with diet and exercise.

**WARNINGS WHILE TAKING BUPROPION**:

• Do NOT take this medication if you have uncontrolled blood pressure.
• Do NOT take this medication if you have a history of seizures, as this medication can increase your risk of seizures.
• Bupropion may cause psychiatric disorders, including suicidal thinking and behavior, hallucinations, confusion, paranoia, irrational fears and manic episodes (for people with undiagnosed bipolar disorder).
• Bupropion has caused some people to have suicidal thoughts or actions or unusual changes in behavior, whether or not they are taking medicines used to treat depression. Bupropion may increase the risk of suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. If you already have depression or other mental illnesses, taking bupropion may cause it to get worse, especially within the first few months of treatment.
  
• The most common side effects of using bupropion with naltrexone include nausea, constipation, headache, vomiting, dizziness, trouble sleeping, dry mouth, and diarrhea.
  
• Do not take any medications that are monoamine oxidase inhibitors (MAOIs). You must stop these medications at least 2 weeks before taking these capsules.

NALTREXONE (LDN)

Naltrexone was first approved by the FDA in 1984 to treat opioid addiction. Later on, it was discovered that low-dose naltrexone (LDN)---low dose being one-tenth of naltrexone’s usual dose---has anti-inflammatory and immune-modulating effects. LDN appears to be safe with few side effects and no abuse potential. It is also cost-effective because only a small amount is needed. Research on LDN also demonstrated improvements in other diseases.

LDN appears to contribute to weight loss by a number of mechanisms. Studies have shown that LDN may help curb your appetite by reducing the appeal of food. As a result, you start losing your cravings for food. LDN may also aid in increasing the body’s growth hormone levels. Growth hormone helps in weight loss by facilitating the building of lean muscles and burning of fats. Insulin resistance is another issue. It contributes to weight gain, obesity, and a number of other diseases like diabetes, heart attacks, and strokes. LDN helps reduce insulin resistance therefore, not only does it have the potential to help with weight loss, but it may also address other potential diseases!

**WARNINGS WHILE TAKING LDN**:

• Do not take any opioid medications for at least 2 weeks before starting LDN or you experience sudden opioid withdrawal. People who take naltrexone must not use any type of opioid (must be opioid free) including prescription pain medicines (including tramadol), cough, cold, or diarrhea medicines that contain opioids, or opioid dependence treatments, buprenorphine or methadone, for at least 7 to 10 days before starting LDN. Using opioids in the 7 to 10 days before you start taking LDN may cause you to suddenly have symptoms of opioid withdrawal when you take it. Sudden opioid withdrawal can be severe, and you may need to go to the hospital.
• You may be at risk of opioid overdose. Naltrexone can increase your chance of having an opioid overdose if you take opioid medicines while it. You can accidentally overdose in 2 ways:

1. Naltrexone blocks the effects of opioids, such as methadone or opioid pain medicines. Do not take large amounts of opioids, including opioid-containing medicines, such as prescription pain pills, to try to overcome the opioid-blocking effects of naltrexone. This can lead to serious injury, coma, or death.
2. After you take naltrexone, its blocking effect slowly decreases and completely goes away over time. If you have used opioid-containing medicines while on LDN, using opioids in amounts that you used during treatment with naltrexone after discontinuing it can lead to overdose and death. You may also be more sensitive to the effects of lower amounts of opioids if you miss a dose of LDN or discontinue LDN.

**It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose

METFORMIN

There are a few ways that metformin might impact weight. One is that the medication can reduce your appetite. This is because metformin increases the body’s sensitivity to hormones such as insulin and leptin. Leptin is in charge of telling your body when it is full and should stop eating, so increased sensitivity to this hormone can result in you feeling less hungry.

Additionally, research suggests that metformin may increase secretion of the GLP-1 hormone, which suppresses appetite and can cause weight loss. Tirzepatide and semaglutide also target this hormone.

Metformin may also reduce weight by decreasing the amount of visceral fat in the liver and muscle tissue. Visceral fat is stored within the abdominal cavity, which contains several internal organs, including the liver, stomach, and intestines. It can also build up in muscles including the heart muscle. Visceral fat is considered more dangerous than subcutaneous fat because it is associated with an increased risk of various health conditions, such as heart disease.

TOPIRAMATE

Topiramate may be used off-label to help with weight loss in people who have obesity. It’s also combined with phentermine in an FDA-approved weight loss medication called Qsymia. It can aid with weight loss in several ways:

1. It can speed up your metabolism.
2. It is also known to facilitate weight loss by suppressing appetite.
   
3. Topiramate also facilitates weight loss by reducing the excitation of the nerves in your brain’s addiction centers. If you’re like many Americans, you are addicted to sugar. If you try to cut back on your sugar consumption to lose weight, you may experience such withdrawal symptoms as dizziness, fatigue, debilitating headaches, difficulty concentrating, cravings, depression, and anxiety. This drug changes the neural pathways in these parts of the brain, reducing withdrawal symptoms, including cravings and mood swings. Therefore, you will be less likely to binge due to anxiety or depression caused by sugar withdrawal.
4. You may find weight loss easier if you take topiramate because it reduces the amount of leptin your body produces. Leptin is known as the hunger hormone and tells you that you need to fuel your body. This drug also reduces cortisol, a hormone known to cause belly fat gain.

OXYTOCIN

Oxytocin plays a key role in regulating energy homeostasis by controlling appetite and expenditure. Studies have shown that oxytocin can reduce food intake by decreasing the desire to eat and increasing feelings of fullness. This is thought to be mediated by oxytocin’s effects on the hypothalamus, a brain region controlling hunger and satiety.

In addition to reducing food intake, oxytocin has also been shown to increase energy expenditure. This can be achieved by increasing thermogenesis, which is the process of burning calories to produce heat, and by promoting the use of fat as an energy source. This can lead to a decrease in body fat and an increase in lean muscle mass.

Overall, oxytocin’s effect on energy homeostasis promotes weight loss by decreasing food intake and increasing energy expenditure. This can help to regulate body weight and improve overall health.

VITAMIN B12 (METHYLCOBALAMIN)

Known as the "energy vitamin", vitamin B12 can increase your energy level and help prevent fatigue. Vitamin B12 increases energy, aids in fat and carbohydrate metabolism, and has been shown to suppress your appetite. It also stimulates the utilization of proteins, fats, and carbohydrates in the body.

One of the ways vitamin B12 works in your body is by reducing energy. This energy allows you to be active and not feel fatigued. Energy is very important when it comes to losing weight. Vitamin B12 injections help with this process by increasing your energy, which ramps up your metabolism. A faster metabolism burns more calories This vitamin is also used to help your body get rid of fat more efficiently. It plays an important role in the metabolism of fat through your liver. Some research shows that low levels of vitamin B12 in the body actually contributes to weight gain and obesity. Sufficient levels of the vitamin in your body have been linked to a decreased risk of obesity.