Contraindications
The manufacturer recommends against its use in people that have/are:
History of seizures
History of an eating disorder such as bulimia nervosa or anorexia nervosa
Taking opioid pain medicines, taking medicines to stop opioid addiction, or are in opiate withdrawal
Taking an MAOI or have taken an MAOI in the last 14 days
Pregnant
Abruptly stopped using: alcohol, benzodiazepines, barbiturates, or antiepileptic drugs

Adverse effects
The U.S. Food and Drug Administration (FDA) has put a boxed warning onto this medicine because it may affect mood and increase the likelihood of suicidal thoughts in people under 25 years old. This is attributed to the bupropion component, as antidepressants have been associated with increased risk of suicidal thoughts, but not suicide, and only in people younger than 25.The safety and effectiveness in children under the age of 18 has not been studied. Mechanism of action
Individually, naltrexone and bupropion each target pathways in the central nervous system that influence appetite and energy use. Bupropion is a reuptake inhibitor and releasing agent of both norepinephrine and dopamine, and a nicotinic acetylcholine receptor antagonist, and it activates proopiomelanocortin (POMC) neurons in the hypothalamus which give an effect downstream, resulting in loss of appetite and increased energy output. The POMC is regulated by endogenous opioids via opioid-mediated negative feedback. Naltrexone is a pure opioid antagonist, which further augments bupropions activation of the POMC.Combined, naltrexone/bupropion has an effect on the reward pathway that results in reduced food craving.
The risk is greater when the mother is small or when the infant is of large weight. Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching themselves by a branch as they fall from a tree. Lower brachial plexus injuries should be distinguished from upper brachial plexus injuries, which can also result from birth trauma but give a different syndrome of weakness known as Erbs palsy. Other trauma, such as motorcycle accidents, that have similar spinal cord injuries to C8 and T1, also show the same symptoms of Klumpkes paralysis. Diagnosis
Electromyography and nerve conduction velocity testing can help to diagnose the location and severity of the lesion. Otherwise, the diagnosis is one made clinically after a thorough neurologic exam. Treatment
Treatment effectiveness varies depending on the initial severity of the injury. Physiotherapy is used to increase strength of muscle and improve muscle functions. Electrical modalities such as electric nerve stimulation can also be used.Occupational therapy to provide exercises and coping mechanisms to improve the patients ability to perform activities of daily living. Goals of therapy are to improve tactile sensation, proprioception, and range of motion.Acute treatment of a severe injury will involve repositioning and splinting or casting of the extremity. Epidemiology
Klumpke Palsy is listed as a rare disease by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH).