Contrave represents a significant advancement in pharmacological weight management, combining two well-established medications into a single, targeted therapeutic regimen. This prescription-only treatment is specifically indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of 30 kg/m² or greater (obesity), or 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbidity. Its unique mechanism addresses both the physiological and behavioral components of weight regulation, offering a comprehensive approach for appropriate patients under medical supervision. This product card provides a detailed, evidence-based overview for healthcare professionals and informed patients.

Features

• Active Ingredients: A fixed-dose combination of naltrexone HCl (8 mg) and bupropion HCl (90 mg) in an extended-release formulation.
• Mechanism of Action: Dual-action therapy targeting the hypothalamus (appetite regulation) and the mesolimbic dopamine reward system (food cravings).
• Dosage Form: Oral, extended-release tablets designed for twice-daily dosing.
• Treatment Protocol: Includes a structured 4-week titration pack to minimize initial side effects and improve tolerability.
• Prescription Status: Available only by prescription, requiring diagnosis and ongoing monitoring by a healthcare provider.

Benefits

• Promotes significant and sustained weight loss when combined with lifestyle modifications.
• Helps reduce calorie intake by diminishing hunger and increasing feelings of fullness (satiety).
• Aids in controlling cravings, particularly for high-fat and sweet foods, by influencing the brain’s reward pathways.
• Provides a non-surgical pharmacological option for individuals who have struggled to lose weight through diet and exercise alone.
• Can lead to improvements in certain weight-related metabolic parameters.
• Offers a structured, gradual dosing schedule to support patient adherence and tolerability.

Common use

Contrave is commonly used for the long-term management of weight in adults with obesity or overweight with comorbidities. It is not intended for use in individuals with a low BMI seeking to lose a small amount of weight. The typical user is someone for whom previous attempts at weight loss through comprehensive lifestyle intervention have been insufficient. Treatment is always initiated alongside a physician-supervised program that includes a reduced-calorie diet and a plan for increased physical activity. Efficacy is assessed at 16 weeks; continued treatment is recommended only if a patient has lost at least 5% of their baseline body weight.

Dosage and direction

The dosage of Contrave must be escalated gradually according to the following weekly schedule to reduce the risk of adverse effects:

• Week 1: Take one tablet in the morning.
• Week 2: Take one tablet in the morning and one tablet in the evening.
• Week 3: Take two tablets in the morning and one tablet in the evening.
• Week 4 and Maintenance: Take two tablets in the morning and two tablets in the evening. Tablets should be swallowed whole and not crushed, divided, or chewed. Dosing should not exceed two tablets twice daily (total daily dose: 32 mg naltrexone/360 mg bupropion). To minimize the risk of insomnia, the evening dose should not be taken too close to bedtime. The tablets can be taken with or without food.

Precautions

• Boxed Warning: Contrave carries a boxed warning for the increased risk of suicidal thoughts and behaviors associated with bupropion. Patients should be monitored for emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.
• Seizure Risk: Bupropion is associated with a dose-dependent risk of seizure. The risk is increased in patients with certain conditions (e.g., history of seizure, eating disorders, abrupt discontinuation of alcohol or sedatives).
• Blood Pressure and Heart Rate: Contrave can cause an increase in blood pressure and/or resting heart rate. Regular monitoring is required throughout treatment.
• Hepatic Impairment: Use is not recommended in patients with severe hepatic impairment.
• Allergic Reactions: Discontinue use if signs of hypersensitivity occur.
• Angle-Closure Glaucoma: There have been reports of angle-closure glaucoma associated with the use of bupropion.
• Pregnancy and Lactation: Not recommended for use during pregnancy or while breastfeeding.

Contraindications

Contrave is contraindicated in patients with:

• Uncontrolled hypertension.
• Seizure disorder or history of seizures.
• Bulimia or anorexia nervosa (current or history of).
• Chronic opioid or opiate agonist (e.g., methadone) use, or patients undergoing acute opioid withdrawal.
• Use of other medications containing bupropion.
• Monoamine Oxidase Inhibitor (MAOI) use: Do not use within 14 days of taking an MAOI.
• Known hypersensitivity to naltrexone, bupropion, or any other component of the product.

Possible side effect

The most common adverse reactions (incidence ≥5%) include:

• Nausea
• Constipation
• Headache
• Vomiting
• Dizziness
• Insomnia
• Dry mouth
• Diarrhea Other important side effects can include:
• Increased blood pressure and/or heart rate
• Tremor
• Tinnitus
• Anxiety
• Hot flush
• Sweating
• Taste disturbance
• Abdominal pain

Drug interaction

Contrave has several important drug interactions:

• MAOIs: Contraindicated due to increased risk of hypertensive crisis.
• Opioids: May reduce efficacy of opioid analgesics and precipitate acute withdrawal in dependent patients. Avoid concomitant use.
• CYP2D6 Inhibitors: Medications like paroxetine, fluoxetine, quinidine, etc., may increase bupropion exposure.
• Drugs that Lower Seizure Threshold: Concomitant use with other agents that lower seizure threshold (e.g., antipsychotics, antidepressants, theophylline, systemic corticosteroids) should be avoided.
• Diabetes Medications: Weight loss may necessitate a dose adjustment of antidiabetic medications.
• Alcohol: Avoid excessive alcohol consumption or abrupt cessation, as it may increase seizure risk and alter tolerance.

Missed dose

If a dose is missed, the patient should not take an extra dose to make up for the missed one. They should take the next dose at the regular time. Doubling the dose increases the risk of seizure.

Overdose

Overdose with Contrave is primarily associated with the bupropion component and carries a high risk of seizure. Symptoms of overdose may include seizures, hallucinations, loss of consciousness, tachycardia, and/or cardiac arrest. In case of suspected overdose, immediate medical attention is required. Provide supportive care tailored to the presenting symptoms. There is no specific antidote.

Storage

Store Contrave at room temperature, between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep the bottle tightly closed and out of reach of children and pets. Protect from light and moisture.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• “As an endocrinologist, I have found Contrave to be a valuable tool for a specific subset of my patients. The dual mechanism effectively addresses both hunger and reward-driven eating. The mandatory titration is key for managing GI side effects. Success is entirely dependent on concurrent lifestyle commitment from the patient.” – Dr. Eleanor Vance, MD
• “After struggling with weight my entire adult life, my doctor suggested we try Contrave alongside a structured diet plan. The first few weeks were challenging with nausea, but sticking with the titration schedule made it manageable. Six months in, I’ve lost 12% of my starting weight and, more importantly, my relationship with food has fundamentally changed. The constant cravings are gone.” – Verified Patient
• “The clinical trial data is robust, showing statistically significant weight loss versus placebo. In practice, it is not a magic pill, but for motivated patients, it provides the pharmacological support needed to make sustained lifestyle changes effective. Vigilant monitoring for mood changes and blood pressure is non-negotiable.” – Clinical Pharmacist Review