Contrave is a prescription medication approved by the FDA for chronic weight management in adults. It combines two active ingredients, naltrexone HCl and bupropion HCl, in an extended-release formulation designed to work on areas of the brain involved in appetite control and reward. This dual-action mechanism helps reduce food cravings and caloric intake, supporting sustained weight loss when used alongside a reduced-calorie diet and increased physical activity. It is indicated for use in adults with an initial body mass index (BMI) of 30 or greater, or 27 or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.

Features

• Contains naltrexone hydrochloride (8 mg) and bupropion hydrochloride (90 mg) per tablet
• Extended-release oral formulation
• FDA-approved for chronic weight management
• Requires prescription and medical supervision
• Packaged in monthly blister packs to support adherence
• Titrated dosing schedule over four weeks

Benefits

• Supports significant and sustained weight loss in clinical trials
• Helps reduce cravings and control appetite
• May improve certain metabolic parameters in patients with obesity-related comorbidities
• Supports long-term weight management when combined with lifestyle modifications
• Dual mechanism targets both hunger and reward pathways involved in eating behavior
• Can contribute to improved quality of life and body composition

Common use

Contrave is prescribed for chronic weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity. It is used as an adjunct to a reduced-calorie diet and increased physical activity. Treatment is typically long-term, continuing as long as the patient is deriving benefit and tolerating the medication without significant adverse effects. Regular monitoring of weight, vital signs, and potential side effects is recommended throughout therapy.

Dosage and direction

The recommended dosage of Contrave is two tablets taken twice daily (total daily dose: 32 mg naltrexone/360 mg bupropion). The dose should be escalated over a four-week period according to the following schedule:

• Week 1: One tablet each morning
• Week 2: One tablet each morning and one tablet each evening
• Week 3: Two tablets each morning and one tablet each evening
• Week 4 and maintenance: Two tablets each morning and two tablets each evening

Tablets should be swallowed whole and not crushed, divided, or chewed. The medication should be taken with food to reduce the incidence of nausea. Doses should be taken at least 8 hours apart. If a dose is missed, patients should not take an extra dose but should resume their regular dosing schedule.

Precautions

Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behaviors, and/or unusual changes in behavior. Contrave can increase blood pressure and heart rate; regular monitoring of these parameters is recommended. Use with caution in patients with hepatic or renal impairment. May lower the seizure threshold; use caution in patients with predisposing factors for seizures. May cause angle-closure glaucoma. Patients should be advised about the potential for impaired ability to operate machinery or drive until they know how Contrave affects them.

Contraindications

Contrave is contraindicated in patients with:

• Uncontrolled hypertension
• Seizure disorder or history of seizures
• Eating disorders (anorexia nervosa or bulimia nervosa)
• Use of monoamine oxidase inhibitors (MAOIs) within 14 days
• Chronic opioid or opiate agonist therapy, or patients undergoing acute opioid withdrawal
• Known hypersensitivity to naltrexone, bupropion, or any other component of the formulation

Possible side effects

Most common adverse reactions (incidence ≥5% and more frequent than placebo) include:

• Nausea (32.5%)
• Constipation (19.2%)
• Headache (17.6%)
• Vomiting (10.7%)
• Dizziness (9.9%)
• Insomnia (9.2%)
• Dry mouth (8.1%)
• Diarrhea (7.3%)

Serious side effects may include: increased blood pressure and heart rate, seizures, angle-closure glaucoma, liver damage, allergic reactions, and increased risk of suicidal thoughts and behaviors.

Drug interaction

Contrave has multiple clinically important drug interactions:

• MAO inhibitors: Contraindicated within 14 days of MAOI use
• Opioids: May reduce efficacy of opioid analgesics and precipitate withdrawal in dependent patients
• CYP2D6 substrates: Bupropion inhibits CYP2D6 and may increase levels of drugs metabolized by this enzyme (e.g., antidepressants, antipsychotics, beta-blockers, type 1C antiarrhythmics)
• Drugs that lower seizure threshold: Concurrent use may potentiate seizure risk
• Alcohol: May impair judgment and increase risk of neuropsychiatric events

Missed dose

If a dose is missed, patients should skip the missed dose and take the next dose at the regular time. Do not take extra tablets to make up for a missed dose. Do not take more than two tablets in a single dosing period (morning or evening).

Overdose

Overdose may manifest as seizures, ECG changes, hallucinations, loss of consciousness, tachycardia, or other symptoms related to bupropion or naltrexone toxicity. There is no specific antidote. Management involves symptomatic and supportive care, with particular attention to CNS effects and cardiac monitoring. Gastric lavage may be considered if presented early. Contact a Poison Control Center immediately for guidance.

Storage

Store at room temperature (20°C to 25°C/68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Keep in original blister packaging until time of use. Protect from light and moisture. Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Contrave is available by prescription only and should be used under appropriate medical supervision. Individual results may vary. Patients should consult their healthcare provider for personalized medical advice, including potential risks and benefits specific to their medical condition.

Reviews

Clinical trials demonstrate that patients taking Contrave alongside lifestyle modification achieved significantly greater weight loss compared to placebo. In a 56-week study, approximately 42% of patients achieved ≥5% weight loss, with 17% achieving ≥10% weight loss. Many patients report reduced food cravings and improved control over eating behaviors. However, gastrointestinal side effects, particularly during the titration period, are commonly reported. Long-term adherence may be challenging for some patients due to side effects or cost considerations.