Contrave

Contrave is a prescription medication approved for chronic weight management in adults. It combines two established active ingredients, naltrexone HCl and bupropion HCl, in an extended-release formulation. This dual-action approach targets areas of the brain involved in hunger control and reward-based eating behaviors. It is intended as an adjunct to a reduced-calorie diet and increased physical activity for patients with an initial body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with at least one weight-related comorbidity. Treatment should be initiated and monitored by a healthcare professional familiar with the patient’s medical history and concomitant conditions.

Features

• Contains naltrexone hydrochloride (8 mg) and bupropion hydrochloride (90 mg) per extended-release tablet
• Utilizes a proprietary bilayer extended-release delivery system
• Administered orally, typically twice daily
• Available in a titration pack to facilitate gradual dose escalation
• Requires prescription and medical supervision
• Packaged with desiccant to maintain stability

Benefits

• Promotes significant and sustained weight loss when combined with lifestyle modifications
• Helps reduce cravings and control appetite through central nervous system activity
• Addresses both the physiological and behavioral aspects of overeating
• May improve certain metabolic parameters in overweight and obese individuals
• Supports long-term weight maintenance in responders to therapy
• Provides a non-surgical pharmacological option for appropriate candidates

Common use

Contrave is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial BMI of 30 kg/m² or greater (obese), or 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia. It is typically prescribed for patients who have not achieved adequate weight loss through diet and exercise alone. Treatment response should be evaluated by week 16; if a patient has not lost at least 5% of baseline body weight, discontinuation should be considered as the patient is unlikely to achieve sustained weight loss with continued therapy.

Dosage and direction

The recommended dosage is two tablets taken orally twice daily. The dose should be escalated according to the following schedule to minimize the risk of adverse reactions:

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

Tablets should be swallowed whole and not crushed, divided, or chewed. Administration with food may reduce the incidence of nausea. The maximum recommended daily dose is 32 mg naltrexone/360 mg bupropion (four tablets). Dose escalation should not proceed if the patient experiences intolerable side effects.

Precautions

Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behaviors, and/or unusual changes in behavior. Contrave contains bupropion, which is associated with a risk of seizure; the risk is dose-related and increased in patients with certain predisposing factors. Blood pressure and heart rate should be monitored regularly, particularly in patients with controlled hypertension prior to treatment. Use with caution in patients with hepatic or renal impairment. Abrupt discontinuation should be avoided; gradual dose reduction is recommended. Patients should be advised about the potential for impaired ability to perform hazardous activities until they are reasonably certain Contrave does not adversely affect them.

Contraindications

Contrave is contraindicated in patients with:

• Uncontrolled hypertension
• Seizure disorder or history of seizures
• Eating disorders (current or prior diagnosis of anorexia nervosa or bulimia nervosa)
• Use of monoamine oxidase inhibitors (MAOIs) within 14 days
• Chronic opioid or opiate agonist (e.g., methadone) or partial agonist (e.g., buprenorphine) use, or acute opiate withdrawal
• Known hypersensitivity to naltrexone, bupropion, or any other component of the formulation
• Pregnancy or attempting to become pregnant

Possible side effects

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

• Nausea
• Constipation
• Headache
• Vomiting
• Dizziness
• Insomnia
• Dry mouth
• Diarrhea

Serious side effects may include:

• Suicidal thoughts and behaviors
• Seizures
• Increases in blood pressure and heart rate
• Hepatotoxicity
• Angle-closure glaucoma
• Hypersensitivity reactions
• Manic episodes

Drug interaction

Contrave has significant interaction potential due to its metabolic pathways and pharmacodynamic effects. Important interactions include:

• MAOIs: Risk of hypertensive crisis (contraindicated within 14 days)
• Other products containing bupropion: Increased seizure risk
• Opioids: May decrease efficacy of opioids and precipitate withdrawal in dependent patients
• Drugs that lower seizure threshold (e.g., antipsychotics, antidepressants, systemic corticosteroids)
• CYP2D6 inhibitors (e.g., paroxetine, fluoxetine): May increase bupropion exposure
• Drugs metabolized by CYP2D6 (e.g., certain antidepressants, antipsychotics, beta-blockers): Contrave may inhibit their metabolism
• Dopaminergic drugs (e.g., levodopa, amantadine): Increased risk of adverse reactions
• Alcohol: May impair judgment and increase risk of neuropsychiatric events

Missed dose

If a dose is missed, the patient should take the next dose at the regular time. Do not double the dose to make up for a missed dose. If multiple doses are missed, re-titration may be necessary to minimize gastrointestinal side effects; patients should consult their healthcare provider for guidance.

Overdose

Overdose may manifest as seizure, hallucinations, loss of consciousness, tachycardia, or ECG changes. Bupropion overdose is known to cause seizures and may lead to status epilepticus. Naltrexone overdose may cause injection site reactions (if applicable) and gastrointestinal distress. There is no specific antidote; management involves symptomatic and supportive care with ECG monitoring. Due to the extended-release formulation, gastrointestinal decontamination should be considered even if presented late after ingestion.

Storage

Store at 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 the original container with the dessicant provided. Protect from light and moisture. Keep out of reach of children and pets. Properly dispose of any unused medication after the expiration date or when treatment is discontinued.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Contrave is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Individual results may vary. Patients should discuss their complete medical history, including all current medications and supplements, with their physician before starting treatment. Only a healthcare professional can determine if Contrave is appropriate for a specific individual based on their unique health profile.

Reviews

Clinical trials demonstrate that patients on Contrave achieved significantly greater weight loss compared to placebo when combined with lifestyle modification. In pooled data from multiple studies, approximately 42-48% of patients achieved ≥5% weight loss at 56 weeks, compared to 17-23% with placebo. Approximately 21-25% achieved ≥10% weight loss. Patient-reported outcomes indicate improvements in quality of life measures related to weight control. Real-world evidence suggests similar efficacy in compliant patients, though individual responses vary based on adherence to lifestyle recommendations and physiological factors. Long-term maintenance studies support sustained benefit in responders who continue treatment under medical supervision.