Contrave for Weight Loss: Side Effects, Dosage, Cost, & More

What Is Contrave?

Contrave, with the active ingredients bupropion and naltrexone, is an FDA-approved medication for promoting weight loss. It is recommended as a treatment alongside a low-calorie diet and exercise for the treatment of obesity in adults. Patients who qualify for this medication have an initial BMI of 30 or more or have a BMI of 27 or greater with at least one weight-related condition, such as type 2 diabetes.^{1, 2} FDA-approved status means that the drug has been reviewed and determined that it is both safe and effective for specific uses.

Contrave belongs to a class of weight loss medications called anorexigenic agents, also known as a weight loss agent. Bupropion is an antidepressant, and naltrexone is an opioid receptor antagonist (blocks specific receptors). This medication works by targeting the brain’s appetite regulatory center and reward system. There is no generic version of Contrave available.

How Does Contrave Work for Weight Loss?

Contrave’s components, naltrexone and bupropion, each work differently on the central nervous system to influence your appetite and energy. Bupropion is thought to influence the presence of natural chemicals in your body to result in a loss of appetite. Naltrexone reduces cravings using a different chemical action.^{1, 2}

Who Might Benefit From Taking Contrave for Weight Loss?

Contrave is indicated for those who have a BMI of 30 and above or 27 and a comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia. It is meant to be used alongside diet and exercise and is designed to reduce hunger and control cravings. This medication may be beneficial for those who may struggle with losing weight and keeping it off. People who struggle with emotional eating could potentially benefit as well due to the medication’s intended effect of controlling cravings.

Side Effects of Contrave for Weight Loss

Contrave has two active ingredients. Bupropion is traditionally used as an antidepressant, while naltrexone is typically used to prevent relapses with alcohol or opioid use disorder. These two together help to promote weight loss, but also can carry side effects associated with each component. Common side effects of Contrave include dizziness and headaches.

Temporary side effects can occur when a person starts a new medication, but they tend to go away around a week after consistent usage of the medication. If a side effect is persistent or worsens, talk with your doctor.

Common Side Effects of Contrave

Some people may experience side effects associated with their treatment with Contrave, which may range from mild to severe. Contrave’s most common side effects include nausea and headaches, as well as gastrointestinal effects. Bupropion, a component of Contrave, is associated with insomnia.

Common side effects of Contrave include:^{1, 2}

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

*All medications, including Contrave, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Contrave

Contrave has two notable components that make up its active ingredients. Bupropion and naltrexone have side effects associated with them, some of them serious and requiring immediate medical attention. For example, bupropion is traditionally used as an antidepressant, which carries a risk of new or increased suicidal behavior or ideation. Contrave can cause serious side effects.

Serious side effects of Contrave include:^{1, 2}

• Seizures
• Suicidal ideation or behavior
• Severe allergic reactions
• Angle-closure glaucoma
• Increased blood pressure
• Increased heart rate
• Liver injury

*All medications, including Contrave, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Contrave for Weight Loss Warnings & Precautions

There are warnings and precautions associated with Contrave, which may require medical attention, some being more serious than others. If you experience any signs or symptoms that you suspect to be linked to your usage of Contrave, contact your healthcare provider or seek emergency medical care. Serious reactions like suicidal ideation or behaviors, severe allergic reactions, and seizures are medical emergencies.

These are potential reactions that could occur but may not develop for everyone who takes Conrave. If you have concerns about a possible adverse event happening, discuss with your doctor about the likelihood of such an event. Contrave is considered safe and effective, especially when used as prescribed.

Warnings and precautions for taking Contrave include:^{1, 2}

• Allergic reactions: Some may be sensitive to Contrave or its components, potentially resulting in a serious allergic reaction requiring immediate medical attention. Symptoms of a serious allergic reaction include swelling of the face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; and rapid heartbeat.
• Increase in blood pressure and heart rate: Contrave can cause an increase in blood pressure as well as an increase in resting heart rate. This effect was observed in both patients with and without preexisting hypertension.
• Patients taking opioids: Contrave should not be given to patients receiving chronic opioids due to its component naltrexone, which blocks its effects. Spontaneous opioid withdrawal is uncomfortable but is not usually severe enough to require hospitalization.
• Seizures: Bupropion, a component of Contrave, can cause seizures. This risk of seizures is related to the dosage but is also related to patient factors, other medications being taken that may also induce seizures and other clinical situations. Contrave should not be given to those with a seizure disorder, current or prior diagnosis of anorexia or bulimia, or undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs.
• Suicidal behavior and ideation: Contrave contains an antidepressant known as bupropion, known by its brand name, Wellbutrin. Adults and children with major depressive disorder may experience worsening psychiatric illnesses.
• Angle-closure glaucoma: Bupropion may trigger a worsening of glaucoma in a patient with this condition.
• Risk of hypoglycemia: This medication may increase the risk of low blood sugar in patients with type 2 diabetes treated with insulin or insulin secretagogues, such as glipizide. If signs of hypoglycemia occur after starting Contrave, there may need to be adjustments to your antidiabetic therapy.
• Liver damage: Cases of inflammation of the liver and liver dysfunction were observed in association with naltrexone. If patients experience symptoms of acute hepatitis, they should seek immediate medical care.
• Activation of mania: Bupropion, a component of Contrave, is an antidepressant and can trigger a manic, mixed, or hypomanic episode. The risk appears to be increased in patients with bipolar disorder.
• Neuropsychiatric adverse events and suicide risk in smoking cessation treatment: Contrave is not used for treatment to help a patient stop smoking, but bupropion, a component of Contrave, is used for this purpose. It has been reported that some patients who have stopped smoking experienced psychiatric events such as suicidal ideation.

There may be additional warnings or precautions with this medication. Talk with your healthcare provider about all risks before you start taking this medication.

Interactions With Contrave

All medications have the potential to interact with other medications or substances. Contrave is a combination of two different medications, resulting in interactions that pertain to their individual components. It is important to update your medication list with both your doctor and pharmacist to ensure that you do not have a potential drug interaction. This includes prescription medications, over-the-counter remedies, and herbal and recreational substances. Some interactions may potentially require medical attention, so seek medical care should you experience an adverse event.

8 substances you should avoid while taking Contrave include:^{1, 2}

• Monoamine oxidase inhibitors (MAOI): Bupropion-containing products should not be combined with MAOIs as this can lead to an increased risk of extremely high blood pressure.
• Opioids: Patients taking Contrave may not fully benefit from treatments with opioid-containing medications, such as cough and cold medicines, antidiarrheals, and opioid pain treatments. Chronic opioid use should be stopped 7-10 days in order to prevent withdrawal, and intermittent opiate treatment should be temporarily discontinued.
• Antidepressants and antipsychotics: Certain medications, such as SSRIs, tricyclic antidepressants, and risperidone, should be started at the lower end of the dose range. If Contrave is added to a patient’s regimen, a decrease in the dosage of the other medication should be considered.
• Beta-blockers and type 1C antiarrhythmics: Medications like metoprolol, propafenone, and others within these categories may have increased effects when Contrave is added to the therapy. Lowering the dosage of these medications may be necessary.
• Digoxin: Contrave may decrease the amount of digoxin within the body, so digoxin therapy should be monitored.
• Drugs that lower the seizure threshold: Medications that may increase the risk of seizures (certain antipsychotics, antidepressants, steroids, etc.) should be used with caution in combination with Contrave. Therapies should be started low and increased gradually.

• Alcohol: Patients on Contrave may experience reduced alcohol tolerance or experience adverse psychiatric events. Consumption of alcohol should be limited or avoided.
• Drugs that increase dopamine: Drugs such as levodopa and amantadine combined with Contrave, a product that also contains a drug that increases dopamine actions, may interact and cause toxicity to the central nervous system. Side effects include tremors, agitation, restlessness, dizziness, vertigo, and movement.

This is not a comprehensive list of the possible interactions with Contrave. You should talk with your healthcare provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting Contrave.

Contrave Dosages for Weight Loss

Contrave comes as an extended-release tablet where the strength is 8 mg naltrexone/90 mg bupropion. When first starting Contrave, patients are typically started on 1 tablet taken in the morning during their first week, then 1 tablet in the morning and 1 tablet in the evening for the second week.

During the third week, the dosage is increased to 2 tablets in the morning and 1 tablet in the evening. In the fourth week and onward, 2 tablets are taken in the morning and 2 in the evening.^{1, 2} Dosages may vary from person to person, taking in personal factors such as your kidney or liver functions which can cause your dosage to be lower.

How Do I Take Contrave for Weight Loss?

Contrave should be taken by mouth as directed by your physician. Do not cut, chew, or crush Contrave pills. As your treatment progresses, you may be instructed to increase your dosage of Contrave, where you will take 2 pills in the morning and 2 pills in the evening (unless you have kidney or liver problems in which your dose may be lower).

You should not take more than 2 pills in the morning and 2 pills in the evening, and no more than 2 pills at a time or more than 4 pills in a day. Contrave should not be taken with high-fat meals as it affects how it is absorbed, increasing your risk of seizures. It is important to follow your doctor’s instructions to ensure your treatment is safe and effective.

What Happens If I Miss a Dose of Contrave?

If you miss a dose of Contrave, wait until your next regular time to take it. Do not take more than one dose of Contrave at a time, even if you missed a dose. It is important to not stop taking Contrave abruptly or try to catch up with extra doses to avoid raising the risk of side effects.

If you have missed a dose and aren’t sure if you should take it, contact your pharmacist or healthcare professional.

How to Get Contrave for Weight Loss

If you are interested in taking Contrave for weight loss, consult with your primary healthcare provider. Contrave is only available via prescription. Authorized prescribers may include physicians, physician assistants, and nurse practitioners. Before a prescription is written, a prescriber will assess whether Contrave may be an appropriate treatment for you. They will discuss your weight loss concerns, overall health, health history, and more. If they believe Contrave is appropriate for you, they will send a prescription to the pharmacy of your choice.

Contrave Vs. Other Weight Loss Methods

Several medications are available to help patients achieve weight loss. Semaglutide is the active ingredient in Ozempic and Wegovy, two widely used medications for promoting weight loss. Ozempic is approved by the FDA as a medication for type 2 diabetes. However, it may be used off-label for weight loss. Wegovy has the same active ingredient and is specifically FDA-approved for weight loss.^{3, 4, 5}

Other weight loss medications include Zepbound, Saxenda, Qysmia, phentermine, Xenical, and Imcivree. Keep in mind that your individual factors may mean that certain medications are a better choice for your needs.

Contrave in Combination With Lifestyle Changes

It is important that patients on Contrave adhere to their reduced-calorie diet and increased exercise regimen. Medication is not a replacement for diet and exercise. Patients may also consider taking two tablets both in the morning and evening to be a drawback, compared to other medications that may be taken less frequently.

Naltrexone, a medication used in alcohol use disorder, is an ingredient within Contrave. Contrave may not be suitable for those who consume alcoholic beverages as it blocks the feeling of euphoria, potentially leading some to consume more alcohol to feel intoxicated.

The benefit of Contrave is that it is not a stimulant medication, so it is not addictive. It is also taken by mouth and is easy to use, unlike some other weight loss medications that are given as an injection. Overall, Contrave may be an effective tool for those looking to achieve weight loss.

FAQs About Contrave

It is difficult to navigate weight loss options, much less navigate the available prescriptions meant for this condition. Below are some commonly asked questions about Contrave.

Is Contrave the Same As Wellbutrin?

While Contrave has bupropion as an active ingredient, it is not the same as Wellbutrin. Contrave works in combination with naltrexone to help promote weight loss, while Wellbutrin is approved for the treatment of depression or as an aid in smoking cessation.^{1, 6} They are two separate medications meant for different conditions.

Which Is Better for Weight Loss, Ozempic or Contrave?

In one experiment, Contrave patients, on average, had a weight loss of 11.5% compared to 7.3% at 56 weeks when they completed their trial. This resulted in an average of 25 lbs vs 16 lbs for placebo.⁴

In trials, patients on semaglutide (the active ingredient in Ozempic) had an average loss of 14.9% of their total body weight in 68 weeks compared to the 2.5% weight loss of the placebo group.⁵ It is important to note that these medications have not been compared directly and that individual factors of the patient must be considered to see which one is right for you.

Why Might Contrave Not Work for Me?

Contrave may not work for you for a variety of reasons. There may be individual factors, such as your personal response to the medication due to your metabolism, genetics, or other underlying conditions.

Your adherence to taking the medication as prescribed and lifestyle factors can also influence your results. Not following a reduced-calorie diet or increased physical activity can result in a person not meeting their weight loss goals. If, after 12 weeks at the target dose, you aren’t seeing weight loss or a decrease in cravings, then your prescriber may recommend stopping Contrave.^{1, 2}

If I Take Opioids, Is There a Risk of an Overdose?

There is a risk of an opioid overdose while on Contrave. Naltrexone blocks the effects of opioids, potentially leading someone to take more opioids to feel the effects. Or, they may become more sensitive to lower amounts of opioids, leading to an overdose. If you use opioid medications or substances, discuss the situation with your doctor to prevent or reduce potential harm.^{1, 2}

Questions to Ask Your Healthcare Provider About Contrave for Weight Loss

If you are considering Contrave for weight loss, come to your appointment with a list of questions to ask to determine if this medication is right for you. You may have concerns about whether Contrave fits with your current weight loss goals and routine, what you should expect with results, and if it interacts with any medications you might currently be on.

Questions to ask your care team about Contrave include:

• How safe is Contrave?
• How long will it take for me to adjust to taking Contrave?
• Am I at risk for more serious symptoms if I am already taking other medications?
• Will Contrave allow me to lose weight and keep it off long-term?
• Are there other weight loss options available to me?
• Is Contrave a long-term medication?
• I take opioids – what is my risk of overdosing while on Contrave?
• How long do I take Contrave before I see results?
• Could Contrave be considered as a alternative to Wegovy or phentermine for weight loss?
• Are their cost saving options available for Contrave, like coupons for Trulicity and other medications?

How to Know if Contrave Is Right for You

There are several factors to consider when determining if Contrave is right for you. Factors like your BMI and other health conditions will determine if you meet the criteria to be on this medication. The best way to determine if Contrave is right for you is to consult a doctor, as they have the medical knowledge to make this decision.