8 Contrave Interactions to Be Aware of

Sometimes, a healthy diet and regular exercise aren’t enough to help you reach or maintain a healthy weight. That’s when your healthcare provider may decide that weight-loss medications are an option for you. And Contrave (naltrexone / bupropion) is a popular choice to help reduce hunger and manage cravings.

Contrave contains two different medications — bupropion and naltrexone. And while it’s effective for weight loss, there are some drug interactions you should be aware of while you’re taking it.

Let’s take a closer look at eight Contrave interactions. Keep in mind that this isn’t a complete list of all possible interactions. It’s best to have your healthcare provider or pharmacist review your medication list before taking Contrave.

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1. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) are used to treat depression and Parkinson’s disease. But if they’re combined with Contrave, it raises your risk for dangerously high blood pressure. In severe cases, a hypertensive crisis is possible, which can be life-threatening. Symptoms of this include a headache, dizziness, and blurry vision. You may also feel confused and have trouble breathing.

This likely happens because bupropion and MAOIs both raise the levels of certain chemicals in the brain: dopamine and norepinephrine. If these levels get too high, it can raise your blood pressure to a dangerous level.

Examples of MAOIs include selegiline (Emsam, Eldepryl) and rasagiline (Azilect). You shouldn’t take MAOIs at the same time or within 14 days of starting Contrave. If you’re currently taking an MAOI, your healthcare provider can recommend a safer weight-loss medication for you.

2. Opioid pain medications

Opioids are medications that treat different types of pain. If you’re taking Contrave, opioid medications won’t work as well for you. This is because naltrexone blocks opioid effects in the brain.

If you need to take an opioid pain medication while you’re taking Contrave, your healthcare provider may have you stop taking Contrave for a short time. But you shouldn’t stop taking it on your own. Be sure your healthcare provider is aware of any opioids you’re prescribed while you’re taking Contrave.

Good to know: If you take opioids regularly for pain, Contrave is likely not the best choice for you. If you start taking Contrave with opioids, not only can it block their effect, but it can also cause withdrawal symptoms. You shouldn’t start taking Contrave until at least 7 to 10 days after you’ve stopped taking any opioid medications.

3. Medications that lower the seizure threshold

Certain medications, including bupropion, can make seizures more likely. This is known as lowering the seizure threshold. So combining Contrave (which contains bupropion) with other medications that lower the seizure threshold can raise your risk of seizures. 

Other medications that make seizures more likely include:

• Antipsychotics such as clozapine (Clozaril)

• Tricyclic antidepressants (TCAs) such as amitriptyline

• Theophylline

• Prednisone

In some cases, your healthcare provider may decide it’s OK for you to take Contrave with one of these medications. If they’re combined, it’s best to start with a low dose of Contrave and raise the dose slowly over time. That way, your provider can watch for any signs of this interaction. If you have a seizure while taking Contrave, seek medical care right away, and be sure to let your healthcare provider know. You'll likely need a different weight-loss medication.

4. Alcohol

Alcohol and Contrave interact in several ways:

• Contrave can make you more sensitive to alcohol. This can make it harder for you to judge your level of impairment. And it can raise the chance of unwanted side effects from alcohol.  

• In rare cases, combining alcohol and Contrave can cause mental health problems. It can also make seizures more likely, especially if you consume large amounts of alcohol over time and then stop. 

• Alcohol can interfere with weight loss. Drinking alcohol can slow your metabolism and add extra calories. This works against Contrave when it comes to helping you maintain a healthy weight.

It’s best to limit or avoid alcohol while taking Contrave. It’s possible that the naltrexone component of Contrave may help lessen alcohol cravings if that’s an issue for you. But if you drink alcohol regularly, it’s best to discuss this with your healthcare provider before you start taking Contrave. They can help decide if it’s safe for you to take.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

5. Other weight-loss medications

In addition to Contrave, there are several other FDA-approved weight-loss medications. And even more are expected in the coming years. But it’s best to avoid combining Contrave with another weight-loss medication unless your provider tells you to. Doing so can raise your risk of side effects or have a negative impact on your health. 

Typically, if one medication isn’t working, you’ll stop taking it before trying a new one. You should also talk to your provider before taking any over-the-counter (OTC) herbs or supplements that promote weight loss while you’re taking Contrave. They can help decide if the combination is safe for you.   

6. Medications that affect dopamine levels

As mentioned, bupropion raises dopamine levels in the body. If you take Contrave with other medications that affect dopamine, it could cause unwanted side effects. High dopamine levels can cause symptoms such as:

• Restlessness

• Tremors

• Dizziness

• Trouble walking

• Agitation

In studies, this interaction was mainly seen with medications used to treat Parkinson’s disease, such as amantadine and levodopa. If you’re taking Contrave with one of these medications, be sure to let your provider know if any of the above symptoms appear.  

7. Medications that affect Contrave levels

Certain medications affect liver enzymes (proteins) that can change Contrave levels in the body.

Medications that can lower Contrave levels include:

• Certain HIV medications, such as lopinavir / ritonavir (Kaletra) and efavirenz (Sustiva)

• Paxlovid and other medications that contain ritonavir (Norvir)

Lower levels can make Contrave less effective. So talk to your provider about a different weight-loss option if you’re taking one of these medications long term. But you can likely continue taking Contrave with a short course of Paxlovid.

Other medications, such as clopidogrel (Plavix) and ticlopidine, can raise Contrave levels. This can make Contrave side effects more likely. A lower Contrave dosage is recommended if you’re taking it with one of these medications.

Good to know: The medications in Contrave, naltrexone and bupropion, can also be prescribed on their own for other health conditions. But you shouldn’t take either one along with Contrave. It could raise your levels too high and cause side effects. Let your healthcare provider know if you’re already taking either medication before you start taking Contrave.

8. Other medications

Contrave can affect the levels of other medications in the body as well. For example, taking Contrave with digoxin (a medication for heart conditions) can lower your digoxin levels. You may need your digoxin levels checked more often if you’re taking Contrave.

Contrave can also raise the levels of certain medications in the body if they’re combined. Examples include:

• Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) 

• TCAs

• Antipsychotics, such as risperidone

• Beta blockers, such as metoprolol (Lopressor, Toprol XL)

• Antiarrhythmics, such as propafenone and flecainide

You may need a lower dose of these medications while taking Contrave. But don’t make any changes on your own. Your healthcare provider can see if anything on your medication list should be changed before you start taking Contrave.

When should I contact my healthcare provider about a Contrave interaction?

It’s best to discuss any concerns you have with your healthcare provider before you start taking Contrave. Be sure they have a complete medication list to look over, including OTC supplements and medications. This can help prevent interactions before they happen.

You should also talk to your provider or pharmacist before starting any new medications while you’re taking Contrave. They can make sure they’re safe for you.

Talk to your healthcare provider about any bothersome symptoms that appear while you’re taking Contrave. They can check to see if an interaction is the culprit. But if you have a seizure or feel confused, dizzy, or have trouble breathing, seek emergency care right away.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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