Contrave
Contrave (naltrexone / bupropion) is used along with a lower-calorie diet and exercise routine to help with weight loss for certain adults. This combination medication is a tablet that's taken by mouth. The dosage is slowly raised over the first 3 weeks of treatment until you reach the maintenance dosage of two tablets twice daily. Common side effects include nausea, constipation, and headache. But it can also have more serious risks, such as unusual changes in behavior.
What is Contrave (naltrexone / bupropion)?
What is Contrave (naltrexone / bupropion) used for?
Long-term treatment for weight management in adults with a body mass index (BMI) of 30 kg/m2 or greater; or BMI of 27 kg/m2 or greater and a weight-related condition (e.g., high blood pressure, Type 2 diabetes, high cholesterol)
How Contrave (naltrexone / bupropion) works
Contrave (naltrexone / bupropion) is a combination of two medications.
Naltrexone is an opioid antagonist.
Bupropion is a dopamine and norepinephrine reuptake inhibitor. It raises levels of dopamine and norepinephrine.
It's not completely clear how these two medications work together to help with weight. But it's suggested that they work on parts of your brain that are responsible for appetite control and the reward system. This might help manage your food cravings.
Drug Facts
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What are the side effects of Contrave (naltrexone / bupropion)?
Common Side Effects
- Nausea (33%)
- Constipation (19%)
- Headache (18%)
- Vomiting (11%)
- Dizziness (10%)
- Trouble sleeping (9%)
- Dry mouth (8%)
- Diarrhea (7%)
Other Side Effects
- Stomachache
- Shakiness
- A lot of sweating
- Ringing in the ears
- Fatigue
- Suddenly feeling hot
- Feeling anxious
- Feeling irritable
- Higher blood pressure
- Flu-like symptoms
- Urinary tract infection
Serious Side Effects
- Thoughts of self-harm or suicidal thoughts and behavior
- Seizures
- Allergic reaction: rash, hives, blistering or peeling skin, chest pain, shortness of breath, swelling
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Fast or irregular heartbeat
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Seizures
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Dizziness
- Dry mouth
- Fatigue
- Headache
- Nausea
- Trouble sleeping
- Vomiting
Pros and cons of Contrave (naltrexone / bupropion)
Pros
Is a tablet that's taken by mouth
Can see results in as early as 4 weeks (when it's taken along with a balanced diet and regular exercise)
Combines 2 different medications into a single pill to help with weight
Cons
Must take twice a day (after the dose ramp-up at the beginning)
Might raise your risk for unusual behavior and thoughts of self-harm
Not available as a lower-cost generic
Pharmacist tips for Contrave (naltrexone / bupropion)
Follow the dosing schedule at the beginning of treatment. You'll start Contrave (naltrexone / bupropion) at a lower dose at first. Then, your primary care provider will raise your dose over a few weeks. This helps give your body time to get used to the medication and lessen side effects like nausea and headache.
Swallow Contrave (naltrexone / bupropion) tablets whole. Don't chew, cut, or crush the tablets. Otherwise, too much medication can get released into the body too quickly and raise your risk for side effects.
Don't take more than 2 tablets of Contrave (naltrexone / bupropion) at one time, and don’t take more than 2 tablets twice in a day. Taking too much of this medication can raise your risk of having a seizure.
You can take Contrave (naltrexone / bupropion) with food. But make sure to avoid taking it with high-fat meals, such as meals with eggs, avocado, or cheese. These foods can cause the medication to reach very high levels in your body, which can raise your risk for seizure. Speak with your care team about how to best plan your meals so that you have a balanced diet while avoiding high-fat foods.
Contrave (naltrexone / bupropion) can raise your risk of having unusual behavior and suicidal thoughts and actions. It's important that you and the people around you watch for changes in your behavior or mood, like anxiety, uneasiness, and anger. Stop taking the medication and contact your primary care provider if you or your loved ones notice unusual changes in thoughts, behavior, or mood. Call 911 right away if you have suicidal thoughts or behavior.
Don't use Contrave (naltrexone / bupropion) together with other weight loss products because it's not known whether this is safe.
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Frequently asked questions about Contrave (naltrexone / bupropion)
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What are the risks and warnings for Contrave (naltrexone / bupropion)?
Contrave (naltrexone / bupropion) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts and behavior
Risk factors: History of depression or any mental health condition | Age 24 years or younger
Bupropion, one of the ingredients in Contrave, is a medication that can raise the risk for worsening depression, suicidal thoughts or actions, and unusual changes in your behavior. Changes in behavior are most likely to happen in the first few months after you start the medication or when your dose changes. Get medical help right away if anyone notices that your depression got worse or that you start to have unusual changes in behavior or thoughts of self-harm or suicide while you're taking Contrave (naltrexone / bupropion).
Changes in thoughts, behavior, and mood
Risk factors: History of depression or mental health condition
Contrave (naltrexone / bupropion) isn't approved to help you quit smoking, but bupropion by itself is sometimes used for this purpose. People who’ve taken bupropion by itself for smoking cessation have had changes in thoughts, behavior, and mood. They've included depression, hallucinations, paranoia, anxiety, and suicidal thoughts or behavior. Some people who took naltrexone by itself have also had depression and suicidal thoughts and behavior.
Make sure to watch out for depressed mood; feelings of uneasiness; and any changes of behavior, thoughts, or feelings. Stop taking Contrave (naltrexone / bupropion) right away and get medical help if you or your loved ones notice that you start to have any unusual thoughts, behavior, or mood.
Seizures
Risk factors: History of seizures | History of an eating disorder | History of head injury or medical conditions that can cause seizures | Frequent alcohol, sedative, cocaine, or stimulant use | Recently quit drinking alcohol or stopping certain medications | Taking other medications that can raise the risk for seizures | Taking higher doses of Contrave (naltrexone / bupropion) | Taking insulin or certain other diabetes medications
Although rare, bupropion, an ingredient in Contrave, can cause seizures. The risk is greater if you're taking higher doses of Contrave (naltrexone / bupropion). Let your care team know about your medical history and all the medications you take. Some medical conditions and medications can raise your risk for seizure. Also tell your care team if you've recently stopped drinking alcohol or stopped taking certain anxiety, sleep, or anti-seizure medications because this can also put you in danger for seizures.
Get medical help if you have a seizure while you're taking Contrave (naltrexone / bupropion). You probably won't be able to take this medication anymore if a seizure happens.
Don't take Contrave with opioid medications
Don't take Contrave (naltrexone / bupropion) with opioid medications. Taking Contrave at the same time as opioid medications can raise the risk for opioid overdose or withdrawal symptoms, both of which can be dangerous and life-threatening.
Tell your primary care provider if you're already taking an opioid before you start Contrave (naltrexone / bupropion). You must be "opioid-free" for at least 1 to 2 weeks before you can start this medication. Your primary care provider will work with you to help you safely stop any opioid medications.
Taking Contrave (naltrexone / bupropion) with opioid medications can raise the risk for an opioid overdose. Contrave contains naltrexone, which can block the effect of opioids and make them work less well for pain. Some people might feel the need to take more of the opioid medication for the pain relief they need. This can lead to serious side effects, such as slow breathing or loss of consciousness.
Taking Contrave (naltrexone / bupropion) with opioid medications can also lead to symptoms of withdrawal. Contrave can block opioids from working well, which has similar effects as if you were to suddenly stop taking opioids.
High blood pressure and fast heart rate
Risk factors: History of high blood pressure
Contrave (naltrexone / bupropion) can raise your heart rate at rest and blood pressure. In studies, heart rate and blood pressure went up slightly during the first 3 months of treatment.
Your primary care provider will check your blood pressure and heart rate before you start taking Contrave (naltrexone / bupropion) and occasionally during your follow-up visits. Your primary care provider also might recommend that you regularly check your blood pressure at home.
Tell your care team if your blood pressure is consistently higher than usual or if you feel your heart racing. Don't take Contrave (naltrexone / bupropion) if you have high blood pressure that's not controlled.
Liver problems
Risk factors: History of liver problems
Some people who've taken naltrexone, one of the ingredients in Contrave, have had liver problems. In most cases, there were other potential causes or contributing factors, such as having medical conditions or taking medications that can damage the liver.
Tell your care team if you have liver problems before you start Contrave (naltrexone / bupropion). You might need to take a lower dose of the medication to lower your risk of worsening liver damage. But you won't be able to take the medication if you have severe liver disease.
Stop taking Contrave (naltrexone / bupropion) and contact your primary care provider if you have yellowing skin or eyes (jaundice), nausea, stomach pain, fatigue, or fever. These might be signs of liver damage.
Extreme enthusiasm or excitement (mania)
Risk factors: Personal or family history of bipolar disorder | Family history of depression or suicide
It's possible that taking Contrave (naltrexone / bupropion) can cause you to have a manic, mixed, or hypomanic episode. This is more likely to happen if you have bipolar disorder or if you have risk factors for bipolar disorder, such as having a family member with bipolar disorder or depression. Contact your primary care provider if you or a loved one notices that you're more talkative or irritable, have racing thoughts, or have other changes in mood while you're taking Contrave (naltrexone / bupropion).
Worsening of glaucoma
Contrave (naltrexone / bupropion) can cause worsening eye problems in people with a certain type of glaucoma called angle-closure glaucoma. Before you start this medication, let your primary care provider know if you have glaucoma so they can make sure it's safe for you.
Potential risk for low blood sugar in certain people with Type 2 diabetes
Risk factors: Type 2 diabetes and taking certain diabetes medications
For people with Type 2 diabetes who use insulin or take medications like glipizide, losing weight can put them at risk for having low blood sugar.
If you have Type 2 diabetes, you'll get your blood sugar levels checked before you start Contrave (naltrexone / bupropion). It's also recommended that you regularly check your blood sugar at home while you're taking Contrave (naltrexone / bupropion). Your primary care provider might adjust the dose of certain diabetes medications to lower your risk for very low blood sugar levels.
Make sure you can recognize the symptoms of low blood sugar, such as sweating, shakiness, dizziness, racing heart, and confusion. Check your blood sugar as soon as possible, follow the “15-15-15 Rule" to help get your sugars back up, and call for medical help if needed. Tell your primary care provider if your blood sugar drops while you're taking Contrave (naltrexone / bupropion).
Contrave (naltrexone / bupropion) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 8mg/90mg | 120 tablets | $99.00 | $0.82 |
Typical dosing for Contrave (naltrexone / bupropion)
You'll typically start Contrave (naltrexone / bupropion) at a low dose. Then, your prescriber will raise the dose over a few weeks until you've reached a maintenance dose. Each tablet contains 8 mg of naltrexone and 90 mg of bupropion.
The typical dosing schedule might look like the following.
Week 1: Take 1 tablet by mouth in the morning.
Week 2: Take 1 tablet by mouth in the morning and 1 tablet in the evening.
Week 3: Take 2 tablets by mouth in the morning and 1 tablet in the evening.
Week 4 and beyond (maintenance dose): Take 2 tablets by mouth in the morning and 2 tablets in the evening.
Don’t take more than 2 tablets twice per day.
Your dose might differ if you have kidney or liver problems of if you take certain medications that interact with Contrave (naltrexone / bupropion).
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Contrave (naltrexone / bupropion) contraindications
High blood pressure that's not controlled
History of seizures
History of eating disorders (anorexia or bulimia)
Recently stopped drinking alcohol
Recently stopped taking certain anxiety, sleep, headache, or anti-seizure medications
Take opioids long term
Take medications called monoamine oxidase inhibitors (MAOIs), such as selegiline, linezolid (Zyvox), or methylene blue
Take other medications containing bupropion, such as Wellbutrin, Forfivo XL, or Aplenzin
Allergy to its single ingredients (naltrexone or bupropion)
What are alternatives to Contrave (naltrexone / bupropion)?
Long-term treatment for weight management in adults with a body mass index (BMI) of 30 kg/m2 or greater; or BMI of 27 kg/m2 or greater and a weight-related condition (e.g., high blood pressure, Type 2 diabetes, high cholesterol)
30 kg/m^2^ or greater or
27 kg/m^2^ or greater and at least one weight-related condition (e.g., high blood pressure, type 2 diabetes, or high cholesterol)
Weight loss and long-term weight management in:
Lowering the risk of heart attack, stroke, and death due to heart problems in adults with a larger body size and heart disease
What is the latest news about Contrave (naltrexone / bupropion)?
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References
Best studies we foundBilles, S.K., et al. (2014). Naltrexone/bupropion for obesity: An investigational combination pharmacotherapy for weight loss. Pharmacological Research.
Nalpropion Pharmaceuticals LLC. (2023). CONTRAVE EXTENDED-RELEASE- naltrexone hydrochloride and bupropion hydrochloride tablet, extended release [package insert]. DailyMed.
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