Contrave
Contrave is a combination medication that helps with weight loss for certain adults. It's taken along with a balanced diet and exercise plan. Contrave is a tablet with two active ingredients that help regulate your appetite. They are naltrexone (an opioid antagonist) and bupropion (a dopamine and norepinephrine reuptake inhibitor). Your dosage will slowly increase over the first 3 weeks. Then, you take the maintenance dose of two tablets by mouth twice a day. Some side effects are nausea, constipation, and headache. But it can also have serious risks, like unusual changes in behavior. Contrave is brand name only; there isn't a generic version available yet.
What is Contrave (naltrexone / bupropion)?
What is Contrave (naltrexone / bupropion) used for?
Long-term weight management in certain adults
Adults with a body mass index (BMI) of 30 kg/m2 or greater
Adults with a 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. It blocks proteins in the brain called opioid receptors. It helps block the rewarding effects of substances like opioids.
Bupropion is a dopamine and norepinephrine reuptake inhibitor. It raises the levels of dopamine and norepinephrine in the brain.
It's not completely clear how Contrave works to help with weight. But it seems to work on parts of your brain for appetite regulation and the reward system. This might help you feel less hungry and control 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
- Stomach pain
- Shakiness (tremor)
- A lot of sweating
- Ringing in the ears
- Fatigue
- Suddenly feeling hot
- Muscle strain
- Feeling anxious
- Feeling irritable
- Changes in taste
- Rash
- Higher blood pressure
- Racing heart
- Flu-like symptoms
- "Stomach flu"
- Urinary tract infection (UTI)
Serious Side Effects
- Suicidal thoughts or behaviors
- Unusual changes in thoughts, mood, or behavior
- Seizure
- Liver problems: yellow skin or eyes, nausea, stomach pain, fatigue, fever
- Allergic reaction: rash; hives; itchiness; trouble breathing; swelling of the face or around the eyes
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
Comes as a tablet that you take by mouth
Might start to notice results in as early as 4 weeks (when taken along with a balanced diet and regular exercise)
Cons
Must take twice a day (after the dose ramp-up at the beginning)
Might raise your risk of unusual behavior and thoughts of self-harm
Interacts with a lot of medications
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 dose gets raised over a few weeks. This helps your body get used to the medication and lessen the risk of side effects like nausea and headache.
You can take Contrave (naltrexone / bupropion) with food. But make sure to avoid taking it with high-fat meals. Examples include meals with eggs, avocado, or cheese. These foods can make the level of medication in your body to get very high, which can raise your risk for seizure. Speak to your care team about a good meal plan. This can help you eat balanced, nutritious foods and avoid foods with a lot of fat.
Swallow Contrave (naltrexone / bupropion) tablets whole. Don't chew, cut, or crush the tablets. If you do, too much medication can get released into the body too quickly. This can raise your risk of side effects.
If you miss a dose of Contrave (naltrexone / bupropion), skip the missed dose. Then, take your usual dose and the next usual time. Don't double up your dose because this can put you at risk of side effects, like seizure.
Don't take more than 2 tablets of Contrave (naltrexone / bupropion) at any 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.
Contrave (naltrexone / bupropion) can raise your risk of having unusual behavior. It's important that you and the people around you watch for changes in how you act or feel. Examples include being anxious, uneasy, or angry. If this happens, stop taking the medication and tell your prescriber. If you ever have suicidal thoughts or behavior, call 911 right away.
Make sure to tell your prescriber and pharmacist about all the medications you take and plan to take. Contrave (naltrexone / bupropion) interacts with many medications, which can be harmful for you. Your care team can review your medications and check they're safe to take together.
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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.
Risk of 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, can raise the risk of worsening depression and unusual changes in behavior. It can also raise the risk of suicidal thoughts or actions. The risk might be higher if you have a history of depression or if you're 24 years or younger.
To be safe, you and your loved ones should watch for changes in behavior while you're taking Contrave (naltrexone / bupropion). This is especially important when you first start the medication and when your dose goes up. Talk to your prescriber if you have worsening depression or unusual changes in behavior. Call 911 right away if you start to think about hurting yourself.
Possible 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. People who’ve taken bupropion by itself for smoking cessation have had changes in thoughts, behavior, and mood. This included depression, hallucinations, paranoia, and anxiety. It's also included suicidal thoughts or behavior. Some people taking naltrexone by itself have also had depression or thoughts or behaviors of self-harm.
Watch out for signs of depression and feelings of uneasiness. Also be aware of any strange changes of behavior, thoughts, or feelings. Stop taking Contrave (naltrexone / bupropion) and get medical help right away if you or your loved ones notice 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 | Drink a lot of alcohol | Recently quit drinking alcohol | Take too much sedatives | Addiction to cocaine or stimulants | Recently stopped taking sedatives or seizure medications | Taking other medications that can raise seizure risk | Taking higher doses of Contrave (naltrexone / bupropion) | Taking insulin or certain other diabetes medications
Although rare, the bupropion in Contrave can cause seizures. The risk is greater with higher doses of Contrave (naltrexone / bupropion).
Before starting Contrave (naltrexone / bupropion), tell your prescriber about your medical history. Also tell them about all the medications you take. Some health problems and medications can raise your risk of seizure. Let your care team know if you've recently stopped drinking alcohol or stopped taking certain medications. This can also put you in danger of seizures. Your prescriber can check your risk and see if Contrave (naltrexone / bupropion) is safe for you.
Get medical help right away if you have a seizure while you're taking Contrave (naltrexone / bupropion). You 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. Contrave contains naltrexone, which can block the effects of opioids and make them work less well. This can lead to two possible dangerous and life-threatening problems.
First, it can make people think they need to take more of the opioid to get enough pain relief. This can cause serious side effects, like slow breathing or loss of consciousness. It can raise the risk of an opioid overdose.
Second, because naltrexone blocks the effects of opioids, it can be like suddenly stopping the opioid medication. This can lead to opioid withdrawal symptoms.
Before you start Contrave (naltrexone / bupropion), tell your prescriber if you're already taking an opioid. Also if you need opioids for any reason during treatment, tell your care teams that you're taking Contrave (naltrexone / bupropion). In both cases, your care teams can tell you what to do to keep you safe.
Higher blood pressure and faster heart rate
Risk factors: History of high blood pressure
Contrave (naltrexone / bupropion) can make your resting heart rate and blood pressure go up. In studies, these changes generally happened during the first few months of treatment. For some, blood pressure went back closer to usual 3 months after starting the medication.
To be safe, your prescriber will check these vital signs before you start Contrave (naltrexone / bupropion). They'll also check your heart rate and blood pressure during your follow-up visits. And they might recommend you to regularly check your blood pressure at home.
Tell your care team if your blood pressure stays 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 | Taking medications that can harm the liver
Some people who've taken naltrexone, an ingredient in Contrave, have had liver problems. Most times, there were other potential reasons for liver injury. Examples include having medical conditions or taking certain medications that can damage the liver.
Before starting Contrave (naltrexone / bupropion), tell your care team if you have any liver problems. Depending on how serious it is, your prescriber might tell you to take a lower dose. But this medication isn't recommended for people with severe liver problems.
Stop taking Contrave (naltrexone / bupropion) and get medical help right away if you see any signs of liver damage. They can include yellow skin or eyes, nausea, stomach pain, fatigue, or fever.
Mania (extreme enthusiasm or excitement)
Risk factors: Personal or family history of bipolar disorder | Family history of depression or suicide
It's possible that bupropion, an ingredient in Contrave, can cause some people to have a manic, mixed, or hypomanic episode. The risk is higher if you have bipolar disorder. It's also higher if you're at risk of bipolar disorder, like if someone in your family has bipolar disorder or depression. Tell your prescriber if you or your family has mental health issues. Your prescriber can check to see if you're at risk.
If you or a loved one thinks you're having an episode while taking this medication, call your care team. You might be more talkative or irritable than usual, have racing thoughts, or have very elevated or sad mood.
Worsening of glaucoma in certain people
Risk factors: Have "narrow-angle eyes" and haven't had eye surgery
Bupropion, which is in Contrave, can sometimes cause eye problems in some people. Tell your prescriber if your eye specialist has said you have narrow-angle eyes and you haven't had laser eye surgery. Your risk of a serious eye problem called angle-closure attack might be higher. Your prescriber can make sure this medication is safe for you.
Call your eye specialist right away if you suddenly have blurry vision, severe eye pain, or see halos around lights. These could be signs of an angle-closure attack.
Potential risk of low blood sugar in people taking certain medications for Type 2 diabetes
Risk factors: Using insulin | Taking sulfonylureas like glipizde
Weight loss can put certain people with Type 2 diabetes at risk of having low blood sugar. People at risk are those who use insulin or take sulfonylureas like glipizide.
If you have Type 2 diabetes, you should get your blood sugar checked before you start Contrave (naltrexone / bupropion). Then, continue to regularly check your blood sugar at home while you're taking this medication. Your primary care provider might adjust your diabetes medications to lower your risk of very low blood sugar.
Make sure you can recognize the symptoms of low blood sugar. Look out for sweating, shakiness, dizziness, racing heart, and confusion. If this happens, check your blood sugar as soon as possible and follow the “15-15 rule" to help get your sugars back up. Call for medical help if needed. Tell your primary care provider if your blood sugar drops too low 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)
Each tablet of Contrave contains 8 mg of naltrexone and 90 mg of bupropion.
The typical dosing schedule is listed below.
Week 1: Take 1 tablet by mouth in the morning each day.
Week 2: Take 1 tablet by mouth in the morning and 1 tablet in the evening each day.
Week 3: Take 2 tablets by mouth in the morning and 1 tablet in the evening each day.
Week 4 and onward: Take 2 tablets by mouth in the morning and 2 tablets in the evening each day.
Don’t take more than 2 tablets twice per day.
Your dose might differ if you have kidney or liver problems. It also might be different if you take certain medications that interact with Contrave.
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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 benzodiazepines, barbiturates, or seizure medications
Take opioids long term
Currently experiencing opioid withdrawal
Take medications called monoamine oxidase inhibitors (MAOIs), like selegiline, linezolid (Zyvox), or methylene blue
Take other medications containing bupropion, such as Wellbutrin, Forfivo XL, or Aplenzin
Allergy to naltrexone or bupropion
What are alternatives to Contrave (naltrexone / bupropion)?
Long-term weight management in certain adults
Adults with a body mass index (BMI) of 30 kg/m2 or greater
Adults with a BMI of 27 kg/m2 or greater and a weight-related condition (e.g., high blood pressure, Type 2 diabetes, high cholesterol)
Obesty management in adults with a body mass index (BMI) of:
Weight loss in adults when combined with a lower-calorie and low-fat diet
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
Metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate-to-advanced liver scarring, but not cirrhosis
What is the latest news about Contrave (naltrexone / bupropion)?
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References
Best studies we foundKhazaeni, B., et al. (2023). Acute angle-closure glaucoma. StatPearls.
Nalpropion Pharmaceuticals LLC. (2025). Contrave extended-release- naltrexone hydrochloride and bupropion hydrochloride tablet, extended release [package insert]. DailyMed.
Porter, D. (2020). Narrow angles. American Academy of Ophthalmology.
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