Contrave: Indications for Use, Dosing & Side Effects

Contrave is a prescription medication used to support weight loss in adults with obesity or overweight. It contains bupropion and naltrexone, two active ingredients that act on specific areas of the brain to help reduce and control appetite.

When combined with a balanced diet and regular physical activity, Contrave can help people lose up to 10% of their body weight within 12 months. It can also help reduce waist circumference, which may lower the risk of developing conditions such as type 2 diabetes and heart disease.

Approved by the FDA for long-term weight management, Contrave is available in extended-release tablets containing 8 mg of naltrexone hydrochloride and 90 mg of bupropion hydrochloride. It can only be purchased with a valid prescription from a licensed healthcare provider.

Indications for use

Contrave is indicated for:

• Chronic weight management in adults with a body mass index (BMI) of 30 kg/m² or greater (obese);

• Adults with a BMI of 27 kg/m² or greater (overweight) who also have at least one weight-related medical condition, such as type 2 diabetes, high cholesterol, or high blood pressure.

Contrave should only be used under medical supervision as part of a comprehensive weight management plan that includes a reduced-calorie diet and regular physical activity.

It’s important to understand that Contrave does not directly treat diabetes, high cholesterol, or hypertension. However, by supporting weight loss, it can help improve the overall management of these conditions.

Prescription requirement

Contrave is a prescription-only medication that must be prescribed by a licensed healthcare professional.

Although Contrave is not a controlled substance, it contains bupropion and naltrexone, which must be used under medical supervision due to their potential for drug interactions and neurological side effects.

How it works

Contrave combines two active ingredients (naltrexone and bupropion) that work together on the central nervous system to help control hunger and food cravings.

Bupropion influences dopamine and norepinephrine activity, which helps reduce appetite and improve mood, while naltrexone blocks certain opioid receptors in the brain, reducing food cravings and helping to prevent compulsive eating.

Together, these effects help decrease calorie intake and promote long-term weight loss in people with obesity or overweight.

Dosing instructions

Contrave must be taken exactly as prescribed. The usual recommended dosing schedule involves a gradual increase over four weeks to help minimize side effects:

• Week 1: 1 tablet in the morning;

• Week 2: 1 tablet in the morning and 1 tablet in the evening;

• Week 3: 2 tablets in the morning and 1 tablet in the evening;

• Week 4 and onward: 2 tablets in the morning and 2 tablets in the evening (maximum dose).

Contrave tablets should be swallowed whole with water. Do not split, crush, or chew the tablets. They should not be taken with high-fat meals, as this can increase the risk of seizures and other side effects.

Missed doses

If you forget to take a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take extra tablets to make up for a missed dose.

Contrave side effects

The most common side effects of Contrave include nausea, vomiting, headache, dizziness, constipation, diarrhea, dry mouth, insomnia, restlessness, anxiety, irritability, mood changes, and muscle or joint pain. These symptoms are usually mild to moderate and tend to occur during the first few weeks of treatment, often improving over time as the body adjusts to the medication.

More serious side effects can occur and require immediate medical attention. These include a rapid or irregular heartbeat, severe headache, blurred vision, ringing in the ears, seizures, loss of consciousness, or signs of a severe allergic reaction such as swelling, rash, or difficulty breathing. If any of these occur, seek emergency medical care right away.

Contrave also carries an FDA boxed warning for suicidal thoughts and behaviors, similar to other medications that contain bupropion. Patients should be monitored for mood changes, depression, or unusual behavior, especially during the first few months of treatment or after dose adjustments.

Contraindications for use

Contrave should not be used by:

• Children or teenagers under 18 years old;

• People who are pregnant or breastfeeding;

• People who are allergic to bupropion, naltrexone, or any ingredients in the formula;

• Those with uncontrolled high blood pressure;

• People with seizure disorders or a history of seizures;

• Individuals with a current or prior diagnosis of bulimia or anorexia nervosa;

• People who are abruptly stopping alcohol, benzodiazepines, barbiturates, or antiepileptic drugs;

• Individuals who are using opioids or undergoing opioid withdrawal;

• People taking other bupropion-containing medications;

• Individuals who have used monoamine oxidase inhibitors (MAOIs) such as isocarboxazid, phenelzine, or tranylcypromine within the past 14 days;

• Those with severe liver or kidney impairment.

People with a history of mental health conditions such as depression or bipolar disorder should use Contrave with caution and under close medical supervision.