Contrave: A Dual-Action Weight Management Medication
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Synonyms | |||
Contrave is a prescription medication approved by the FDA for chronic weight management in adults with obesity or overweight with at least one weight-related condition, such as hypertension, type 2 diabetes, or dyslipidemia. It combines two established active ingredients—naltrexone HCl and bupropion HCl—in an extended-release formulation. This unique combination works on areas of the brain involved in hunger control and reward-based eating, offering a pharmacological approach to support sustained weight loss when used alongside reduced-calorie diet and increased physical activity. It is intended for patients with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater in the presence of comorbidities.
Features
- Contains naltrexone hydrochloride (8 mg) and bupropion hydrochloride (90 mg) per tablet
- Extended-release oral formulation
- FDA-approved for chronic weight management
- Requires prescription and medical supervision
- Packaged in monthly supply blister packs
- Titration schedule over first four weeks to optimize tolerability
Benefits
- Supports significant and sustained weight loss when combined with lifestyle modifications
- Helps reduce cravings and control appetite by acting on hypothalamic and mesolimbic pathways
- May improve certain metabolic parameters, such as waist circumference and glycemic indicators
- Can contribute to improved quality of life and psychological well-being through successful weight management
- Provides a non-surgical option for individuals who have struggled with diet and exercise alone
- Dual mechanism may help address both physiological and behavioral aspects of overeating
Common use
Contrave is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:
- 30 kg/m² or greater (obesity), or
- 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
It is typically prescribed after other weight loss attempts have not yielded sufficient results. Treatment response should be evaluated by week 16; if a patient has not lost at least 5% of baseline body weight, discontinuation should be considered, as the medication is unlikely to be effective.
Dosage and direction
The recommended dosage of Contrave is two tablets taken twice daily (total daily dose: 32 mg naltrexone/360 mg bupropion). To minimize the risk of adverse reactions, a gradual dose escalation is mandatory:
- Week 1: Take one tablet in the morning
- Week 2: Take one tablet in the morning and one tablet in the evening
- Week 3: Take two tablets in the morning and one tablet in the evening
- Week 4 and onward: Take two tablets in the morning and two tablets in the evening
Tablets should be swallowed whole and not crushed, divided, or chewed. Contrave can be taken with or without food. To reduce the risk of insomnia, avoid taking doses late in the evening.
Precautions
- Contrave contains bupropion, which is associated with a risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. Monitor all patients for worsening depression or emergence of suicidal ideation.
- May increase blood pressure and/or resting heart rate. Monitor blood pressure and heart rate prior to and during treatment.
- Use with caution in patients with a history of seizures or conditions that may lower seizure threshold.
- May cause angle-closure glaucoma. Patients should be advised to seek immediate medical attention if visual changes occur.
- Do not use in combination with other bupropion-containing products or monoamine oxidase inhibitors (MAOIs).
- Use with caution in patients with hepatic or renal impairment.
- May cause hypersensitivity reactions, including anaphylaxis.
Contraindications
- Uncontrolled hypertension
- Seizure disorder or history of seizures
- Use of other bupropion-containing products
- Current or prior diagnosis of bulimia or anorexia nervosa
- Concomitant use of monoamine oxidase inhibitors (MAOIs); must allow 14 days between discontinuation of an MAOI and initiation of Contrave
- Known hypersensitivity to naltrexone, bupropion, or any other component of the product
- Chronic opioid use or acute opioid withdrawal; patients must be opioid-free for at least 7–10 days before starting Contrave
- Pregnancy and breastfeeding
Possible side effects
Common adverse reactions (≥5%) include:
- Nausea
- Constipation
- Headache
- Vomiting
- Dizziness
- Insomnia
- Dry mouth
- Diarrhea
Serious side effects may include:
- Suicidal thoughts or behaviors
- Seizures
- Increases in blood pressure and/or heart rate
- Angle-closure glaucoma
- Liver damage
- Allergic reactions
- Manic episodes
Drug interaction
Contrave has several important drug interactions:
- MAOIs: Contraindicated due to risk of hypertensive crisis.
- Other bupropion-containing products: Increased risk of adverse effects.
- Opioids: May reduce efficacy of opioid analgesics or precipitate withdrawal.
- Drugs that lower seizure threshold (e.g., antipsychotics, antidepressants, corticosteroids): Increased seizure risk.
- CYP2B6 inhibitors (e.g., ticlopidine, clopidogrel): May increase bupropion exposure.
- Drugs metabolized by CYP2D6 (e.g., antidepressants, antipsychotics, beta-blockers): Bupropion inhibits CYP2D6 and may increase levels of these drugs.
- Alcohol: Avoid or limit use; may increase risk of neuropsychiatric events.
Missed dose
If a dose is missed, patients should skip the missed dose and take the next dose at the regular time. Do not double the dose to make up for a missed one. Taking extra tablets can increase the risk of seizure.
Overdose
Overdose with Contrave may lead to seizures, hallucinations, loss of consciousness, tachycardia, and/or ECG changes. There is also risk of nausea, vomiting, and dizziness. Due to the bupropion component, large overdoses may be fatal. In case of suspected overdose, seek immediate medical attention or contact a Poison Control Center. Management is supportive and symptomatic; there is no specific antidote.
Storage
Store at room temperature (20°–25°C or 68°–77°F), with excursions permitted between 15°–30°C (59°–86°F). Keep in the original blister pack to protect from moisture. Keep out of reach of children and pets. Do not use if the blister pack is torn or damaged.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. Individual results may vary.
Reviews
Clinical trials and post-marketing studies have demonstrated that Contrave can lead to an average weight loss of 5–10% of initial body weight over one year when combined with lifestyle intervention. Many patients report reduced food cravings and improved eating behaviors. However, individual experiences vary, and some users may experience side effects such as nausea, especially during the titration phase. Adherence to the prescribed dosing schedule and regular follow-up with a healthcare provider are important for achieving optimal results.