Contrave is one of many weight loss drugs exploding onto the market. Unlike other medications prescribed for weight management, Contrave (bupropion and naltrexone) is FDA-approved for the treatment of obesity and excess weight in adults. But with all the weight management options out there, is Contrave right for you?

This article will detail what Contrave is used for, how it works, what you should consider before taking it, and how it stacks up to other prescription weight-loss drugs.

What is Contrave?

Contrave is a prescription medication that contains two drugs: bupropion and naltrexone. The U.S. Food and Drug Administration approved it in 2014 to help adults with obesity or adults who are overweight and who also have a weight-related health condition lose weight. Contrave combines the distinct actions of its two active ingredients toward this end.

Bupropion (also available under the brand name Wellbutrin) is classified as an antidepressant. When prescribed by itself, it is used to treat depression and seasonal affective disorder. It may also be prescribed to help an individual quit smoking— also known as a smoking cessation aid. It works by preventing the reabsorption of dopamine and norepinephrine in the brain, which can improve mood and activate reward pathways, making it effective in treating depression and seasonal affective disorder (SAD). Additionally, bupropion is used as a smoking cessation aid because it blocks dopamine reuptake, reducing cravings and withdrawal symptoms, thus prolonging feelings of motivation and reward, which, when combined with nicotine replacement therapy, has proven highly effective in helping individuals quit smoking.

Naltrexone (also available under the brand name ReVia) is classified as an opioid antagonist. When prescribed by itself, it is used to help individuals who have quit drinking or using street drugs to continue to avoid using substances. Naltrexone blocks the pleasurable effects of substances like opiates and alcohol. It does so by binding to opiate receptors in the brain, preventing them from responding to these substances and reducing cravings to get "high." Naltrexone doesn't cause impairment, produce a "high," or lead to physical or mental dependence. Instead, it can help prevent relapse in individuals recovering from substance addiction when used in conjunction with cognitive behavioral therapy (CBT) and support groups.

The combination of these two drugs yields a dual action on pathways in the brain, effecting a reduced appetite and improving craving control.

How does Contrave cause weight loss?

Contrave is FDA-approved specifically to help individuals with obesity or overweight individuals with a weight-related medical condition lose weight. It is prescribed in conjunction with a reduced-calorie diet and increased physical activity.

Contrave is a combination drug consisting of two active ingredients: bupropion and naltrexone, each with distinct mechanisms of action contributing to its weight loss effects.

Appetite Control (Bupropion): Bupropion, one of the active ingredients in Contrave, is primarily known for its properties as an antidepressant and smoking cessation aid. However, it also plays a crucial role in weight management. Bupropion affects the brain's neurotransmitters, particularly dopamine and norepinephrine, which are involved in mood and the sensation of pleasure. By influencing these neurotransmitters, bupropion can help reduce food cravings and control appetite. This effect can be especially beneficial for individuals struggling with emotional eating or managing portion sizes.

Craving Reduction (Naltrexone): Naltrexone, the other active component of Contrave, is classified as an opiate antagonist. It primarily works by binding to opiate receptors in the brain and blocking the pleasurable effects associated with substances like opioids and alcohol. When used in Contrave, naltrexone helps reduce cravings for high-calorie, unhealthy foods, as it dampens the reward response that typically drives people to overindulge in such foods. This effect can make it easier for individuals to stick to a healthier diet plan.

A healthcare provider will prescribe Contrave in conjunction with lifestyle changes like a healthy diet and regular exercise as a part of a comprehensive weight management program.

Is Contrave safe?

Contrave was approved by the FDA in 2014 as a chronic weight management aid in adults with obesity or overweight adults with weight-related health problems.

Several clinical trials were conducted to study how Contrave works when combined with lifestyle changes. These trials involved over 4,500 patients who were overweight or obese and had health issues like high blood pressure or high cholesterol. These trials showed that Contrave helped many participants achieve a 5 percent or more reduction in body weight.

While Contrave is considered safe for most adults, it has been shown to cause some side effects.

Common side effects of Contrave include:

• Nausea
  
• Vomiting
  
• Headache
  
• Dizziness
  
• Fatigue
  
• Diarrhea
  
• Constipation
  
• Dry mouth
  
• Excessive sweating
  
• Changes in taste
  
  

Serious side effects include:

• Allergic reactions like skin rash, hives, swelling, or shortness of breath
  
• Seizures
  
• Chest pain
  
• Cardiovascular problems like a rapid heart rate or elevated blood pressure
  
• Fever symptoms
  
• Yellowing of the skin or eyes
  
• Muscle or joint pain
  
• Dark-colored urine
  
  

The risk of seizures increases when taking higher doses of Contrave. If you begin to experience seizures or any serious adverse effects while taking Contrave, talk to your healthcare provider. They may elect to lower or discontinue your dosage. Additionally, do not take Contrave after eating a high-fat meal. Taking Contrave with a high-fat meal can overexpose the body to the active ingredients (naltrexone/bupropion) in the medication and cause seizures.

Contrave contains bupropion, an antidepressant. Antidepressants may cause suicidal thoughts in some patients. If you or someone you know is experiencing any mental health symptoms while taking Contrave, seek medical advice from a healthcare professional immediately.

Does Contrave cause any drug interactions?

Before starting treatment with any prescription medication, you should tell your doctor about any medical conditions you have, any prescription drugs or supplements you are taking, and any allergies you may have. This information will help reduce the risk of any drug interactions or adverse reactions.

You should inform your provider if you are currently using a monoamine oxidase inhibitor like isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), rasagiline (Azilect), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate), or if you have stopped using one of these MAOIs in the last 14 days.

In addition, inform your provider if you are currently using opioid medications or any street drugs, including prescription pain medications, tramadol, opioid dependence treatments like buprenorphine or methadone, and specific medications for diarrhea, cough, or cold. Mention any recent use of these substances within the last 7 to 10 days. Seek clarification from your provider if you're uncertain whether a medication is an opioid. Your provider will advise against taking naltrexone and bupropion together if you've used opioids within the past 7 to 10 days.

During your treatment with the combination of naltrexone and bupropion, avoid using any opioid medications or street drugs. Naltrexone blocks the effects of opioids, so you may not sense their effects at typical or lower doses. This can lead to opioid withdrawal symptoms. However, taking higher doses of opioids during this treatment can lead to severe harm, unconsciousness, or even death.

Healthcare providers may avoid prescribing Contrave for people with:

• A history of seizures
  
• Eating disorders (such as anorexia or bulimia nervosa)
  
• Mood disorders (like bipolar disorder or major depressive disorder)
  
• Hypertension (high blood pressure)
  
• Type 1 or type 2 diabetes
  
• Hypoglycemia (low blood sugar)
  
• Alcohol or substance abuse
  
• Liver problems or hepatitis
  
• Kidney problems
  
• Heart disease
  
• Glaucoma
  
• Use of other Bupropion-containing products
  
  

Contrave may not be prescribed to pregnant women, women who are trying to conceive, or women who are breastfeeding.

Who should take Contrave for weight loss?

Contrave is specifically indicated for use in adults with obesity (with a body mass index— BMI—of 30 kg/m2 or greater) or overweight adults (a BMI of 27 kg/m2 or greater) who also have weight-related health conditions such as hypertension (high blood pressure), high cholesterol, or obstructive sleep apnea.

Contrave is not prescribed to children.

Contrave should not be used by individuals who are currently taking opioid medications or using street drugs.

How do you take Contrave?

Contrave is supplied as an oral tablet. Each tablet contains 8 mg of naltrexone and 90 mg of bupropion.

The standard starting dose of Contrave is usually one tablet in the morning, increasing gradually to the full recommended dose of two tablets in the morning and two tablets in the evening. This increase in dosage usually takes about 4 weeks before the maintenance dosage is reached. After 16 weeks, your healthcare provider may ask to evaluate how much weight you lost to determine the medication’s efficacy. Discontinuation should be considered if weight loss is <4% to 5% of baseline after 3 months.

Are there alternatives to Contrave?

Contrave is specifically indicated as a chronic weight management aid. However, it can cause serious side effects in some patients and may not be suitable for everyone. If you are looking for an alternative to Contrave, discuss these options with your healthcare provider:

Semaglutide (available as Ozempic, Wegovy, or Rybelsus): Semaglutide is a diabetes drug that assists with weight loss when prescribed with a healthy diet and regular exercise. Semaglutide works by managing blood sugar levels, curbing appetite, and slowing stomach emptying (which makes you feel fuller longer). Wegovy, a brand-name medication containing semaglutide, is specifically approved for the treatment of obesity in patients without type 2 diabetes.

Tirzepatide (available as Mounjaro or Zepbound): Like semaglutide, tirzepatide is a GLP-1 receptor agonist used to treat type 2 diabetes and obesity. It regulates blood sugar levels, reduces appetite, and slows stomach emptying. Zepbound, a brand name containing tirzepatide, is specifically approved to treat obesity in patients without type 2 diabetes.
Liraglutide (available as Saxenda): Liraglutide is a GLP-1 receptor agonist approved by the FDA to treat obesity in adults and children over 12. It works by reducing blood sugar levels and appetite while slowing stomach emptying.

Metformin: Metformin is a prescription diabetes drug that has been shown to cause weight loss in some patients. It works by regulating blood sugar levels and improving insulin sensitivity. Increased insulin usage lowers the amount of sugar circulating in the blood.

Topiramate (available as Topamax): Topiramate is an anticonvulsant medication that has been shown to cause weight loss in some patients. While its mechanism of action is not fully understood, it is thought to work through appetite suppression (reduced calorie intake), preventing the body from storing excess fat and lowering some fat and cholesterol levels. It might also affect the brain's reward system, potentially preventing binge eating. Topiramate is not FDA-approved for use as a weight loss aid. However, topiramate produced more significant weight loss during clinical trials in individuals who took the medication than in the placebo group.

Do I need a prescription for Contrave?

Contrave is a prescription drug, meaning that you must have a written order from a licensed healthcare provider to get it. It cannot be purchased over the counter.

Contrave is available under its brand name. There are no generic versions of Contrave currently available.

Weight loss drugs are prescribed to individuals with obesity or individuals who are overweight and managing a weight-related health condition. If you are curious about Contrave or any other weight loss drug, talk to your healthcare provider about whether or not these treatment options are right for you. You should also discuss the cost, potential side effects, and any concerns you may have.

Can I get Contrave on Sesame?

Sesame offers a comprehensive online weight loss program to help you get started on your weight loss journey.

Sesame’s online weight loss program is a subscription which renews every 3 months and includes a video consultation with a weight loss doctor or specialist, a GLP-1 prescription (if appropriate), insurance coordination for medication coverage, and 90 days of unlimited messaging with your provider.

Note that all prescriptions are at the discretion of your healthcare provider.

Sources:

• Dahlberg, S., Chang, E. T., Weiss, S. R., Dopart, P., Gould, E., & Ritchey, M. E. (2022). Use of Contrave, Naltrexone with Bupropion, Bupropion, or Naltrexone and Major Adverse Cardiovascular Events: A Systematic Literature Review. Diabetes, metabolic syndrome and obesity : targets and therapy. . NIH
  
• (n.d.). Naltrexone and Bupropion. Medline.
  
• Sherman, M. M., Ungureanu, S., & Rey, J. A. Naltrexone/Bupropion ER. P & T : a peer-reviewed journal for formulary management.
  
• Garvey WT, Mechanick JI, Brett EM, et al; reviewers of the AACE/ACE obesity clinical practice guidelines. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract.