What to Know About Contrave (Naltrexone-Bupropion)

If you need to lose weight and you're looking for a prescription weight loss medication, you have several choices. Your doctor may talk to you about a variety of medications, including Contrave (bupropion and naltrexone). As a weight loss medication, Contrave is prescribed in tablet form and most often alongside a reduced-calorie diet and increased physical activity in order to achieve results.

Before taking any weight loss medication or making changes to your diet, exercise plan, or lifestyle, make sure to consult with a medical professional who can assess your needs and develop the best plan for you. Here's what you need to know about Contrave, including costs, weight loss results, and side effects.

What Is Contrave?

Contrave is a combination of two different medications: naltrexone hydrochloride and bupropion hydrochloride. Each extended-release tablet contains:

  • 8 milligrams of naltrexone, an opioid agonist that is often prescribed for alcohol dependence, opioid dependence, or smoking cessation
  • 90 milligrams of bupropion, an aminoketone antidepressant that is used to treat depression and seasonal affective disorder

The combination of the two medications is prescribed to improve weight loss success. The drug affects your central nervous system to increase the number of calories you burn and reduce your appetite.

Uses

The Food and Drug Administration first approved Contrave to aid in chronic weight management in adults in 2014. Specifically, it is prescribed as a weight loss medication to adults who have a body mass index (BMI) of 30 or more or a BMI of 27 or greater along with a weight-related condition such as type 2 diabetes, high blood pressure, or high cholesterol. Your doctor may prescribe Contrave if you meet the above requirements and if previous weight loss treatments have not been successful.

Effectiveness

Research shows that Contrave can help to promote weight loss, but the numbers aren't staggering. In a 2016 study of patients without diabetes, 42% of patients lost at least 5% of their body weight after a year. That means that most study participants taking Contrave did not hit the 5% weight loss goal.

In a randomized clinical trial, 57% of patients who took Contrave lost at least 5% of their body weight. However, only 53% of the study participants completed the program. The remaining participants dropped out before the research was completed. Most dropped out within the first few weeks, citing adverse reactions such as nausea, constipation, and headaches.

In patients with diabetes, the numbers are modest as well: 36% lost at least 5% of their body weight after a year. In both studies (participants with and without diabetes), the group taking the placebo lost significantly less weight than the patients taking Contrave. All patients in both groups received lifestyle modification counseling that consisted of a low-calorie diet and regular exercise.

In each study, participants taking Contrave also made changes to their diet and exercise program. So even though they did lose some weight with the diet pill (on average, about 12 pounds in about a year), some of that weight loss was likely due to lifestyle changes (diet and exercise) and not the medication. The amount of weight you lose may have a great deal to do with how well you maintain a calorie-controlled diet and an exercise program. 

Before Taking

Speak with a medical professional if you think Contrave is a good fit for you. Your physician can recommend the best course of action and help determine if this weight loss drug could work for you.

Precautions and Contraindications

According to the FDA, Contrave is not a recommended form of treatment for seizures, or people with a history of seizures, eating disorders such as bulimia or anorexia nervosa, or uncontrolled high blood pressure (hypertension). Avoid the medication if you are undergoing abrupt withdrawal from alcohol or other drugs (such as benzodiazepines, barbiturates, and antiepileptic medications) or are taking other medications that contain bupropion (such as Wellbutrin and Aplenzin).

Do not take Contrave if you are under the age of 18, use opioids, are pregnant or breastfeeding, are taking monoamine oxidase inhibitors (MAOIs) or have taken them within 14 days, or are allergic to any of the ingredients in Contrave.

If you consider Contrave, be sure to tell your healthcare provider about every medication you are taking. Once you've started taking the weight loss pill, talk to your doctor about any unusual symptoms. After 12 weeks, if you have not lost at least 5% of your body weight, your doctor may discontinue your treatment with the drug as the lack of results likely indicate that this medication will work for you.

Other Opioid Antagonists

Other commonly-prescribed FDA-approved opioid antagonists include:

Dosage

According to Orexigen Therapeutics, Inc. (the manufacturer), a single Contrave pill contains a combination of naltrexone (8mg) and bupropion (90mg) in a single tablet. The recommended dosage of Contrave is progressive, with the dosage changing from week one of the medication onward.

In the first week of taking Contrave, Orexigen recommends a daily morning dose of one tablet. You should not take any tablets in the evening during the first week.

In week two, the proper dosage includes one tablet in the morning and one tablet in the evening.

In week three, Orexigen recommends two tablets in the morning and one tablet in the evening.

Finally, beginning with week four and onward, the recommended dosage for Contrave is two tablets in the morning and two tablets in the evening.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

Speak to your healthcare provider before beginning a Contrave treatment. Your doctor may change your recommended dosage if necessary.

How to Take and Store

When taking Contrave, always swallow the tablet in its whole form. Do not cut, chew, or crush the tablet into pieces.

The maximum number of tablets to take daily is four: two in the morning and two in the evening. Do not take more than one dosage (two tablets) at one time, or more than four total tablets in a single day.

Do not take Contrave with high-fat foods, as it may increase your chances of a seizure.

If you miss a single dose of Contrave, wait until your next scheduled dose to take it. For example, if you miss a morning dose, skip it and simply take your evening dose that night. Don't double your dose in the evening and don't take more than one prescribed dose at a time.

If you take more than the recommended dose of Contrave, contact your doctor or go to the emergency room immediately.

Store your Contrave medication at a room temperature of 59F to 86F (15C to 30C). 

Contrave Side Effects

Common

The most common side effects reported by patients taking Contrave include:

  • Constipation
  • Diarrhea
  • Dizziness
  • Dry mouth
  • Headache
  • Insomnia
  • Nausea
  • Vomiting

In the clinical trials, 24% of people stopped taking Contrave because of side effects. Only 12% of people taking the placebo discontinued treatment.

Severe

Along with the common side effects listed above, Contrave can also cause serious reactions including suicidal thoughts or actions. Bupropion, one of the main ingredients in Contrave has been linked with suicidal thoughts and may increase these symptoms in some people while taking Contrave.

If you experience suicidal thoughts, have increased irritability, new or worsened depression or anxiety, or have other unexpected changes in your mood or behavior, stop taking Contrave and contact your doctor.

Additional severe side effects of Contrave include seizures, severe allergic reaction, sudden increase in blood pressure or lower blood sugar, potential liver damage, and changes or issues with vision.

Naltrexone, one of the ingredients in Contrave, can also increase the chances of an opioid overdose, so always check with your doctor prior to beginning treatment. Taking Contrave may cause sudden opioid withdrawal if you have not stopped using opioids prior to starting Contrave.

Warnings and Interactions

Researchers don't know how taking Contrave effects long-term cardiovascular health. So if you are already at risk for cardiovascular disease, you may want to speak to your doctor about the potential for harm if you take this weight loss drug. The drugmaker began a randomized clinical trial in early 2016 to evaluate the heart health safety of Contrave. However, the study was terminated early after a data leak, and no further results have been released.

Researchers also don't know how Contrave interacts with other weight loss products, including prescription medications, over-the-counter drugs, and herbal supplements. Be sure to let your doctor know if you are taking any other prescription or non-prescription treatment when you discuss whether or not the medication is right for you.

Black Box Warning

Contrave is required to carry a black box warning stating that users should be cautious about an increased risk of suicidal thoughts and behaviors in adolescents and young adults. People who have experienced depression or mania may see their conditions return while on Contrave. 

Don't consume large amounts of alcohol while taking Contrave. If you do consume alcohol regularly and in large quantities, speak with your doctor before stopping. Cutting alcohol completely while taking Contrave can increase your chances of a seizure.

Cost

The number of Contrave tablets that you take each day will determine the overall cost. According to prescribing information provided by the company, your dose is likely to vary as you continue with the treatment.

The cost of Contrave varies from about $99 per month to over $250 per month depending on dose, location, and insurance coverage. The drugmaker offers a discount coupon plan for people whose insurance does not cover Contrave or who do not have insurance coverage. With the savings card, you may be able to pay no more than $4 a day for a monthly prescription.

A Word From Verywell

There is no weight loss medication that works perfectly for everyone. Talk to your doctor about your diet and exercise experience and your medical history to determine if Contrave might work for you. You will need to stay in contact with your healthcare team and have a strong commitment to nutritious eating and regular physical activity to make sure that your body stays strong and healthy. 

Was this page helpful?
6 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sherman MM, Ungureanu S, Rey JA. Naltrexone/Bupropion ER (Contrave): Newly approved treatment option for chronic weight management in obese adults. P T. 2016;41(3):164-172.

  2. FDA. Full Prescribing Information: Contrave. Revised September 2014.

  3. Wadden TA, Foreyt JP, Foster GD, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trialObesity (Silver Spring). 2011;19(1):110-120. doi:10.1038/oby.2010.147.

  4. Yanovski SZ, Yanovski JA. Naltrexone extended-release plus bupropion extended release for treatment of obesity. JAMA. 2015;313(12):1213-1214. doi:10.1001/jama.2015.1617

  5. Wadden TA, Foreyt JP, Foster GD, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: The COR-BMOD trialObesity (Silver Spring). 2011;19(1):110-120. doi:10.1038/oby.2010.147

  6. CONTRAVE Prescribing Information. La Jolla, CA: Orexigen Therapeutics, Inc. 2017.

Additional Reading