Naltrexone/Bupropion
Contrave
Contrave is a prescription medication that the FDA approves to help adults who are obese or overweight with weight-related health issues manage their weight. It contains bupropion, an antidepressant that reduces appetite, and naltrexone, which is used to treat addiction and may also curb hunger. Contrave is taken as extended-release oral tablets. It should be used alongside a balanced diet and exercise as part of a weight loss program approved by a doctor. It is not approved to treat depression or other psychiatric conditions or to aid in quitting smoking. Common side effects include dry mouth, insomnia, and nausea. It’s important to consult a doctor before starting Contrave, especially if you have any health conditions or are taking other medications.
Product Overview
Contrave is an FDA-approved weight management medication designed for adults who are obese or overweight and have weight-related health problems. Losing weight and maintaining a healthy weight can reduce the risk of several health issues associated with obesity, including heart disease, diabetes, high blood pressure, and a shorter lifespan. The drug is a combination of bupropion, an antidepressant that helps reduce appetite, and naltrexone, traditionally used to block the effects of opioids or alcohol in people with addiction issues. Together, these ingredients work to reduce hunger and cravings for food.
Contrave comes in the form of extended-release oral tablets, meaning the medication is released gradually into the body over time. Each tablet contains 8 milligrams (mg) of naltrexone and 90 mg of bupropion. There are certain restrictions on who can use this drug, and it is only recommended for people who meet specific body mass index (BMI) criteria. (BMI is a way to estimate a person’s body fat based on their height and weight.) The recommended dosing schedule starts with one tablet in the morning in the first week, increasing to two tablets in the morning and two in the evening by the fourth week. It’s important to follow the dosing instructions provided by your doctor, who will adjust the dosage based on your response to the treatment.
While Contrave can aid in weight management, it is not a cure for weight-related medical conditions such as high blood pressure, diabetes, or high cholesterol. Additionally, it is not approved for treating depression or other psychiatric conditions or for assisting in smoking cessation. Common side effects of Contrave include dry mouth, insomnia, nausea, constipation, and dizziness. Serious side effects may include increased heart rate, seizures, and liver damage. It’s crucial to discuss any existing health conditions and medications with your doctor before starting Contrave to avoid potential interactions. Patients are advised to take Contrave with or without food but avoid high-fat meals to reduce the risk of side effects. If the medication proves ineffective after 12 weeks, your doctor may advise discontinuing its use. Always consult with your healthcare provider for guidance on using Contrave and managing its side effects.
Uses
- It is used as an aid to manage weight in adults who are obese or overweight and have weight-related health problems.
- It is typically used to block the effects of opioids or alcohol in people with addiction issues
- It can also help reduce hunger and cravings for food (thus reducing appetite).
[Important Warning: Contrave is not approved for the treatment of depression or other psychiatric conditions or for helping people quit smoking.]
How to Use Contrave?
Dosage
Contrave is available in the form of extended-release (ER) oral tablets. “Extended-release” means that the tablets gradually release the medication into your body over time after you swallow them. Contrave tablets come in only one strength, and each tablet contains:
- 8 milligrams (mg) of naltrexone
- 90 mg of bupropion
Recommended Dosages of Different Patients
For Weight Loss & Weight Management
Starting Dosage: Your doctor will begin your treatment with a low dose and adjust it gradually to find the right amount for you. The goal is to use the lowest effective dose. Follow your doctor’s instructions for dosing. They will determine the best dosage for your needs based on the chart provided by the drug manufacturer.
- Week 1: Start with one tablet each morning.
- Week 2: Take two tablets, one in the morning and another in the evening.
- Week 3: Take three tablets, two in the morning and one in the evening.
- Week 4: Take four tablets, two in the morning and two in the evening daily.
- Maintenance Dosage: From week four onwards, you will likely continue with two tablets in the morning and two in the evening as your long-term dose.
[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]
How to Take It?
Here’s how to take your Contrave tablets:
- Swallow Contrave tablets whole; do not crush, chew, or break them.
- You can take Contrave with or without food, but avoid taking it with high-fat foods to reduce the risk of side effects.
- If you have difficulty swallowing tablets, seek advice on alternative methods for taking the medication.
- If you have difficulty reading labels or opening containers, ask your pharmacist for accessible options, such as large print labels, audio labels, or easy-open containers. Always follow your doctor’s instructions and consult them for any questions or concerns regarding your Contraceptive treatment.
Taking Your Doses:
- There’s no specific recommended time for taking the evening dose of Contrave.
- You can take the morning and evening doses at times that suit you, but try to keep them 12 hours apart.
- Discuss with your doctor or pharmacist the best timing for your doses based on your daily routine.
Dosage Adjustments:
- Your doctor might reduce your Contrave dosage if your liver or kidneys are not functioning properly.
- Dosage adjustments may also be necessary if you are taking certain other medications.
- Always consult with your doctor before starting or stopping any other medications during your Contrave treatment.
Factors Influencing Dosage:
- Your dosage may depend on factors such as your age, kidney and liver function, and other medications you’re taking.
Long-Term Use:
- Contrave is generally used as a long-term treatment.
- If Contrave is effective and safe for you, you’ll likely take it for an extended period.
- However, if there’s no improvement within 12 weeks, your doctor may advise you to stop taking the medication.
Stopping Contrave:
- If you feel Contrave is not working for you, consult your doctor.
- Do not stop taking Contrave without your doctor’s advice.
- Generally, people do not experience side effects when discontinuing Contrave treatment.
[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]
How Does Contrave Work?
Contrave is a medication for adults who want to lose weight. It should be used with a balanced diet and regular exercise. Contrave comes as an extended-release tablet, which means it releases its active ingredients slowly over time. The medication has two main ingredients: bupropion and naltrexone. Bupropion is a type of antidepressant that affects two brain chemicals, norepinephrine and dopamine, which are involved in mood regulation. It helps keep these chemicals available in the brain, which can improve communication between nerve cells.
Naltrexone is a drug that blocks certain receptors in the brain. By doing this, it helps reduce the release of dopamine, which is related to the feeling of pleasure from eating. The exact way naltrexone helps with weight loss is not fully understood, but it is believed to influence the brain’s signals related to hunger and satisfaction after eating. Together, bupropion and naltrexone work on different parts of the brain to help control cravings and reduce appetite, aiding in weight management.
Important Safety Information
Side Effects
Common side effects of Contrave may include:
- Dry mouth
- Diarrhea
- Insomnia (trouble sleeping)
- Vomiting
- Headache
- Nausea
- Constipation
- Dizziness
Mild side effects of Contrave may include:
- Insomnia (trouble sleeping)
- Diarrhea
- Vomiting
- Nausea
- Tremors
- Fatigue
- Hot flashes
- Headache
- Constipation
- Dizziness
- Mild allergic reaction
- Dry mouth
- Anxiety
- Hair loss
Adverse side effects of Contrave may include:
- Increased heart rate or blood pressure. Signs are:
- Lightheadedness or dizziness
- Rapid heart rate
- Headache
- Heart palpitations
- Seizure. Signs are:
- Confusion
- Uncontrollable body movements
- Loss of consciousness or awareness
- Angle-closure glaucoma. Signs are:
- Seeing rings or halos around lights
- Severe headache
- Blurred vision
- Eye pain
- Hepatitis (liver inflammation) or Liver damage. Signs are:
- Fatigue
- Jaundice
- Dark urine
- Abdominal pain
- Severe allergic reaction
- Risk of suicidal thoughts and behaviors
[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]
Warnings
Before taking Contrave, talk with your doctor about your health history. Contrave may not be right for you if you have certain medical conditions or other factors affecting your health. These include:
- Smoking Cessation: Contrave is not approved for use in quitting smoking. However, one of its active ingredients, bupropion, is used for this purpose. When taking bupropion to stop smoking, some people may experience serious mental health issues. These can include depression, psychosis (losing touch with reality), hallucinations (seeing or hearing things that aren’t there), aggression, anxiety, and thoughts of suicide. If you notice any of these symptoms or any other changes in your behavior while taking Contrave, stop using the medication and contact a healthcare professional immediately.
- Triggering of Manic Episodes: Contrave contains bupropion, an active ingredient commonly used to treat depression. However, antidepressants like bupropion can occasionally lead to episodes of mania, mixed mood states, or hypomania. This risk is higher in individuals with bipolar disorder. If you have bipolar disorder, it’s important to discuss this with your doctor before beginning treatment with Contrave.
- Seizures: Bupropion, a key component in Contrave, can lead to seizures. The risk of seizures is higher with larger doses of bupropion. If you already have a higher risk of seizures, such as having a seizure disorder, this risk increases even further. Before starting Contrave, inform your doctor if you have a seizure disorder. Also, discuss with your doctor if you have a history of anorexia or bulimia or if you are suddenly stopping the use of alcohol or certain medications.
- Low Blood Sugar: If you have type 2 diabetes and are losing weight, you may be at a higher risk of low blood sugar, especially if you are taking insulin or medications that increase insulin production. Some examples of these medications are glyburide (Diabeta), glipizide (Glucotrol XL), and glimepiride (Amaryl). If you are taking Contrave for weight loss, it’s important to regularly check your blood sugar levels before and during your treatment. Your doctor might need to adjust the dose of your diabetes medication to prevent low blood sugar.
- Untreated or Unmanaged High Blood Pressure: If you have high blood pressure that is not controlled or treated, Contrave may not be suitable for you. This medication can raise your blood pressure and heart rate. It’s unclear how this increase might affect individuals with a history of heart disease or stroke. Therefore, doctors usually do not prescribe Contrave to people with untreated high blood pressure. If you have unmanaged high blood pressure or a history of heart disease or stroke, inform your doctor. They will help you decide if Contrave is an appropriate treatment option for you.
- Allergic Reaction: If you have ever had an allergic reaction to Contrave or any of its components, it is advised not to take this medication. Consult your doctor for alternative treatment options that may be more suitable for you.
Boxed Warning
FDA Warning: Risk of Suicidal Thoughts and Behaviors
- Contrave carries a boxed warning, which is the highest level of warning issued by the Food and Drug Administration (FDA). This warning alerts both doctors and patients to potential serious side effects of the drug.
- One of the active ingredients in Contrave, bupropion, is an antidepressant. In people with depression or other mental health conditions, antidepressants like bupropion can increase the risk of having suicidal thoughts and behaviors.
- This risk is particularly high in young individuals, including children, teenagers, and young adults up to 24 years old. The risk is highest during the initial months of treatment or when the dosage is being adjusted.
- If you are taking Contrave, it is important to monitor yourself for any unusual changes in your mood, behavior, thoughts, or feelings. You should also ask your family members, caregivers, and healthcare providers to be alert for these changes.
Precautions
- Pregnancy: It’s not advised to use Contrave during pregnancy. While there are no reports of Contrave causing fetal development issues or pregnancy loss, losing weight during pregnancy is generally not recommended due to potential risks to the fetus; if you become pregnant while on Contrave, your doctor will likely advise stopping the medication.
- Birth Control: If you’re sexually active and there’s a possibility of pregnancy, discuss birth control options with your doctor while taking Contrave.
- Breastfeeding: The active ingredients in Contrave, bupropion and naltrexone can transfer into breast milk and may harm a breastfeeding child. Breastfeeding is not recommended while taking Contrave; if you’re breastfeeding or planning to, consult with your doctor for alternative treatments.
Contraindications
Contrave should not be prescribed to individuals who:
- Have uncontrolled high blood pressure.
- Suffer from seizure disorders.
- Have a history of eating disorders such as anorexia nervosa or bulimia.
- Are abruptly stopping the use of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs.
- Are currently taking medications that contain bupropion, a component of Contrave.
- Are using opioids on a regular basis
- Are taking monoamine oxidase inhibitors (MAOIs), a type of antidepressant.
- Have an allergy to naltrexone or bupropion, the active ingredients in Contrave, or any other components of the medication.
It is important for healthcare providers to review a patient’s medical history and current medications to ensure that Contrave is a safe and appropriate treatment option.
Missed Dose
- If you forget to take a dose of Contrave, don’t worry. Just skip the missed dose and take your next dose at the usual time.
- To help you remember to take your medication, you can use a reminder. This could be setting an alarm or using a timer. You can also download a reminder app on your phone.
- If you have any questions about when to take your next dose of Contrave after missing one, talk to your doctor.
[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]
Overdose
If you take more Contrave than your doctor has prescribed, you might experience serious side effects. Always follow your doctor’s instructions and do not exceed the recommended dosage of Contrave. Signs of a Contrave overdose can include:
- Irregular heartbeat
- Loss of consciousness
- Seizures
- Hallucinations
- Muscle jerks or twitches
If you believe you have taken too much Contrave, contact your doctor immediately. You can also reach out to America’s Poison Centers or use their online tool. In case of severe symptoms, call your local emergency number or 911, or head to the nearest emergency room without delay.
[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]
Storage
- Keep the medication in a cool, dry area where the temperature remains below 25°C (77°F). Ensure it is out of reach of children.
- Avoid freezing the medication.
[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]
Contrave Interactions
Interaction with Alcohol: Although no direct interactions between Contrave and alcohol were reported in clinical trials, it’s important to be cautious. Contrave contains bupropion, which can affect your mood and behavior when combined with alcohol. You might experience agitation, depression, or sleeping problems, and your alcohol tolerance may be lower. To avoid these risks, it’s best to limit or avoid alcohol while taking Contrave.
Interaction with Other Medications: Contrave can interact with several medications, affecting how well it works or increasing side effects. Always tell your doctor and pharmacist about all medicines, vitamins, and supplements you’re taking. Some key interactions to be aware of include:
- MAOIs: Avoid taking Contrave with monoamine oxidase inhibitors (MAOIs) due to the risk of high blood pressure. If you’re on an MAOI, you’ll need to stop it and wait at least 14 days before starting Contrave.
- Opioids: Contrave can reduce the effectiveness of opioid pain relievers and may lead to withdrawal symptoms or overdose if not managed properly. Stop taking opioids at least 7 to 10 days before starting Contrave.
- CYP2B6 Inducers: Drugs that induce CYP2B6 can decrease bupropion levels, making Contrave less effective. Examples include ritonavir, lopinavir, and efavirenz.
- Drugs Affected by CYP2D6: Contrave can alter the levels of medications metabolized by CYP2D6, such as certain antidepressants, antipsychotics, and heart rhythm medications.
- Digoxin: Contrave can decrease the availability of digoxin in the body. Your doctor will monitor your digoxin levels if you take both medications.
- CYP2B6 Inhibitors: These drugs can increase bupropion levels in the body, raising the risk of side effects. Examples include ticlopidine and clopidogrel.
- Drugs That Increase Seizure Risk: Contrave may raise the risk of seizures, especially when taken with other medications that have a similar risk, such as certain antipsychotics, antidepressants, theophylline, and corticosteroids.
- Dopaminergic Drugs: Combining Contrave with dopaminergic drugs like levodopa and amantadine can lead to central nervous system (CNS) toxicity, resulting in symptoms like decreased alertness, restlessness, tremors, trouble walking, or dizziness.
Interaction with Herbs and Supplements: While no specific herbs or supplements have been reported to interact with Contrave, it’s still wise to consult your doctor or pharmacist before using any new products while taking Contrave.
Interaction with Foods: If you take Contrave with meals, avoid high-fat meals. High-fat meals can increase the level of the drug in your body, potentially leading to more side effects.
Interaction with Lab Tests: bupropion, an active ingredient in Contrave, may cause false-positive results in urine tests for amphetamines. If you’re undergoing urine testing, inform the testing facility that you’re taking Contrave to avoid false positives.
Always consult with your healthcare provider before making any changes to your medication regimen or if you have questions about potential interactions. Your doctor can provide personalized advice based on your health history and current medications.
[Note: This isn’t a complete list, and there could be other drugs that interact with Contrave. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]
Contrave Alternatives
- Actos (pioglitazone)
- Zepbound (tirzepatide)
- Jardiance (empagliflozin)
- Ozempic (semaglutide)
- Byette (exenatide)
- Victoza (liraglutide)
- Steglatro (ertugliflozin)
- Tradjenta (linagliptin)
- Avandia (rosiglitazone)
- Nesina (alogliptin)
- Mounjaro (tirzepatide)
- Invokana (canagliflozin)
- Saxenda (liraglutide)
- Farxiga (dapagliflozin)
- Glucophage (metformin)
- Rybelsus (semaglutide oral)
- Adlyxin (lixisenatide)
- Trulicity (dulaglutide)
- Januvia (sitagliptin)
- Prescose (acarbose)
- Wegovy (semaglutide)
- Bydureon Bcise (exenatide)
- Onglyza (saxagliptin)
[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]
Quick Tips
Frequently Asked Questions
Which is better, phentermine or Contrave?
Phentermine and Contrave are both medications used for weight loss. Contrave works by reducing your desire to eat and making you feel fuller, while Phentermine primarily suppresses your appetite. Both can be effective in helping you lose weight. If you’re seeking a short-term solution for quick weight loss, Phentermine might be a suitable choice. It’s important to consult with a healthcare professional to determine which medication is the best fit for your individual needs and to ensure safe and effective use.
How long can I stay on Contrave?
Your doctor will assess your progress with Contrave after 16 weeks. To continue using Contrave, you need to have lost at least 5% of your starting weight by then. Remember, Contrave helps with weight loss when combined with a lower calorie diet and/or increased physical activity. If you don’t meet this weight loss goal, your doctor may advise stopping the medication. It’s important to follow your doctor’s recommendations and maintain a healthy lifestyle for the best results.
What does Contrave do to your body?
Contrave is a weight loss medication approved by the FDA, designed to be used alongside a healthy diet and regular exercise for effective weight management. It functions primarily as an appetite suppressant, helping to reduce hunger and cravings. To achieve the best results in weight loss, it’s important to take Contrave as part of a comprehensive plan that includes eating fewer calories and staying active. This medication is intended to support your efforts in making healthier lifestyle choices and reaching your weight loss goals.
How quickly do you lose weight on Contrave?
The weight loss effects of Contrave can typically be observed within four weeks of starting the medication. By the 16-week mark, approximately 45% of individuals in studies reported losing 5% or more of their body weight. It’s important to note that individual results may vary, and achieving the best outcomes often requires combining the medication with a healthy diet and regular exercise. Consulting with a healthcare provider is essential to determine if Contrave is suitable for you and to monitor your progress while on the medication.
How to lose the most weight with Contrave?
The amount of weight you lose with Contrave can vary based on several factors, including your commitment to a low-calorie diet and regular exercise. In clinical studies, people who took Contrave while engaging in physical activity and adhering to a diet with fewer calories lost significantly more weight—2 to 4 times more—compared to those who did not follow these lifestyle changes. It’s important to combine Contrave with healthy eating and exercise habits to achieve the best results. Your healthcare provider can offer guidance on how to effectively incorporate these strategies into your weight loss plan with Contrave.
Can I drink coffee on Contrave?
You can drink coffee while taking Contrave, but it’s important to be cautious. Contrave contains Bupropion, and consuming large amounts of caffeine can worsen its side effects. You might experience increased nervousness, irritability, trouble sleeping, higher blood pressure, tremors, or even seizures if you have too much caffeine. To stay safe, limit your caffeine intake and monitor how your body responds when combining caffeine with Contrave. If you notice any adverse effects, consult your healthcare provider for guidance.
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