Contrave is a prescription medicine for weight management in adults with obesity or weight-related conditions. Its combined ingredients help reduce hunger and control food cravings as part of a reduced-calorie diet and increased physical activity.
Contrave is a prescription weight-management medicine combining naltrexone hydrochloride and bupropion hydrochloride. It is intended for adults with obesity, or overweight adults with weight-related conditions. Its dual action helps reduce hunger and control food cravings alongside a reduced-calorie diet and increased physical activity.
Naltrexone is an opioid receptor antagonist. It blocks opioid receptors involved in reward signalling and is also used in other settings involving opioid or alcohol dependence. Bupropion affects noradrenaline and dopamine signalling in the central nervous system and is used in certain mood and smoking-cessation treatments.
Bupropion is converted into active metabolites, including hydroxybupropion, threohydrobupropion, and erythrohydrobupropion. Naltrexone is converted mainly into 6-beta-naltrexol. These metabolites contribute to the medicine’s pharmacological activity.
Contrave tablets contain the active ingredients stated on the pack in an extended-release formulation. Follow the dose-escalation schedule stated on the pack and in the package leaflet.
Tablets are taken by mouth and swallowed whole.
Do not crush, chew, or split Contrave tablets. Altering the extended-release tablet can release the ingredients too quickly and may raise the risk of adverse effects, including seizures.
If treatment is interrupted for a prolonged period, restarting at the full maintenance dose may increase nausea and other adverse effects. The escalation schedule may need to be repeated.
The medicine should be stopped if the expected clinical response has not occurred after the assessment period specified by the prescriber. Continuing indefinitely without measurable benefit exposes the patient to adverse effects without a clear treatment gain.
The combination acts on two related pathways:
Food cravings are not the same as physical hunger. Hunger reflects the body’s need for energy, while cravings can arise from reward, habit, stress, visual cues, or emotional triggers. Contrave targets both appetite regulation and reward-related eating behaviour. Its central nervous system effects are described in the European Medicines Agency assessment of naltrexone/bupropion prolonged-release tablets [2].
Contrave contains two active substances in extended-release tablets: naltrexone hydrochloride 8 mg and bupropion hydrochloride 90 mg per tablet. It is used with lifestyle measures for chronic weight management in adults with:
BMI is calculated from body weight and height. It does not describe body composition perfectly, so treatment decisions also consider medical history, waist circumference, existing conditions, and previous weight-management attempts.
The combination is intended for long-term weight management rather than short-term appetite suppression. Clinical guidance and regulatory information describe Contrave as an adjunct to a reduced-calorie eating plan and regular physical activity [1].
Contrave tablets should be prescribed within a broader treatment plan. The medicine may help reduce appetite and cravings, yet it does not replace nutritional planning, movement, sleep management, or treatment of conditions that promote weight gain.
Contrave was developed by Currax Pharmaceuticals LLC.
| Treatment approach | Main pharmacological action | Route and practical focus |
|---|---|---|
| Contrave | Naltrexone plus bupropion affects reward signalling and appetite pathways | Oral extended-release tablets; useful when hunger and cravings are prominent |
| GLP-1 receptor agonists, such as liraglutide or semaglutide | Mimic GLP-1, slow gastric emptying, improve satiety, and influence glucose regulation | Usually injectable; often selected when appetite and metabolic disease require treatment |
| Phentermine/topiramate extended release | Combines sympathomimetic appetite suppression with an anticonvulsant-related appetite effect | Oral treatment; stimulant effects and pregnancy precautions are important |
Saxenda contains liraglutide and is a GLP-1 receptor agonist. Ozempic contains semaglutide and is primarily indicated for type 2 diabetes in many regulatory settings, although semaglutide products may have separate weight-management indications. These medicines do not work through the same mechanism as Contrave.
Qsymia is the commercial name associated with phentermine/topiramate extended release. Its stimulant component may cause insomnia, increased heart rate, or anxiety, while topiramate has cognitive and pregnancy-related precautions.
Lorcaserin, previously marketed as Belviq, acted on serotonin 2C receptors. It was withdrawn from the United States market in 2020 after an FDA safety review identified a possible cancer risk; it is not a current alternative for routine weight management.
Contrave may suit a patient whose main difficulty involves food reward and cravings. A GLP-1 receptor agonist may be considered when type 2 diabetes, strong appetite suppression needs, or metabolic risk dominates the clinical picture. Choice depends on contraindications, treatment goals, tolerability, and previous response.
Naltrexone blocks opioid receptors. It can prevent opioid pain medicines from working and may trigger withdrawal in a person who still has opioids in their system. A planned opioid-free interval is required before starting treatment, with the length determined by the opioid used and the person’s clinical circumstances.
People with liver disease, kidney impairment, bipolar disorder, uncontrolled depression, or a history of head injury may need a different treatment plan or closer monitoring. Bupropion lowers the seizure threshold, so several risk factors together can become clinically significant.
This medication may not be suitable for you if you have uncontrolled blood pressure, a seizure history, an eating disorder, or current opioid use. Do not take it with another bupropion medicine or an MAOI, and do not use it during pregnancy. Tell your clinician if you have liver or kidney problems, bipolar disorder, uncontrolled depression, or a history of head injury.
The most frequent adverse reactions involve the digestive system or central nervous system. In clinical trials, reported effects included:
Nausea was the most common complaint during dose escalation. It often appeared early and became less troublesome as treatment continued. Constipation can be aggravated by low fluid intake, limited movement, or a diet low in fibre.
Bupropion can cause anxiety, agitation, tremor, headache, and difficulty sleeping. Naltrexone can cause abdominal discomfort, nausea, and reduced appetite. Some patients experience an unpleasant taste or dry mouth.
Rare but serious problems require urgent medical attention:
The bupropion component carries warnings about suicidal thoughts and neuropsychiatric changes. These warnings apply across age groups, although younger adults may require closer monitoring for mood changes.
Alcohol can worsen dizziness, mood changes, or seizure risk. Abrupt heavy alcohol withdrawal can also increase seizure risk, so sudden changes in alcohol intake should be discussed with the treating clinician.
Several practical errors reduce benefit or increase risk:
The most dangerous mistake is combining Contrave with opioids or another bupropion-containing medicine. Another common problem is judging treatment after only a few days, before dose escalation is complete.
In clinical practice, doctors usually assess three points before continuing Contrave: tolerability, measurable weight response, and changes in eating behaviour. A lower appetite alone is not enough if blood pressure rises, insomnia becomes persistent, or the patient cannot follow the titration schedule.
Physicians also ask about opioid exposure before prescribing. This includes codeine-containing cough products, tramadol, strong painkillers, opioid substitution treatment, and medicines obtained during emergency care. A patient may forget that an occasional opioid is still relevant.
The first month is often used for gradual dose escalation. Patients may notice nausea or dry mouth before they notice substantial weight change. A gradual start is not a sign that the medicine is failing.
A clinician would also review mood. Bupropion can improve energy for some people, yet activation, anxiety, irritability, or suicidal thinking requires prompt reassessment. Contrave is not a treatment for depression, even though it contains bupropion.
Contrave is intended for adults with obesity or overweight adults with a weight-related medical condition. The BMI thresholds used in regulatory guidance are 30 or above for obesity, or 27 or above when conditions such as hypertension, dyslipidaemia, or type 2 diabetes are present. EMA information describes the medicine as part of a reduced-calorie diet and increased physical activity plan. This indication remains clinically relevant in 2026. Treatment should still be reviewed against current regulatory guidance and the patient's response.
Some patients notice reduced cravings during dose escalation, while measurable weight change usually takes longer. The first four weeks are designed to reach the maintenance dose gradually, so early nausea does not predict the final result. The FDA label (2021) and its reviewed trial data assessed outcomes over months rather than days. A response is judged by weight trend, eating control, tolerability, and metabolic measures.
Naltrexone blocks opioid receptors, so Contrave can reduce or prevent the effect of opioid pain medicines. Starting treatment while opioids remain in the body may trigger withdrawal, and taking opioids during treatment may lead to inadequate pain control. WHO medicines-safety principles (2023) support medication reconciliation before therapy involving opioid antagonists. Emergency clinicians should know about naltrexone treatment before selecting pain relief.
Contrave is not used for weight reduction during pregnancy. Intentional weight loss offers no benefit during pregnancy and may affect foetal growth. The EMA assessment (2015) and FDA prescribing information (2021) advise stopping treatment if pregnancy occurs. Contraception, pregnancy planning, and breastfeeding status should be discussed before treatment begins.
A missed dose should not be replaced with two tablets at the next scheduled time. The next dose is taken according to the normal schedule, while repeated missed doses may require review of the titration plan. The FDA label (2021) emphasises avoiding extra doses because bupropion-related seizure risk increases with excessive exposure. A written dosing routine can reduce accidental duplication.
Contrave is studied as an addition to a reduced-calorie diet and physical activity programme. The COR-BMOD results showed stronger weight reduction when medication was paired with intensive behavioural support. NICE weight-management principles (2023) also treat medicine as one part of a wider plan rather than a replacement for dietary and activity changes. Contrave can reduce hunger and cravings, but food choices and movement still influence the result.
The tablets use extended release to deliver naltrexone and bupropion over time. Crushing, chewing, or splitting can change the release pattern and increase peak exposure. The South African Health Products Regulatory Authority (SAHPRA) (2024) applies medicine-safety principles that support using modified-release tablets exactly as designed. Whole-tablet administration also makes the four-week escalation schedule easier to follow.
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The first week brought nausea and a dry mouth. By the third week, evening snacking felt easier to interrupt, and I stopped buying biscuits for the drive home. Sleep became lighter when I took the second tablet too late.
My blood pressure was already being treated, so it was checked more often after starting. Cravings reduced, but constipation became annoying. More water and regular walking helped, although the weight loss was slower than I expected.
I noticed less interest in takeaway food, especially at night. Headaches appeared during the first several days and then settled. I missed one dose and did not double the next one.
The medicine made me restless and my sleep was poor. I took the evening dose close to bedtime, which probably did not help. My clinician changed the timing, but the symptoms continued and treatment was reassessed.
