Naltrexone/bupropion (Contrave)

Contrave offers a unique approach to weight management by combining two medications originally developed for different purposes. This combination therapy addresses multiple aspects of weight control, from appetite to food cravings.

What's It For?

Contrave is prescribed for weight management in adults who are either:

• Obese (BMI of 30 or higher), or
• Overweight (BMI of 27 or higher) with at least one weight-related condition such as type 2 diabetes, high blood pressure, or high cholesterol

Like other prescription weight management medications, Contrave is intended to be part of a comprehensive program that includes dietary changes and increased physical activity. It's not meant to be used in isolation but rather to support your overall weight management efforts.

How It Works

What makes Contrave distinctive is that it combines two medications that were originally developed for different purposes:

• Naltrexone: Originally used to treat alcohol and opioid dependence, naltrexone helps reduce food cravings by affecting the brain's reward pathways.
• Bupropion: Often prescribed as an antidepressant and for smoking cessation, bupropion may help reduce appetite and can increase energy expenditure.

Together, these medications work on different areas of the brain involved in hunger and reward, creating a dual-action approach to weight management. They help reduce food cravings, decrease appetite, and potentially modify eating behaviors that contribute to weight gain.

This combination addresses both the physiological aspects of hunger and the rewarding aspects of food consumption that can lead to overeating.

How to Take It

Contrave comes as an oral tablet with a specific dosing schedule designed to minimize side effects:

• Week 1: One tablet in the morning
• Week 2: One tablet in the morning and one in the evening
• Week 3: Two tablets in the morning and one in the evening
• Week 4 and beyond: Two tablets twice daily (morning and evening)

Important administration guidelines include:

• Swallow tablets whole; never crush, cut, or chew them
• Take with water and avoid taking with high-fat meals
• Try to maintain consistent timing for your doses each day
• If you miss a dose, wait until your next scheduled dose (don't double up)

Your healthcare provider may adjust this schedule based on your response to the medication and any side effects you experience.

Side Effects: The Real Deal

Since Contrave contains two active medications, its side effect profile reflects aspects of both components.

Common Side Effects

Many people experience one or more of these effects, especially during the first few weeks:

• Nausea (most common)
• Constipation
• Headache
• Dizziness
• Dry mouth
• Trouble sleeping (insomnia)
• Anxiety or jitteriness

These side effects often improve as your body adjusts to the medication, which is why the dose is increased gradually over several weeks.

Serious Side Effects

Though less common, more serious side effects require immediate medical attention:

• Seizures (the risk is higher in people with a history of seizures)
• Significant increases in blood pressure
• Liver problems
• Mental health changes, including suicidal thoughts or behaviors
• Severe allergic reactions

Contact your healthcare provider right away if you experience unusual symptoms, especially changes in mood or thinking, seizures, or symptoms of liver problems like yellowing of the skin or eyes, dark urine, or abdominal pain.

Making It Work For You

To maximize benefits and minimize risks with Contrave, consider these important guidelines:

Medical History

Be completely transparent with your doctor about your health history, especially if you have:

• A history of seizures or seizure disorders
• Uncontrolled high blood pressure
• Current or past eating disorders
• Liver or kidney problems
• Mental health conditions
• History of substance use disorders
• Angle-closure glaucoma

Opioid Medication Warning

Contrave contains naltrexone, which blocks the effects of opioid medications. This creates two important considerations:

• Do not take Contrave if you're currently using opioid pain medications, as it may trigger withdrawal symptoms
• If you need pain medication while taking Contrave, non-opioid alternatives should be used when possible
• In emergency situations requiring opioid treatment, inform medical personnel that you're taking Contrave

Alcohol Considerations

While taking Contrave, it's advisable to limit alcohol consumption. Alcohol may increase your risk of seizures and may affect how the medication works in your body. Some people also find that naltrexone reduces the rewarding effects of alcohol.

Medication Interactions

Contrave can interact with many medications, including:

• MAO inhibitors (certain antidepressants)
• Other medications containing bupropion
• Medications that lower the seizure threshold
• Certain antidepressants, especially SSRIs
• Blood pressure medications
• Diabetes medications (doses may need adjustment as weight changes)

Always provide your healthcare provider with a complete list of all medications, supplements, and herbs you're taking.

Regular Monitoring

While taking Contrave, it's important to keep all scheduled follow-up appointments. Your doctor will want to monitor:

• Your blood pressure and heart rate
• Your weight loss progress
• Any side effects you're experiencing
• Your mental health status

Bottom Line

Contrave offers a different approach to weight management compared to other prescription medications by addressing both appetite and the reward aspects of eating. It can be an effective option for many adults struggling with weight loss, particularly those who haven't responded adequately to diet and exercise alone.

The medication's success rates vary, but studies show that those who combine Contrave with lifestyle modifications typically achieve better results than with lifestyle changes alone. However, the unique side effect profile and contraindications mean it's not suitable for everyone.

As with any weight management approach, a thoughtful conversation with your healthcare provider is essential to determine if Contrave might be appropriate for your individual situation.