Contrave (buproprion-naltrexone)

What is Contrave?

Contrave (bupropion-naltrexone) is a prescription medication used to aid weight loss in adults with obesity. Developed by the U.S. pharmaceutical company Takeda Pharmaceutical Company, Contrave was approved by the U.S. Food and Drug Administration (FDA) in 2014 for the treatment of chronic weight management, combined with a reduced-calorie diet and increased physical activity. It is designed for adults with obesity (body mass index (BMI) >30) or overweight (BMI >27) with one obesity-related condition such as type 2 diabetes, cardiovascular disease, hypertension, or high cholesterol.

How does Contrave work for weight loss?

Contrave is a combination of two drugs, naltrexone and bupropion, both of which have a long history of successful use for problems besides obesity.  Naltraxone was first approved by the FDA in 1984, and is used to treat alcohol use disorder and opioid dependence by reducing the cravings for these substances. Similarly, naltraxone reduces the cravings for food that occur during a weight loss program.

Bupropion was first approved by the FDA in 1985 as an antidepressant and was found also to reduce anxiety and help with smoking cessation. In patients taking bupropion for these other problems, it was found to have the ‘side effect’ of weight loss by reducing hunger and appetite.

Together naltraxone and bupropion work synergistically on different receptors in the brain to help patients follow a weight loss program that includes a more nutritious, lower-calorie diet and increased physical activity.

What are the clinical trial weight loss results for Contrave?

Clinical trials have shown that people who take Contrave along with a diet and exercise program lose more weight than people who only follow a diet and exercise program.

Four 56-week, multi-center, randomized, double-blind, placebo-controlled clinical trials enrolling 4,536 patients to evaluate the efficacy and safety of naltrexone/bupropion found 2-4 times more weight loss in patients taking Contrave compared to placebo.  Additionally, weight loss was maintained throughout the 56 weeks in all these trials. ¹

What are the health benefits of Contrave?

Some of the health benefits that may be associated with losing weight through the use of Contrave include:

• Positive effects on cardiovascular health. Obesity is linked to an increased risk of high blood pressure, high cholesterol, and heart disease.
• Reduction in the risk of developing type 2 diabetes or improving blood sugar control in patients who are already diabetic. Obesity is a significant risk factor for developing type 2 diabetes.
• Improvement in emotional and mental health, such as sleep, energy, vitality, and mood. In addition, one of the active ingredients in Contrave, bupropion, has anti-anxiety and anti-depressant properties that can help to enhance overall mental well-being in some individuals.

The specific health benefits of Contrave can vary depending on individual circumstances and underlying health conditions. This medication should always be used under the supervision of a healthcare professional who will monitor its risks and benefits on an individual basis.

What are the possible side effects of Contrave?

Like any medication, Contrave can have side effects. The most common side effects include nausea, constipation, headache, and vomiting.

In rare cases, Contrave can also cause seizures, especially if taken in high doses.

Am I a good candidate for Contrave?

Contrave is not suitable for everyone. It is only approved for use in adults who have:

• A body mass index (BMI) of 30 or higher, or
• BMI of 27 or higher with at least one weight-related health condition, such as high blood pressure or type 2 diabetes.

Contrave is also not recommended for people who:

• Have a history of seizures
• Have an eating disorder
• Are taking certain medications, such as opioids
• Are pregnant or planning to become pregnant

What should I be sure to tell my provider when considering Contrave?

Be sure to tell your healthcare provider about:

• All past and present medical conditions
• All medicines you are taking, including opioids
• Allergic reactions to medicines or other things
• History of substance abuse or addiction

How to take Contrave

Contrave is typically taken orally in the form of a tablet. It is important to not crush, chew, or break Contrave tablets. They should be swallowed whole with water.

The usual recommended starting dose of Contrave is one tablet in the morning for the first week, followed by one tablet in the morning and one tablet in the evening starting in the second week. The maximum recommended dose is typically two tablets in the morning and two tablets in the evening, for a total of four tablets per day.

It is important to follow the dosing instructions provided by your healthcare provider as instructions may vary depending on your individual needs and medical history.

Can Contrave be addictive?

Contrave is not addictive; it is not on the list of controlled substances.  What can sometimes mislead people on this issue is that bupropion alone (Wellbutrin) can be abused for a recreational ‘high’ when taken in large doses, either by chewing the pills or crushing and snorting the powder.  Always take all medications only as prescribed!

What if I miss taking a dose of Contrave?

If you miss a dose of Contrave, your provider will typically recommend that you take the missed dose as soon as you remember, unless it is close to the time of your next scheduled dose. In that case, you should skip the missed dose and take your next dose at the regular time. You should never take a double dose of Contrave to make up for a missed dose. This can increase the risk of side effects.

How long will it be before I see results from Contrave?

With Contrave, the dose is typically started as one pill a day, building up to 4-a-day over the first month. At this point, weight loss of 3-4% is a good early indicator that your weight loss care plan is effective, with at least 5% the target at 12 weeks.  It is important to understand that weight loss results vary widely between patients, between diet plans, and between weight loss medications. This is why it is important to work closely with your healthcare professional who can modify your care plan, including the medication, as needed to help keep you on track.

What happens if I stop taking Contrave?

It is an unfortunate fact that most people who lose weight regain much or all of the weight that they lost. On the one hand, this should be expected if after losing weight someone stops everything they did to lose weight and goes back to doing everything exactly as they did while gaining weight.

However, making very important lifestyle changes like eating a healthy diet and getting more physically active often are not enough to prevent regaining weight. The reason for this is that when you have obesity, the regulation of your body weight is dysfunctional. 

Your body will try to push you back to your previous weight. In this situation, Contrave or some other long-term weight loss medication may be a necessary part of the care plan needed to keep your weight in a healthier place.

It is as important to work with your health care provider after a weight loss program as it is during the weight loss program! 

Footnotes:

1 National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771085/  

 Sources:

Cleveland Clinic: https://my.clevelandclinic.org/health/drugs/19686-bupropion-naltrexone-extended-release-tablets  
Mayo Clinic: https://www.mayoclinic.org/drugs-supplements/naltrexone-and-bupropion-oral-route/before-using/drg-20122495
National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771085/

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