Contrave: Clinically Proven Weight Management Therapy
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Synonyms | |||
Contrave is a prescription medication approved for chronic weight management in adults. It combines two established active ingredients, naltrexone HCl and bupropion HCl, in an extended-release formulation designed to work on areas of the brain involved in appetite control and reward. This dual-action approach helps reduce hunger and curb cravings, supporting sustainable weight loss when used alongside a reduced-calorie diet and increased physical activity. It is indicated for use in patients with an initial body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with at least one weight-related comorbidity.
Features
- Contains naltrexone hydrochloride (8 mg) and bupropion hydrochloride (90 mg) per tablet
- Extended-release oral formulation
- Titration pack available for gradual dose escalation
- Requires prescription and medical supervision
- Not a controlled substance
Benefits
- Supports significant and sustained weight loss in clinical trials
- Helps reduce caloric intake by decreasing appetite and food cravings
- Addresses both physiological and behavioral aspects of overeating
- Can improve certain metabolic parameters in conjunction with weight loss
- Non-amphetamine mechanism of action
- Compatible with comprehensive lifestyle modification programs
Common use
Contrave is prescribed for chronic weight management in adult patients with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia. It is used as an adjunct to a reduced-calorie diet and increased physical activity. Treatment is typically long-term, continuing as long as the patient is deriving benefit and tolerating the medication without significant adverse effects.
Dosage and direction
The recommended dosage is two tablets taken twice daily (total daily dose: 32 mg naltrexone/360 mg bupropion). Patients should follow a specific titration schedule:
- Week 1: One tablet each morning
- Week 2: One tablet each morning and evening
- Week 3: Two tablets each morning and one tablet each evening
- Week 4 onward: Two tablets each morning and two tablets each evening
Tablets should be swallowed whole and not crushed, divided, or chewed. The medication should be taken with food to reduce the incidence of nausea. Doses should be taken at least 8 hours apart, and the evening dose should not be taken too close to bedtime due to the potential for insomnia.
Precautions
Patients should be monitored for increased blood pressure and heart rate; regular monitoring is recommended, especially during initial titration. Use with caution in patients with hepatic or renal impairment. May lower seizure threshold; use caution in patients with predisposing factors for seizures. May cause angle-closure glaucoma. Monitor for emergence or worsening of depression, suicidal thoughts, or unusual changes in behavior. Not recommended for use during abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs.
Contraindications
Contrave is contraindicated in patients with:
- Uncontrolled hypertension
- Seizure disorder or history of seizures
- Eating disorders (anorexia nervosa or bulimia nervosa)
- Use of monoamine oxidase inhibitors (MAOIs) within 14 days
- Chronic opioid or opiate agonist therapy, or patients undergoing acute opioid withdrawal
- Known hypersensitivity to naltrexone, bupropion, or any component of the formulation
- Pregnancy
Possible side effects
Common adverse reactions (≥5%) include:
- Nausea (32.5%)
- Constipation (19.2%)
- Headache (17.6%)
- Vomiting (10.7%)
- Dizziness (9.9%)
- Insomnia (9.2%)
- Dry mouth (8.1%)
- Diarrhea (7.3%)
Serious side effects may include:
- Increased blood pressure and heart rate
- Seizures
- Angle-closure glaucoma
- Liver damage
- Allergic reactions
- Increased risk of suicidal thoughts and behaviors
Drug interaction
Significant interactions include:
- MAO inhibitors: Risk of hypertensive crisis (contraindicated within 14 days)
- Opioids: May decrease efficacy and precipitate withdrawal
- Drugs that lower seizure threshold (antidepressants, antipsychotics, etc.)
- CYP2B6 inhibitors (e.g., ticlopidine, clopidogrel): May increase bupropion exposure
- Drugs metabolized by CYP2D6 (e.g., antidepressants, beta-blockers, antipsychotics)
- Alcohol: May impair judgment and increase risk of neuropsychiatric events
Missed dose
If a dose is missed, patients should take it as soon as they remember, unless it is close to the time of the next scheduled dose. In that case, the missed dose should be skipped. Patients should never take two doses at the same time to make up for a missed dose. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy, as dose titration may need to be reinitiated.
Overdose
Overdose may manifest as seizures, ECG changes, hallucinations, loss of consciousness, tachycardia, or other symptoms consistent with bupropion or naltrexone overdose. There is experience with bupropion overdose alone, which demonstrates that seizures occur in approximately one-third of cases. Other serious reactions may include cardiac conduction disturbances, respiratory failure, and death. There is no known antidote; management involves symptomatic and supportive care with ECG monitoring. Activated charcoal may be considered if presented early after ingestion.
Storage
Store at room temperature (20-25°C/68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep in original container, tightly closed. Protect from light and moisture. Keep out of reach of children and pets. Do not use if tablets are crushed, broken, or otherwise damaged. Properly dispose of any unused medication after treatment completion or expiration.
Disclaimer
This information is for educational purposes only and does not replace professional medical advice. Contrave is available by prescription only and should be used under appropriate medical supervision. Individual results may vary. Patients should discuss their complete medical history with their healthcare provider before starting treatment and report any side effects promptly. The full prescribing information contains additional important safety information.
Reviews
Clinical trials demonstrated that patients taking Contrave achieved average weight loss of 4-8% beyond diet and exercise alone at one year. In pooled analyses, 42% of patients achieved ≥5% weight loss compared to 17% with placebo. Many patients report reduced food cravings and improved control over eating behaviors. Some patients discontinue treatment due to gastrointestinal side effects, particularly during the titration phase. Most adverse events are mild to moderate and tend to decrease over time. Patient satisfaction surveys indicate that those who tolerate the medication well typically report positive experiences with weight management outcomes.