Contrave is a modified-release tablet for weight management in adults with obesity or excess weight and related health concerns. Its naltrexone and bupropion combination acts on brain pathways that influence appetite, cravings, and food reward.
Contrave is a tablet medicine containing naltrexone hydrochloride and bupropion hydrochloride. The dose is stated on the pack — follow the leaflet. It is a modified-release weight-management medicine, meaning the ingredients are released gradually rather than all at once.
Contrave combines two active substances in one tablet: naltrexone hydrochloride and bupropion hydrochloride. The dose is stated on the pack — follow the leaflet. It is a modified-release weight-management medicine, meaning the ingredients are released gradually rather than all at once.
Contrave is intended for adults with obesity, or adults who are overweight and have weight-related health concerns such as high blood pressure, type 2 diabetes, or abnormal blood lipids. The FDA prescribing information describes its role as an addition to nutrition and activity measures, rather than a replacement for them [1].
Contrave works on two connected brain systems: the hypothalamus, which helps regulate hunger and energy balance, and the mesolimbic reward pathway, which influences cravings and the pleasure associated with food.
Bupropion stimulates pro-opiomelanocortin neurons, often shortened to POMC neurons. These cells send appetite-regulating signals. Naltrexone blocks feedback at opioid receptors that can otherwise reduce that signalling. Together, the medicines may help sustain appetite control.
This approach can be useful when hunger feels persistent or when eating is strongly linked to cravings rather than physical need alone. Clinical trials in the COR programme found that adults using naltrexone/bupropion alongside lifestyle support achieved greater average weight loss than participants receiving lifestyle support with placebo [2]. Results varied between individuals. Some people notice reduced appetite within several weeks, while others mainly notice fewer urges to snack or overeat.
Contrave is intended for adults with obesity, or adults who are overweight and have weight-related health concerns such as high blood pressure, type 2 diabetes, or abnormal blood lipids. The FDA prescribing information describes its role as an addition to nutrition and activity measures, rather than a replacement for them [1].
Contrave has a central appetite-and-craving mechanism. Other treatments target digestion, glucose regulation, or gut hormones instead.
| Option | Main mechanism | Typical consideration |
|---|---|---|
| Contrave: naltrexone/bupropion | Influences appetite and food-reward signalling in the brain | May suit adults troubled by cravings or reward-driven eating |
| GLP-1 receptor agonists | Slow gastric emptying and regulate appetite through GLP-1 signalling | Usually administered by injection and may cause nausea or vomiting |
| Orlistat | Reduces absorption of dietary fat in the intestine | Can cause oily stools, urgency, and other gastrointestinal effects |
GLP-1 receptor agonists can produce larger average weight reductions in many studies, though they are not appropriate for every person and require a different treatment approach. Orlistat acts outside the brain, so it does not target cravings directly.
Naltrexone blocks opioid receptors. Opioid pain relief may not work as expected during treatment, and trying to overcome this blockade with larger opioid doses can cause life-threatening overdose once naltrexone’s effect fades.
Blood pressure and pulse should be assessed before starting treatment and monitored during use, especially in people with hypertension or cardiovascular disease. Alcohol can worsen dizziness, reduce seizure threshold, and intensify mood-related side effects.
This medication is NOT for you if you have a seizure disorder, a current or past diagnosis of bulimia nervosa or anorexia nervosa, uncontrolled high blood pressure, or an allergy to naltrexone, bupropion, or any tablet component.
Do not use it if you take opioid-containing medicines, another bupropion medicine, or an MAOI, or if you are pregnant or breastfeeding. It is also unsuitable during acute opioid withdrawal, after abruptly stopping certain medicines or alcohol, and in severe liver impairment.
Nausea is the most common adverse effect with Contrave. It is often most noticeable while the dose is being increased and may settle as the body adapts.
Other commonly reported effects include:
Taking the dose with a normal meal rather than a high-fat meal may reduce stomach upset for some people. Drinking enough water and increasing fibre gradually can help with constipation. If nausea is persistent, the titration schedule may need review by the prescriber.
Bupropion can increase the risk of seizures, especially at excessive doses or in people with predisposing conditions. Mood changes, agitation, depression, suicidal thoughts, severe headache, chest pain, allergic swelling, or a seizure require urgent medical assessment.
Another common mistake is interpreting early nausea as proof that the treatment has failed. Tolerability often changes after the dose-stabilisation period.
Doctors usually assess Contrave as one option within a broader weight-management plan. It may be a reasonable choice for adults whose main difficulty is frequent cravings, emotional eating, or loss of control around highly palatable foods.
The first month deserves patience. Nausea, sleep disturbance, and headaches can appear during dose escalation, so clinicians often ask about timing of doses, caffeine intake, hydration, and blood-pressure readings before deciding that the medicine is unsuitable.
A realistic expectation is gradual progress, not rapid weight change. In the COR-II trial, weight loss was greater with naltrexone/bupropion than placebo when both groups also followed lifestyle measures, though not every participant responded to treatment [3].
Some people notice changes in hunger or cravings during the first few weeks, though the dose is increased gradually over four weeks. Weight change is usually assessed over months rather than days. The FDA’s 2023 prescribing information uses a 16-week treatment review point to judge whether continuing therapy is likely to provide meaningful benefit. This assessment is based on weight change from the beginning of treatment, not on a single week’s result.
Contrave should not be combined with opioid medicines because naltrexone blocks opioid receptors. This includes opioid analgesics such as codeine, tramadol, morphine, and oxycodone, as well as opioid substitution treatments. The 2023 FDA prescribing information warns that opioid use can trigger withdrawal in opioid-dependent people and reduce the expected effect of opioid pain relief. A prescriber must plan any transition carefully.
Insomnia is a recognised side effect because bupropion can have a stimulating effect. Taking the evening dose earlier may help some people, while caffeine late in the day can make the problem worse. The EMA’s 2024 safety information describes insomnia and anxiety as effects that can occur with bupropion-containing treatment. Persistent sleep disruption deserves clinical review because poor sleep can also make weight management more difficult.
Yes. Contrave may increase blood pressure and heart rate, especially early in treatment. People with controlled hypertension may still be candidates for treatment, though regular monitoring is needed. The WHO’s 2024 obesity guidance highlights cardiovascular risk assessment as part of long-term obesity care. Uncontrolled hypertension is a contraindication.
Alcohol can increase dizziness, impair judgement, worsen mood symptoms, and lower the seizure threshold associated with bupropion. Heavy alcohol use or suddenly stopping regular heavy alcohol intake can create added seizure risk. NICE guidance published in 2025 supports assessing alcohol intake when prescribing medicines that affect the central nervous system. Limiting alcohol exposure is the cautious approach during treatment.
Contrave is not used during pregnancy because weight loss offers no benefit during pregnancy and medicine exposure may pose avoidable risk. Treatment should be stopped if pregnancy occurs. The FDA’s 2023 pregnancy section for naltrexone/bupropion-containing therapy advises against use for weight management during pregnancy. Breastfeeding is also a contraindication because both active substances may pass into breast milk.
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I started with one morning tablet and felt nauseated for the first few days. By the third week, afternoon snacking was less automatic. I lost weight slowly, but the bigger change was that I stopped ordering sweets after stressful workdays.
The appetite effect was noticeable after the dose increased. I had dry mouth and slept lightly when I took the second dose too late, so moving it earlier helped. I preferred the gradual change over feeling restricted.
I discontinued it after repeated headaches and higher blood-pressure readings. It reduced cravings, but the side effects were not a good trade-off for me.
I had tried calorie tracking before, but I still struggled with evening eating. Contrave did not make food uninteresting; it gave me more pause before acting on cravings. Constipation was annoying during the first month and improved when I increased fluids and fibre.
