Bupropion / Naltrexone (Contrave)
Medication Guide
Written by: Khandi-Kae Sweeney PA and Justin Zaghi MD
Last updated: 5-8-2024
Table of contents:
About bupropion/naltrexone (Contrave)
How to get started
What is bupropion/naltrexone?
Bupropion and naltrexone are the two active ingredients in the weight loss medication Contrave®. Bupropion is used to treat depression and aid with smoking cessation. Naltrexone is an opioid antagonist and is used to treat alcohol and opioid dependence. Bupropion/naltrexone was FDA-approved in 2014 for weight management under the brand name Contrave®1.
How does bupropion/naltrexone work?
Bupropion/naltrexone is believed to work in two parts of your brain: the hypothalamus (which controls hunger) and the mesolimbic reward system (to help control cravings). When taken together, the medications promote feeling full and reduce food cravings1.
What are the benefits of bupropion/naltrexone?
Bupropion/naltrexone has been shown to lead to 5% weight loss after 12 weeks of treatment, with sustained weight loss over 56 weeks1. Weight loss can have significant benefits across many domains of your health, including sleep, mood, energy, and other organs in your body. Studies have shown specific benefits for bupropion/naltrexone including:
- Reduced alcohol intake2
- Reduced smoking2
- Improvement of symptoms in major depressive disorder, seasonal affective disorder, and attention-deficit disorder1
- Improvement in diabetes and blood sugar control
What side effects should I look out for?
The most common side effects are gastrointestinal in nature, including nausea, vomiting, diarrhea, and constipation. Other common side effects include headaches, dizziness, trouble sleeping and dry mouth3.
Bupropion/naltrexone may cause other less common, but more serious, side effects. These include3:
- Seizures
- Risk of opioid overdose
- Sudden opioid withdrawal
- Severe allergic reactions
- Increased high blood pressure or heart rate
- Liver damage or hepatitis
- Manic episodes
- Visual problems
Who should avoid bupropion/naltrexone?
People with any of the following conditions should not take bupropion/naltrexone3:
- Suicidal thoughts or actions
- Seizures
- Uncontrolled hypertension
- An allergic reaction to bupropion/naltrexone or any of its ingredients
- History or anorexia or bulimia
- Going through opiate withdrawal
- Taking opioids for chronic pain
- Taking methadone or buprenorphine to help stop taking opioids
- Pregnant women
- Use medications like benzodiazepines and monoamine oxidase inhibitors (MAOIs)
- Drinking a lot of alcohol
How do I take bupropion/naltrexone?
Bupropion/naltrexone is taken orally by mouth. The branded medication called Contrave® is typically taken twice daily by mouth. However, to help save you money, your Shapely provider may prescribe you the generic versions of the active ingredients in Contrave®. If this is the case, you will be taking two different tablets only once daily and will require a pill cutter.
What dose of bupropion/naltrexone should I take?
- Week 1: 1 tablet bupropion 150 mg XL by mouth daily
- Week 2: 1 tablet bupropion 150 mg XL plus ¼ tablet of naltrexone 50 mg by mouth daily
- Week 3: 2 tablets bupropion 150 mg XL plus ¼ tablet of naltrexone 50 mg by mouth daily
- Week 4: 2 tablets bupropion 150 mg XL plus ½ tablet of naltrexone 50 mg by mouth daily
Maintenance: 1 tablet bupropion 300 mg XL tablets plus ½ tablet of naltrexone 50 mg by mouth daily
What should I expect while taking bupropion/naltrexone?
Because bupropion/naltrexone works by helping you to feel full, you may not feel as hungry as often. You may also find a decreased desire to consume alcohol and smokers may even want to quit smoking.
You may not notice significant weight loss in the first 4 weeks of taking bupropion/naltrexone, but you may notice increased energy and decreased food intake.
What foods should I avoid while on bupropion/naltrexone?
While you don’t need to make any strict dietary changes while taking bupropion/naltrexone. It is recommended to avoid taking the medication with high-fat meals — like fried or greasy foods, as well as spicy or acidic foods, as this may increase your risk of seizures.
Can I drink alcohol while on bupropion/naltrexone?
Typically it’s recommended to minimize or avoid alcohol consumption while on bupropion/naltrexone. Bupropion/naltrexone may reduce the “buzz” from alcohol and also increase the risk of side effects. You should not discontinue alcohol use abruptly without talking with your healthcare provider as this may increase your chance of seizures.
Am I required to exercise while on bupropion/naltrexone?
Exercise is not strictly required while on bupropion/naltrexone, but it is strongly recommended. Weight loss is associated with muscle loss. Doing exercise regularly will help ensure that you retain muscle mass and stay healthy.
We’re excited to help you achieve the best shape! For any additional questions on bupropion/naltrexone, please reach out to your Shapely provider using the chat feature in Healthie. Or feel free to give us a call at 424-600-8360.
References:
- Sherman MM, Ungureanu S, Rey JA. Naltrexone/Bupropion ER (Contrave): Newly Approved Treatment Option for Chronic Weight Management in Obese Adults. P T. 2016 Mar;41(3):164-72. PMID: 26957883; PMCID: PMC4771085.
- Nicholson ER, Dilley JE, Froehlich JC. Co-Administration of Low-Dose Naltrexone and Bupropion Reduces Alcohol Drinking in Alcohol-Preferring (P) Rats. Alcohol Clin Exp Res. 2018 Mar;42(3):571-577. doi: 10.1111/acer.13577. Epub 2018 Jan 22. PMID: 29222923; PMCID: PMC5832575.
- Contrave (bupropion/naltrexone) [package insert]. Morristown, NJ: Nalpropion Pharmaceuticals LLC; 2021.
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