Verified
The first week brought nausea and a dry mouth, but eating smaller meals helped. By the sixth week, evening cravings were less intense. Sleep was worse when I took the last dose late.
27 Sep 2026
Contrave
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Active ingredient
Bupropion
Contrave is a prescription medicine for adults with obesity or overweight who need medically supervised weight management. It is used alongside a reduced-calorie diet and increased physical activity. Its naltrexone-bupropion combination helps influence appetite and food cravings.
Description
Contrave is a prescription weight-management treatment containing naltrexone hydrochloride and bupropion hydrochloride. It is intended for adults with obesity or overweight alongside a reduced-calorie diet and increased physical activity. The combination acts on appetite and reward pathways to help reduce food intake and cravings.
Composition
The active ingredients are naltrexone hydrochloride and bupropion hydrochloride. The dose is stated on the pack — follow the leaflet.
Dosage and usage
Contrave uses a dose escalation schedule. The dose is stated on the pack — follow the leaflet.
Administration points include:
- Swallow each tablet whole with water.
- Do not crush, chew, or divide the tablets.
- Avoid taking Contrave with a high-fat meal because this can increase exposure to the active ingredients.
- Take the evening dose early enough to reduce the chance of sleep disturbance.
- If a dose is missed, skip it and take the next scheduled dose. Do not take extra tablets to compensate.
- Do not increase the dose faster than prescribed.
A clinician should review treatment response after the recommended assessment period. If an adult has not achieved clinically meaningful weight loss after the maintenance dose, continued treatment is usually reconsidered.
One practical issue is timing. Taking the evening tablets close to bedtime can worsen insomnia, while taking them with a heavy, fatty meal can increase nausea or dizziness. A consistent breakfast and evening meal routine often makes the schedule easier to tolerate.
The word “extended-release” is clinically significant. Crushing, chewing, or splitting a Contrave tablet can release the ingredients too quickly and may increase adverse effects, including seizure risk.
How it works
Contrave combines two centrally acting substances with different pharmacological actions. Bupropion hydrochloride is an aminoketone antidepressant derivative that affects noradrenaline and dopamine signalling. Naltrexone hydrochloride is an opioid receptor antagonist, meaning it blocks the action of opioid receptors.
Bupropion stimulates neurons involved in the pro-opiomelanocortin, or POMC, pathway. POMC neurons are located in the hypothalamus, a brain region involved in hunger, satiety, and energy regulation. Their activity produces signals associated with reduced food intake.
Naltrexone modifies opioid-receptor signalling in the same appetite-control network. It helps reduce the feedback that can limit POMC activity. The combination also influences the mesolimbic dopamine circuit, which is involved in food reward, cravings, and reinforcement.
The two ingredients therefore work through complementary pathways:
- Bupropion increases activity in appetite-regulating neurons.
- Naltrexone blocks opioid-receptor effects that can weaken that signal.
- Together, they may reduce hunger and the urge to continue eating after food is no longer needed.
This mechanism differs from a medicine that acts mainly through gastrointestinal absorption or insulin signalling. Contrave acts centrally, so sleep, mood, blood pressure, and neurological history are relevant before treatment begins.
Indications
Contrave 8/90 is an extended-release tablet used for chronic weight management in adults with obesity or overweight accompanied by a weight-related health condition. The treatment is used with dietary calorie reduction and regular physical activity, not as a replacement for either measure.
The usual clinical criteria are:
- Body mass index (BMI) of 30 kg/m² or higher.
- BMI of at least 27 kg/m² with a condition such as hypertension, type 2 diabetes, or abnormal blood lipid levels.
- Adult use under a clinician-directed treatment plan.
- Regular monitoring of body weight, blood pressure, mood, and tolerability.
The FDA-approved prescribing information describes Contrave as a long-term weight-management option for selected adults whose weight increases their risk of medical complications [1]. BMI is a screening calculation, not a complete assessment of health. Waist circumference, cardiovascular risk, eating patterns, medication history, and mental health also influence treatment decisions.
Approved indications for use
Contrave is prescribed for obesity or overweight with associated medical risk. It is not intended for routine cosmetic weight loss in adults who do not meet clinical criteria.
Comparison
Different weight-management treatments act on different physiological systems. The most suitable option depends on BMI, diabetes status, cardiovascular history, eating patterns, current medicines, and contraindications.
| Approach | Main action | Main limitation |
|---|---|---|
| Contrave | Acts on hypothalamic appetite signals and reward-related cravings | Not suitable with chronic opioid use, seizure disorders, or uncontrolled hypertension |
| GLP-1 receptor agonist therapy | Enhances satiety signalling and slows gastric emptying | Gastrointestinal effects, injection requirements for some products, and treatment-specific contraindications |
| Structured lifestyle treatment | Reduces calorie intake and increases activity through behavioural planning | Requires sustained daily effort and may not produce enough weight loss alone for every patient |
| Bariatric surgery | Changes gastrointestinal anatomy and appetite physiology | Invasive treatment requiring long-term nutritional and medical follow-up |
Contrave may suit an adult whose main difficulty involves food cravings and reward-driven eating, provided the person can use bupropion safely. A GLP-1-based approach may be considered when diabetes, appetite regulation, or metabolic risk points toward that mechanism. Lifestyle treatment remains part of every option.
Contrave has no opioid pain-relieving action. Its naltrexone component can block opioid analgesia, which creates a major prescribing issue for anyone who may need surgery, emergency pain treatment, or opioid-based cough or diarrhoea medicines.
Contraindications
It should not be used in the following situations:
- Uncontrolled hypertension.
- Current seizure disorder or a previous seizure.
- Anorexia nervosa or bulimia.
- Current use of another bupropion-containing product.
- Use of an opioid analgesic or opioid-containing medicine.
- Acute opioid withdrawal.
- Regular opioid dependence without an appropriate opioid-free interval.
- Use of a monoamine oxidase inhibitor, or MAOI, within the restricted interval specified by the prescriber.
- Known allergy to naltrexone, bupropion, or an excipient in the tablets.
When this is not for you
Not for you if you have uncontrolled hypertension, seizure risk, an eating disorder, current opioid use, or another listed contraindication. Ask a clinician to review these risks before prescribing Contrave.
The medication also requires careful review in people with bipolar disorder, psychosis, suicidal thoughts, severe liver disease, kidney impairment, glaucoma risk, or a history of uncontrolled blood pressure. Bupropion can precipitate mania in vulnerable patients.
Tell the prescriber about codeine, tramadol, morphine, oxycodone, buprenorphine, methadone, opioid cough medicines, and opioid antidiarrhoeal products. Naltrexone may block their effect, and stopping opioids abruptly can trigger withdrawal.
Side effects
The most frequently reported reactions include nausea, constipation, headache, vomiting, dizziness, dry mouth, insomnia, and increased blood pressure. Nausea is often strongest during dose escalation and may improve as treatment continues. Bupropion contributes to activating effects such as restlessness, sleep difficulty, tremor, or anxiety in susceptible people.
Common reactions may include:
- Nausea or stomach discomfort.
- Constipation.
- Dry mouth and altered taste.
- Headache or dizziness.
- Difficulty falling asleep.
- Increased heart rate or blood pressure.
- Anxiety, irritability, or agitation.
Serious reactions require prompt medical assessment. These include seizures, severe allergic reactions, marked mood changes, suicidal thoughts, severe hypertension, liver injury symptoms, and acute eye pain or visual disturbance in people at risk of angle-closure glaucoma.
For mild nausea, smaller meals, slower eating, and avoiding a high-fat meal around the dose can help. Persistent vomiting, dehydration, severe abdominal pain, or inability to keep tablets down needs medical review.
Bupropion can lower the seizure threshold. The risk rises with excessive alcohol use, abrupt alcohol or sedative withdrawal, stimulant misuse, eating disorders, head injury, and medicines that also increase seizure susceptibility.
A useful detail for people undergoing workplace screening is that bupropion has been associated with false-positive amphetamine immunoassay results. A confirmatory laboratory test can distinguish the medicines, so the testing service should receive an accurate medication history.
Naltrexone can cause liver-related problems. Dark urine, yellowing of the skin or eyes, unusual upper-abdominal pain, or persistent severe fatigue should be assessed promptly.
Common mistakes
Several avoidable errors can reduce tolerability or create safety problems:
- Starting at the maintenance dose instead of completing the four-week escalation.
- Taking an extra tablet after a missed dose.
- Crushing or chewing extended-release tablets.
- Taking the evening dose immediately before sleep.
- Using Contrave with an opioid painkiller without informing the prescriber.
- Continuing another bupropion-containing medicine at the same time.
- Ignoring rising blood pressure, agitation, or severe insomnia.
- Stopping regular opioids without a planned withdrawal assessment.
- Assuming that reduced appetite removes the need for meals containing adequate protein, fibre, and fluids.
- Failing to report heavy alcohol use or abrupt alcohol reduction.
Keep a written record of dose changes, sleep quality, blood pressure readings, bowel movements, and opioid exposure. This gives the prescriber useful information during the first month.
What doctors say
Clinicians generally assess three issues before prescribing Contrave: whether the patient meets weight-management criteria, whether bupropion and naltrexone are medically suitable, and whether the person can follow the escalation schedule.
A realistic clinical expectation is gradual weight reduction rather than an immediate change in appetite. Early nausea or insomnia does not necessarily mean the treatment will be intolerable, but severe symptoms should not be ignored. Blood pressure should be checked before treatment and monitored during dose escalation.
Doctors also look for changes beyond the scale. Reduced evening snacking, fewer cravings, better portion control, improved mobility, and lower waist measurements can show useful progress. Contrave should not be continued automatically when there is no meaningful response.
The treatment has advantages: it is an oral option, it can address craving-related eating, and it does not contain an opioid. Its limitations include central nervous system effects, seizure-related restrictions, blood-pressure concerns, and incompatibility with opioid therapy.
Frequently asked questions
Does Contrave work for obesity and overweight?
Contrave is approved for chronic weight management in selected adults with obesity or overweight plus a weight-related condition. The 2024 FDA prescribing information describes its use alongside reduced-calorie eating and increased physical activity, with treatment response assessed over time. The clinical benefit differs between individuals, and continued use depends on meaningful progress and tolerability. The key assessment is not appetite alone but sustained improvement in weight-related health risk. Follow-up also includes blood pressure and tolerability.
How long does Contrave take to start working?
Some people notice fewer cravings during the first several weeks, while measurable weight change often develops gradually during dose escalation and maintenance treatment. The 2024 FDA product information uses a longer assessment period rather than judging the medicine after a few doses. Sleep disturbance, nausea, and headache can appear before appetite effects become clear. A clinician should evaluate both benefit and adverse reactions throughout the first months.
Can Contrave be taken with opioid painkillers?
Naltrexone blocks opioid receptors, so Contrave can reduce or eliminate the pain-relieving effect of medicines such as codeine, tramadol, morphine, or oxycodone. The 2023 EMA product information for the naltrexone-bupropion combination warns that opioid use requires careful planning, including before surgery or emergency treatment. Opioid withdrawal can also occur if treatment begins while opioids remain in the body. Do not alter opioid treatment without a supervised plan.
Is Contrave suitable during pregnancy?
Contrave should not be used for weight loss during pregnancy because weight reduction has no therapeutic purpose during gestation. 2022 WHO guidance on obesity and reproductive health supports careful management of maternal weight before pregnancy rather than intentional weight-loss treatment during pregnancy. Treatment should be discontinued when pregnancy is recognised. Breastfeeding also requires an individual assessment because both active substances can enter breast milk.
Can Contrave cause insomnia or anxiety?
Bupropion can produce activating effects, including insomnia, restlessness, anxiety, agitation, or tremor. The 2023 EMA product information identifies psychiatric and sleep-related reactions among effects requiring clinical attention. Taking the evening dose earlier may reduce sleep disruption, but severe agitation, suicidal thoughts, or major mood changes require urgent medical assessment. People with bipolar disorder need careful screening before treatment.
What happens if a Contrave dose is missed?
A missed dose should be skipped rather than replaced with an extra tablet. The next dose should be taken at the regular scheduled time, following the current titration stage. The 2024 FDA prescribing information warns against taking more than the recommended amount because excessive bupropion exposure increases seizure risk. Repeated missed doses may require a clinician to review whether dose escalation should continue.
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Comparison
Alli
Active ingredient: Orlistat
60mg
Contrave Current
Active ingredient: Bupropion
98mg
Xenical
Active ingredient: Orlistat
120mg
60mg
Contrave: Reviews and Experiences
3.4
Based on 4 reviews
Verified
Weight loss was gradual rather than dramatic. I noticed fewer unplanned snacks at work, although constipation became annoying and required more fluids and fibre.
5 Oct 2026
Verified
Headaches and insomnia were difficult during the second week. My clinician changed the plan after my blood pressure rose, so I did not continue to the full dose.
11 Oct 2026
Verified
The tablets were convenient, and appetite control improved after several weeks. I still needed meal planning because the medicine did not prevent eating when I was stressed.
23 Oct 2026
Sources
- U.S. Food and Drug Administration (2024). Contrave (naltrexone hydrochloride and bupropion hydrochloride) extended-release tablets: Prescribing Information.
