From the Guidelines
The recommended dose of Contrave is started at 1 tablet daily in the morning, followed by weekly escalation to 1 tablet twice per day, then 2 tablets in the morning and 1 in the afternoon, until the maintenance dose of 2 tablets twice per day is reached, as stated in the 2022 clinical practice guideline on pharmacological interventions for adults with obesity 1. The dose titration is crucial to minimize the risk of side effects such as insomnia, and it's essential to take the second dose early in the day to avoid sleep disturbances.
- The maintenance dose consists of 2 tablets taken twice daily, containing naltrexone 8 mg and bupropion 90 mg per tablet, resulting in a total daily dose of naltrexone 32 mg and bupropion 360 mg.
- It's also important to note that Contrave should be taken with food and swallowed whole, not crushed or chewed, to ensure proper absorption and minimize gastrointestinal side effects.
- The medication should be discontinued if the patient has not lost at least 5% of their total body weight after 12 weeks of therapy on the maintenance dose, as they are likely a poor responder, as recommended by the guideline 1.
- Additionally, special considerations should be taken into account, such as reducing the total daily dose by one-half in patients with moderate to severe renal impairment, and avoiding the medication in patients with end-stage renal disease or moderate to severe hepatic impairment, as well as in patients requiring short-term or long-term opiate therapy, due to the opioid antagonism from the naltrexone component 1.
From the Research
Contrave Dose Information
- The typical dose of Contrave, a combination of naltrexone and bupropion, is naltrexone 32 mg and bupropion 360 mg per day 2.
- This dose is administered as an extended-release tablet, taken orally once a day.
- In some studies, the dose of naltrexone and bupropion was lower, such as naltrexone 50 mg and bupropion 300 mg per day 3, 4.
Efficacy and Safety
- The efficacy and safety of the naltrexone/bupropion combination for weight loss have been evaluated in several studies 2, 5, 6.
- These studies have shown that the combination is effective for weight loss and is generally well-tolerated, with common side effects including nausea, constipation, and headache 2, 5.
- The combination has also been shown to be safe in terms of cardiovascular risk, with no increased risk of major cardiovascular adverse events compared to placebo 6.
Specific Study Findings
- A study published in 2021 found that the combination of naltrexone and bupropion was effective for reducing binge-eating frequency and weight in patients with binge-eating disorder and obesity 3.
- Another study published in 2015 found that the combination of naltrexone and bupropion resulted in significant weight loss and improvements in cardiovascular risk factors, such as waist circumference and serum triglycerides 2.
- A study published in 2020 found that the combination of naltrexone and bupropion was effective for reducing binge drinking in human subjects 4.
- A pooled analysis of five clinical trials published in 2019 found that the combination of naltrexone and bupropion was associated with a low risk of psychiatric adverse events, such as anxiety and depression 5.