From the Guidelines
Contrave is a prescription medication used for weight management in adults who are obese or overweight with weight-related medical problems, and it should be used alongside a reduced-calorie diet and increased physical activity. The medication combines two drugs: naltrexone (an opioid antagonist) and bupropion (an antidepressant) 1. It works by affecting areas of the brain involved in appetite regulation and food cravings. The typical starting dose is one tablet (naltrexone 8 mg/bupropion 90 mg) taken once daily in the morning for the first week, then gradually increased over four weeks to the maintenance dose of two tablets twice daily 1. Common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. Contrave should not be used by people with uncontrolled high blood pressure, seizure disorders, eating disorders, or those taking opioid medications 1. It's also contraindicated during pregnancy. Some key points to consider when prescribing Contrave include:
- Monitoring vital signs, especially blood pressure and heart rate, periodically while taking the medication 1
- Avoiding use in patients with seizure disorders or those at risk of seizures 1
- Not using concomitantly with opiate medications 1
- Counseling patients on the potential risks and benefits of the medication, including the risk of suicidal thoughts and behaviors 1
- Considering alternative medications, such as semaglutide 2.4 mg or liraglutide 3.0 mg, for patients who may benefit from glucoregulatory benefits or have comorbidities such as type 2 diabetes 1. Overall, Contrave can be an effective medication for weight management in adults with obesity or overweight, but it should be used under the guidance of a healthcare professional and as part of a comprehensive weight loss plan.
From the Research
Overview of Contrave
- Contrave is a combination of naltrexone hydrochloride extended release and bupropion hydrochloride extended release for the treatment of obesity, used with lifestyle modification 2.
- The safety and efficacy of Contrave were assessed in four randomized, double-blind, placebo-controlled, 56-week Phase III clinical trials in 4536 adult subjects, demonstrating statistically significant and clinically meaningful weight loss compared with placebo 2.
Efficacy of Contrave
- The average weight loss from baseline across the four studies was approximately 11-22 lbs (5-9 kg) 2.
- Contrave has been shown to result in significant improvements in cardiometabolic markers 2.
- A meta-analysis of new anti-obesity drugs, including Contrave, found that naltrexone/bupropion resulted in a placebo-subtracted weight reduction of 4.0% for at least 12 months 3.
Comparison with Other Anti-Obesity Medications
- Contrave is one of several anti-obesity medications approved by the FDA for chronic weight management, including orlistat, phentermine/topiramate, and liraglutide 3.
- A systematic review and meta-analysis found that phentermine-topiramate and liraglutide were associated with the highest odds of achieving at least 5% weight loss at 52 weeks, while Contrave (naltrexone-bupropion) was associated with a moderate odds of achieving at least 5% weight loss 4.
- Another study found that semaglutide 2.4 mg weekly produced much more weight loss than Contrave, with an average weight loss of 15% at 1 year 5.
Safety and Adverse Events
- The incidence of overall adverse events was significantly higher in participants treated with Contrave compared with placebo 6.
- Common adverse events associated with Contrave include nausea, headache, and dizziness 2.
- A systematic review and meta-analysis found that liraglutide and Contrave (naltrexone-bupropion) were associated with the highest odds of adverse event-related treatment discontinuation 4.