From the Guidelines
To replicate the effects of Contrave, the recommended dosing is bupropion 180 mg daily (typically as 90 mg twice daily of the extended-release formulation) combined with naltrexone 16 mg daily (usually as 8 mg twice daily), with a titration schedule starting with 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 recommended by the 2022 clinical practice guideline on pharmacological interventions for adults with obesity 1. The dosing regimen for bupropion and naltrexone to match Contrave should be initiated with caution, considering the potential side effects and interactions.
- The medication should be taken with food to minimize gastrointestinal side effects.
- The second dose should not be taken late in the day to minimize the risk of insomnia, as suggested by the study 1.
- Patients with moderate to severe renal impairment should have their total daily dose reduced by one-half, and those with moderate to severe hepatic impairment should not exceed 1 tablet daily, as recommended by the guideline 1.
- The combination of bupropion and naltrexone works by affecting both appetite and food reward pathways in the brain, with bupropion increasing dopamine and norepinephrine levels to reduce appetite, and naltrexone blocking opioid receptors to diminish food reward sensations.
- Common side effects of this combination include nausea, headache, constipation, dizziness, and insomnia, and patients should be monitored for these adverse effects.
- Patients with certain medical conditions, such as seizure disorders, eating disorders, uncontrolled hypertension, or those taking opioid medications, should not use this combination, as warned by the study 1.
From the FDA Drug Label
To achieve the best possible treatment outcome, appropriate compliance-enhancing techniques should be implemented for all components of the treatment program, especially medication compliance. A dose of 50 mg once daily is recommended for most patients In the first study, the bupropion dose range was 300 mg to 600 mg per day administered in 3 divided doses; 78% of patients were treated with doses of 300 mg to 450 mg per day.
The recommended dosing for bupropion (Wellbutrin) to replicate the effects of Contrave is 300-450 mg per day. The recommended dosing for naltrexone to replicate the effects of Contrave is 50 mg once daily. 2 3
From the Research
Dosing for Wellbutrin and Naltrexone to Match Contrave
To replicate the effects of Contrave, which is a combination of bupropion and naltrexone, the recommended dosing for bupropion (Wellbutrin) and naltrexone is as follows:
- The combination of 32 mg naltrexone and 360 mg bupropion prolonged release (NB32) was approved by the FDA and EMA as an adjunct to a comprehensive lifestyle intervention to achieve weight loss 4.
- This dosing regimen has been shown to result in significant weight loss, with an average weight loss of 5.0-9.3% in clinical trials 4, 5.
- The recommended dosing is typically administered as an extended-release formulation, with naltrexone (8 mg) and bupropion (90 mg) given once daily, increasing to twice daily after a titration period 6.
Key Considerations
When using bupropion and naltrexone to replicate the effects of Contrave, consider the following:
- The combination of naltrexone and bupropion has been shown to be effective for weight loss and improving cardiometabolic markers, with a good safety profile 4, 5, 7.
- The most common side effects of this combination are nausea, constipation, headache, and vomiting, which are generally mild to moderate and transient 4, 8.
- There is no increased risk of major adverse cardiovascular events (MACE) associated with the use of naltrexone/bupropion, bupropion, or naltrexone alone compared to placebo or other treatments 6.