From the Guidelines
Contrave (naltrexone/bupropion) for weight loss should be initiated with a gradual dose escalation schedule, starting with one tablet (8 mg naltrexone/90 mg bupropion) daily, increasing to two tablets twice daily (32 mg naltrexone/360 mg bupropion) by week four, as recommended by the American Gastroenterological Association 1. The medication works through dual mechanisms: naltrexone blocks opioid receptors that influence food reward pathways, while bupropion affects dopamine and norepinephrine to reduce appetite and food cravings. Key considerations for the use of Contrave include:
- Monitoring blood pressure and heart rate, especially in the first 12 weeks of treatment
- Avoiding use in patients with seizure disorders or those at risk of seizures
- Not using concomitantly with opiate medications
- Potential side effects, such as nausea, constipation, headache, and insomnia, which often improve with continued use Patients should continue the medication only if they lose at least 5% of their initial body weight after 12 weeks on the full dose, as suggested by the AGA guideline 1. It is essential to use Contrave alongside a reduced-calorie diet and increased physical activity for optimal results. The AGA recommends adding pharmacological agents, such as Contrave, to lifestyle interventions for adults with obesity or overweight with weight-related complications who have had an inadequate response to lifestyle interventions alone 1.
From the Research
Overview of Contrave for Weight Loss
- Contrave is a combination of naltrexone and bupropion, approved by the FDA for weight loss in adults with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol 2, 3, 4, 5, 6.
- The recommended dosage of Contrave is a combination of naltrexone hydrochloride extended release and bupropion hydrochloride extended release, taken orally with lifestyle modification 3, 6.
Efficacy of Contrave for Weight Loss
- Clinical trials have demonstrated that Contrave can result in significant weight loss, with an average weight loss of 5-9 kg (11-22 lbs) over 52 weeks of treatment 3.
- Studies have also shown that Contrave can improve metabolic health factors, such as blood pressure and lipid profiles 3, 6.
- The efficacy of Contrave for weight loss is attributed to its ability to inhibit the rewarding and reinforcing effects of food consumption, leading to a reduction in food cravings and appetite 2.
Comparison with Other Weight Loss Medications
- Contrave has been compared to other FDA-approved weight loss medications, including orlistat, phentermine-topiramate, and liraglutide, in terms of efficacy and safety 4, 5.
- While Contrave may result in less weight loss compared to some other medications, it has been shown to be effective in achieving significant weight loss and improving metabolic health factors 4, 5.
Safety and Adverse Events
- Common adverse events associated with Contrave include nausea, headache, constipation, dizziness, vomiting, and dry mouth 6.
- Contrave has not been shown to increase the risk of depression or suicidality events compared to placebo 6.
- The safety and efficacy of Contrave should be carefully evaluated in individual patients, taking into account their medical history and other health factors 3, 6.