What is the recommended dosing for Contrave (bupropion and naltrexone)?

From the Guidelines

Contrave should be started at a low dose and gradually increased to minimize side effects, with a typical dosing regimen of one tablet (naltrexone 8 mg/bupropion 90 mg) taken once daily in the morning for the first week, increasing to two tablets twice daily (total daily dose: naltrexone 32 mg/bupropion 360 mg) by week 4, as recommended by the FDA and supported by recent guidelines 1.

Dosing Regimen

The dosing regimen for Contrave is as follows:

• Week 1: One tablet (naltrexone 8 mg/bupropion 90 mg) taken once daily in the morning
• Week 2: One tablet twice daily, taking one in the morning and one in the evening
• Week 3: Two tablets in the morning and one in the evening
• Week 4: Two tablets twice daily (total daily dose: naltrexone 32 mg/bupropion 360 mg)

Important Considerations

• Take Contrave with food to reduce gastrointestinal side effects
• Avoid taking it late in the evening as bupropion may cause insomnia
• If significant side effects are experienced, the doctor may recommend staying at a lower dose longer before increasing
• The gradual titration helps the body adjust to the medication, particularly to the bupropion component which can cause stimulant-like effects
• Contrave works by affecting both appetite control centers in the brain and the reward pathways associated with food, making it effective for weight management when combined with diet and exercise

Monitoring and Discontinuation

• The medication should be discontinued if a patient has not achieved at least 5% weight loss after 12 weeks on the maintenance dose, as recommended by recent guidelines 1
• Regular monitoring of side effects, blood pressure, and heart rate is necessary while taking Contrave
• Patients with a history of seizure disorders, unmanaged hypertension, or chronic opioid therapy should not take Contrave, and those with depression should be closely monitored for suicidal behavior/ideation 1

From the Research

Recommended Dosing for Contrave (Bupropion and Naltrexone)

• The recommended dosing for Contrave (bupropion and naltrexone) is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, study 6 mentions a novel fixed dose of sustained-released naltrexone/bupropion, but does not specify the exact dosage.
• Study 3 mentions that naltrexone/bupropion is a currently available combination therapy, but does not provide information on the recommended dosing.
• Studies 2, 4, 5 do not provide relevant information on the recommended dosing for Contrave (bupropion and naltrexone).

Safety and Efficacy of Naltrexone/Bupropion

• Study 6 examines the safety and antiobesity effects of naltrexone and bupropion alone and in combination, and reviews the results of four Phase III clinical trials of a novel fixed dose of sustained-released naltrexone/bupropion.
• The study finds that naltrexone/bupropion has a greater weight loss efficacy than two FDA-approved medications, orlistat and lorcaserin, and is well tolerated, with nausea being the most reported adverse event 6.
• Study 2 mentions that naltrexone-bupropion was associated with 4.1% greater weight loss compared with placebo, based on 6 randomized clinical trials with 9949 participants 2.