Is it safe to take Contrave (bupropion and naltrexone) with Adderall (amphetamine and dextroamphetamine)?

Safety of Taking Contrave with Adderall

Combining Contrave (naltrexone-bupropion) with Adderall (amphetamine and dextroamphetamine) should be approached with caution due to potential interactions affecting seizure risk and cardiovascular effects, and is generally not recommended without close medical supervision.

Understanding the Medications

Contrave

• Combination of naltrexone (opioid antagonist) and bupropion (dopamine/norepinephrine reuptake inhibitor)
• FDA-approved for chronic weight management in adults with obesity or overweight with weight-related complications 1
• Works by modulating hedonic eating patterns and producing anorexigenic effects 1

Adderall

• Combination of amphetamine and dextroamphetamine
• Stimulant medication commonly used for ADHD treatment
• Increases levels of dopamine and norepinephrine in the brain

Potential Concerns with Combination

Seizure Risk

• Bupropion (in Contrave) may lower the seizure threshold 1, 2
• The American Gastroenterological Association recommends avoiding Contrave in patients with seizure disorders 2
• No specific studies on the combination of bupropion and stimulants like Adderall were identified in the AACAP Practice Parameters, which notes: "There are no studies of the combination of bupropion and stimulants in the treatment of ADHD or other psychiatric conditions" 1

Cardiovascular Effects

• Both medications can affect blood pressure and heart rate
• Contrave can cause modest increases in blood pressure, particularly in the first 8 weeks of treatment 1, 2
• Adderall also has stimulant effects on the cardiovascular system
• The combination could potentially lead to additive effects on blood pressure and heart rate

Neuropsychiatric Effects

• Both medications can cause insomnia, anxiety, and other neuropsychiatric effects
• The combination might increase the risk of these side effects

Guidance from Available Evidence

• The AACAP Practice Parameters state: "clinicians should proceed with caution in combining these agents until further studies are available" 1
• No specific contraindication for this combination is listed in the guidelines, but the lack of studies on safety is concerning
• The American Gastroenterological Association recommends regular blood pressure and heart rate monitoring with Contrave, especially during the first 12 weeks 2

Recommendations for Clinical Practice

1. Risk Assessment Before Considering Combination:

   • Evaluate for history of seizures or conditions that lower seizure threshold
   • Assess cardiovascular health, including baseline blood pressure and heart rate
   • Review for other medications that might interact with either drug

2. If Combination Is Deemed Necessary:

   • Start with lower doses of both medications
   • Implement more frequent monitoring of vital signs
   • Monitor for neuropsychiatric symptoms (insomnia, anxiety, mood changes)
   • Consider ECG monitoring for patients with cardiovascular risk factors

3. Warning Signs to Monitor:

   • Significant increases in blood pressure or heart rate
   • New or worsening neuropsychiatric symptoms
   • Any signs of seizure activity

Important Considerations

• The combination has not been well-studied, making it difficult to predict all potential interactions 1
• Individual factors such as age, comorbidities, and other medications may influence safety
• The benefits of the combination must clearly outweigh the potential risks
• Alternative weight management approaches may be safer for patients already on Adderall

Special Precautions

• Avoid this combination in patients with:
  • History of seizures
  • Uncontrolled hypertension
  • Significant cardiovascular disease
  • Concurrent use of other medications that lower seizure threshold

Remember that while no absolute contraindication exists in the literature for this specific combination, the lack of safety data and the known risks of each medication individually warrant a cautious approach.