Contrave is Contraindicated for Patients with a History of Seizures
Contrave (bupropion and naltrexone) is absolutely contraindicated for individuals who have had a seizure, even a single one. 1
Rationale for Contraindication
Bupropion, one of the active components in Contrave, significantly lowers the seizure threshold and is explicitly contraindicated in patients with seizure disorders or a history of seizures. The FDA drug label for bupropion clearly states: "Do not take bupropion hydrochloride extended-release tablets (XL) if you have or had a seizure disorder or epilepsy." 1
This contraindication applies regardless of:
- Whether the person had only a single seizure
- How long ago the seizure occurred
- Whether the person is currently on anti-seizure medication
Seizure Risk with Bupropion
The risk of seizures with bupropion is well-documented:
- Bupropion can trigger generalized tonic-clonic seizures even in patients with no prior seizure history 2
- The incidence of seizures at 300 mg per day (a standard dose in Contrave) is approximately 1/1000 patients 2
- Even the extended-release formulation of bupropion (which is used in Contrave) has been reported to induce grand mal seizures 3
Clinical Guidelines Support
Clinical guidelines reinforce this contraindication:
- The American Academy of Emergency Medicine's clinical policy on seizures notes that patients with a history of seizures have an increased risk of recurrence 4
- Even patients with a single unprovoked seizure have a substantial risk (approximately one-third to one-half) of experiencing another seizure within 5 years 4
- The FDA label for bupropion-containing products explicitly lists seizure disorders as an absolute contraindication 1
Alternative Weight Loss Options
For patients with a history of seizures who need weight management medication:
- Consider medications that do not contain bupropion
- Consult with both a neurologist and weight management specialist
- Focus on non-pharmacological approaches to weight management including diet and exercise programs
Important Monitoring if Bupropion is Used Despite Risks
If a physician were to make the highly unusual decision to prescribe Contrave despite this contraindication (which is not recommended):
- The patient would require extremely close neurological monitoring
- Anti-seizure medication would need to be optimized first
- The patient should be informed of the significant risk of seizure recurrence
- A gradual titration schedule with lower maximum doses would be necessary
Bottom Line
The evidence is clear and consistent: a person with any history of seizures, including a single seizure, should not take Contrave due to the significant risk of seizure recurrence. This is an absolute contraindication based on the FDA labeling and clinical evidence.