What is the starting dose of Contrave (bupropion/naltrexone) for a patient taking Imovane (zopiclone) and lorazepam?

Starting Dose of Contrave in a Patient Taking Imovane and Lorazepam

The starting dose of Contrave for a 43-year-old female taking Imovane 7.5 mg and lorazepam 1 mg BID should be one tablet (naltrexone 8 mg/bupropion 90 mg) once daily in the morning for the first week, with gradual weekly increases to the target dose. 1

Dosing Schedule for Contrave

• Initial dose: One tablet (naltrexone 8 mg/bupropion 90 mg) once daily in the morning for Week 1 1
• Week 2: Increase to one tablet twice daily (morning and evening) 1
• Week 3: Increase to two tablets in the morning and one tablet in the evening 1
• Week 4 and beyond: Increase to the target dose of two tablets twice daily (total daily dose: naltrexone 32 mg/bupropion 360 mg) 1

Important Considerations with Concurrent Medications

• Benzodiazepine use (lorazepam): Monitor carefully as bupropion lowers the seizure threshold, which may interact with benzodiazepine therapy, especially during dose adjustments or discontinuation 1
• Zopiclone (Imovane): No specific contraindications with Contrave, but monitor for potential additive CNS effects 1
• Seizure risk: Bupropion is contraindicated in patients with seizure disorders; use with caution in patients taking medications that may lower seizure threshold 1

Efficacy and Monitoring Parameters

• Assess efficacy at 12 weeks; discontinue if 5% weight loss is not achieved 1
• Expected weight loss: 2.0-4.1 kg (36-57% of patients achieve ≥5% weight loss) 1
• Monitor for improvements in cardiometabolic parameters including waist circumference, triglycerides, and insulin resistance 2, 3

Common Side Effects to Monitor

• Nausea (most common side effect leading to discontinuation) 1, 4
• Constipation, headache, vomiting 1
• Potential for depression and precipitation of mania 1
• Blood pressure and heart rate changes (small increases may occur) 5, 2

Contraindications and Precautions

• Uncontrolled hypertension 1
• History of seizures or conditions predisposing to seizures 1
• Use of MAO inhibitors (within 14 days) 1
• Pregnancy or planning pregnancy 1
• Chronic opioid therapy (naltrexone component will block opioid effects) 1, 6

Special Considerations for Pain Management

• If acute pain management with opioids becomes necessary, higher doses of opioids may be required to overcome naltrexone blockade, which increases risk of respiratory depression when naltrexone effect wanes 6
• Consider multimodal analgesia strategies if procedures are planned 6