Contraindications for Contrave (Naltrexone/Bupropion)
Contrave is contraindicated in patients with uncontrolled hypertension, seizure disorders, current or prior diagnosis of anorexia nervosa or bulimia, use of opioid medications, and those undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs. 1, 2
Absolute Contraindications
- Uncontrolled hypertension - Bupropion can increase blood pressure and heart rate 1, 2
- Seizure disorders or conditions predisposing to seizures - Bupropion lowers the seizure threshold 1, 2, 3
- Current or prior diagnosis of anorexia nervosa or bulimia - Higher incidence of seizures observed in these patients 3
- Concurrent use of opioid medications or opioid dependence - Naltrexone is an opioid antagonist that blocks opioid effects 2, 4
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs - Increases seizure risk 3
- Use with monoamine oxidase inhibitors (MAOIs) - Increased risk of hypertensive reactions; should not be used within 14 days of MAOI discontinuation 3
- Pregnancy or planning pregnancy - All obesity medications are contraindicated in pregnancy 1, 2
- Known hypersensitivity to naltrexone or bupropion - Risk of anaphylactic reactions or Stevens-Johnson syndrome 3, 4
- Acute opioid withdrawal - Naltrexone can precipitate withdrawal symptoms 4
Special Populations Requiring Caution
- Patients younger than 24 years with depression - Black box warning for increased risk of suicidal behavior/ideation 1
- Patients with hepatic impairment - Both naltrexone and bupropion are metabolized in the liver 2
- Patients with renal impairment - May require dose adjustment 2
- Patients with cardiovascular disease - Although recent evidence suggests no increased risk of major adverse cardiovascular events, careful monitoring is recommended 5
Monitoring Recommendations
- Blood pressure and heart rate should be monitored regularly, especially during dose escalation 1, 2
- Mental health status should be assessed regularly due to potential neuropsychiatric effects 1, 6
- Weight loss efficacy should be evaluated at 12 weeks; discontinue if 5% weight loss is not achieved 2
Drug Interactions to Consider
- Medications that lower seizure threshold - May increase seizure risk when combined with bupropion 3
- Antihypertensive medications - Bupropion may reduce effectiveness 1, 6
- CYP2B6 inhibitors or inducers - May affect bupropion metabolism 2
Clinical Considerations
- Despite contraindications, Contrave has shown modest efficacy with weight loss of approximately 5% from baseline compared to 1.8% with placebo 1, 7
- Common side effects include nausea, constipation, headache, dizziness, insomnia, and dry mouth 1, 7
- Careful patient selection is crucial to minimize risks while maximizing potential benefits 1, 2
When considering Contrave, thorough screening for contraindications is essential to ensure patient safety while pursuing weight management goals.