Can you drink alcohol while taking Contrave (bupropion and naltrexone)?

Alcohol and Contrave: Strong Recommendation to Minimize or Avoid

Alcohol consumption should be minimized or avoided while taking Contrave (naltrexone/bupropion), as the FDA drug label explicitly warns of rare but serious adverse neuropsychiatric events and reduced alcohol tolerance when combining these substances. 1

Primary Safety Concerns

Neuropsychiatric Risks

• The FDA label for bupropion documents postmarketing reports of adverse neuropsychiatric events and reduced alcohol tolerance in patients drinking alcohol during treatment, leading to the explicit recommendation that alcohol consumption should be minimized or avoided. 1
• These neuropsychiatric effects represent unpredictable individual reactions that can occur even with moderate alcohol intake. 1

Seizure Threshold Reduction

• Alcohol significantly lowers the seizure threshold when combined with bupropion, which is particularly concerning since bupropion already lowers seizure threshold in a dose-dependent manner. 2
• In animal studies, the convulsive dose required to induce seizures in 50% of mice (CD50) dropped from 116.72 mg/kg for bupropion alone to 89.40 mg/kg when combined with alcohol—representing approximately a 23% reduction in seizure threshold. 2
• This interaction creates additive risk, as both substances independently affect seizure susceptibility. 2

Clinical Context and Contraindications

Baseline Contraindications

• Contrave is already contraindicated in patients with seizure disorders or conditions predisposing to seizures, making the additional seizure risk from alcohol particularly problematic. 3, 4
• Patients with uncontrolled hypertension should not use Contrave, and alcohol can further complicate blood pressure management. 3, 4

Monitoring Requirements

• Regular blood pressure and heart rate monitoring is essential during Contrave treatment, especially during dose escalation, and alcohol can interfere with accurate assessment. 4
• Mental health status requires ongoing assessment due to potential neuropsychiatric effects, which alcohol consumption can exacerbate. 4

Nuanced Evidence on Alcohol-Bupropion Interactions

Contradictory Older Data

• One older study from 1984 found no significant impairment when combining bupropion with alcohol on vigilance tests, and even suggested bupropion might reverse some alcohol-induced mental slowing. 5
• However, this study predates the FDA's postmarketing surveillance data and used lower doses in controlled settings, making it less applicable to real-world clinical practice. 5

Potential Therapeutic Effects (Not Relevant to Safety)

• Research shows bupropion combined with naltrexone can actually reduce alcohol consumption in animal models, suggesting potential therapeutic applications for alcohol use disorders. 6, 7
• However, this potential benefit does not negate the safety concerns about combining Contrave with alcohol in patients taking it for weight management. 6, 7

Practical Clinical Guidance

Counsel patients explicitly that:

• Alcohol should be minimized or completely avoided during Contrave treatment. 1
• Even small amounts of alcohol may trigger unpredictable neuropsychiatric reactions or increase seizure risk. 1, 2
• If a patient has difficulty abstaining from alcohol, Contrave may not be the appropriate weight loss medication for them. 1

Common pitfall to avoid: Do not assume that patients who tolerated alcohol with other antidepressants will tolerate it with Contrave—the naltrexone/bupropion combination creates unique risks. 1