Is Contrave Used for Food Cravings Like Sugar?
Yes, Contrave (naltrexone/bupropion) is specifically used to reduce food cravings, including sugar cravings, through its mechanism of modulating central reward pathways triggered by food. 1
Mechanism of Action for Craving Reduction
Contrave works through a dual mechanism that directly targets food cravings:
- Bupropion inhibits reuptake of dopamine and norepinephrine, which modulates the central reward pathways that are triggered by food consumption 1
- Naltrexone antagonizes an inhibitory feedback loop that would otherwise limit bupropion's appetite-suppressing properties, enhancing the overall effect on food reward systems 1
- The combination activates pro-opiomelanocortin neurons in the arcuate nucleus of the hypothalamus, promoting release of α-melanocyte-stimulating hormone, an anorectic neuropeptide involved in body weight regulation 1
Clinical Evidence for Craving Reduction
Clinical trials demonstrate that bupropion (the active component in Contrave) decreases body weight by suppressing appetite and specifically reducing food cravings. 1
- In clinical practice, patients who describe cravings for food and/or addictive behaviors related to food have responded particularly well to naltrexone/bupropion 1
- The medication is especially suitable for patients with food addiction-like behaviors, as it targets the reward pathways similar to those involved in substance dependence 1
Efficacy Data
Weight loss outcomes demonstrate the medication's effectiveness at reducing overall food intake:
- Mean weight loss of 4.8-5.0% at 56 weeks compared to placebo 1, 2
- 36-57% of patients achieve ≥5% total body weight loss 2
- Across four major trials (COR-I, COR-II, COR-BMOD, COR-Diabetes), average weight loss ranged from 11-22 lbs (5-9 kg) 3
Specific Evidence for Binge-Eating and Craving Disorders
A 2022 randomized controlled trial specifically demonstrated Contrave's effectiveness for binge-eating disorder, which is fundamentally a disorder of food cravings and loss of control over eating:
- Binge-eating remission rates were 57.1% with behavioral therapy plus naltrexone-bupropion versus 17.7% with placebo alone 4
- Naltrexone-bupropion was significantly superior to placebo for reducing binge-eating episodes 4
- The medication showed improvements in eating disorder psychopathology and eating behaviors 4
Ideal Candidates for Craving Management
Contrave is particularly appropriate for:
- Patients who describe specific cravings for food, especially those with addictive-like eating behaviors 1
- Individuals with binge-eating patterns or loss of control over eating 4
- Patients with BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities 1
- Those who have failed lifestyle modifications alone 1
Dosing Protocol for Craving Management
The standard dose escalation protocol begins with one 8mg/90mg tablet daily in the morning and increases by one tablet per week until reaching the target dose of two tablets twice daily, which minimizes adverse effects while building therapeutic effect 2
Important Contraindications
Contrave should not be used in patients with:
- Uncontrolled hypertension 2
- Seizure disorders or conditions predisposing to seizures (including eating disorders like anorexia or bulimia nervosa) 1, 2
- Current opioid use (naltrexone will block opioid effects and precipitate withdrawal) 2
- Pregnancy 2
- Use of MAO inhibitors within 14 days 1
Monitoring Requirements
- Assess efficacy at 12 weeks: discontinue if <5% weight loss achieved, as continued use is unlikely to provide meaningful benefit 2
- Monitor blood pressure and heart rate periodically, especially during the first 12 weeks 2
- Monitor for neuropsychiatric effects including mood changes, as bupropion carries a black box warning for suicidal thoughts in young adults 1
Common Side Effects
The most frequent adverse effects include nausea, constipation, headache, dizziness, insomnia, and dry mouth 1, with approximately half of patients experiencing gastrointestinal symptoms 5