Contrave Dosing for Food Cravings
The typical dose of Contrave (naltrexone/bupropion) is titrated over 4 weeks to a target maintenance dose of two tablets twice daily (32 mg naltrexone/360 mg bupropion total daily), taken as 16 mg/180 mg in the morning and 16 mg/180 mg in the evening. 1, 2
Dose Escalation Schedule
The gradual titration protocol minimizes adverse effects such as nausea, headache, and dizziness 3:
- Week 1: One tablet (8 mg/90 mg) once daily in the morning 1, 2
- Week 2: One tablet twice daily (morning and evening) 1, 2
- Week 3: Two tablets in the morning (16 mg/180 mg) and one tablet in the evening (8 mg/90 mg) 1
- Week 4 and beyond: Two tablets twice daily (16 mg/180 mg morning and evening) - this is the target maintenance dose 1, 2
Efficacy Assessment and Discontinuation Criteria
Evaluate treatment response at 12 weeks - discontinue Contrave if the patient has not achieved at least 5% weight loss, as continued use beyond this point is unlikely to provide meaningful benefit. 1, 2, 3
Expected outcomes with Contrave include 2, 4:
- Mean weight loss of 4.8-6.4% at 56 weeks compared to placebo 1, 2
- 36-57% of patients achieve ≥5% total body weight loss 2, 3
- Average weight loss of approximately 11-22 lbs (5-9 kg) across clinical trials 4
Ideal Candidates for Contrave
Contrave is particularly effective for patients who describe food cravings and addictive eating behaviors, making it an excellent choice for managing food cravings specifically. 1
Additional good candidates include 1:
- Patients with concomitant depression (bupropion component treats depression) 1
- Patients attempting to quit smoking or reduce alcohol intake 1
- Patients who prefer oral medication over injectables 1
Critical Contraindications and Safety Monitoring
Absolute contraindications that must be screened before prescribing 1, 2, 3:
- Uncontrolled hypertension (Contrave can increase blood pressure and heart rate) 2, 3
- History of seizures or conditions predisposing to seizures (bupropion lowers seizure threshold) 1, 2, 3
- Current opioid use (naltrexone blocks opioid effects and precipitates withdrawal) 3
- Eating disorders (anorexia/bulimia nervosa) 1
- Recent MAOI use 1
- Pregnancy or planning pregnancy 2, 5
Monitor blood pressure and heart rate periodically, especially during the first 12 weeks, as Contrave can elevate both parameters. 2, 3
Important Clinical Considerations
When using Contrave with benzodiazepines (such as lorazepam), exercise careful monitoring due to bupropion's effect on lowering seizure threshold 2. Zopiclone requires monitoring for additive CNS effects but has no specific contraindications 2.
Unlike phentermine, Contrave does not show increased cardiovascular risk and is not a controlled substance, making it suitable for long-term use 1, 6.