Contrave is NOT Appropriate for a Patient with BMI 24.37
Contrave is FDA-approved only for patients with BMI ≥30 kg/m² (obese) or BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidemia—a patient with BMI 24.37 falls below both thresholds and does not meet criteria for pharmacologic weight management. 1, 2
BMI Threshold Requirements
The FDA approval for naltrexone/bupropion ER (Contrave) specifically requires an initial BMI of ≥30 kg/m² OR a BMI of ≥27 kg/m² in the presence of at least one bodyweight-related comorbidity 2
A BMI of 24.37 is classified as normal weight (normal BMI range: 18.5-24.9 kg/m²), which is nearly 3 BMI points below even the lower threshold for overweight patients with comorbidities 1
All four pivotal Phase III clinical trials (COR-I, COR-II, COR-BMOD, and COR-DM) enrolled only patients meeting these BMI criteria, meaning there is no safety or efficacy data for patients with normal BMI 3
Clinical Context and Safety Considerations
Contrave was studied and approved as an adjunct to reduced-calorie diet and increased physical activity for chronic weight management in obesity, not for patients at normal weight 1, 2
The medication carries significant side effects including nausea (29.8%), constipation, headache, vomiting, dizziness, and dry mouth, with a black box warning for suicidal thoughts in young adults due to the bupropion component 1, 4
Using weight loss medications in patients who don't meet BMI criteria exposes them to unnecessary risks without established benefit and falls outside evidence-based practice 1
Common Pitfall to Avoid
Do not prescribe Contrave based solely on patient desire for weight loss or body image concerns when BMI is in the normal range—this represents inappropriate use of a medication designed for obesity management and could cause harm without proven benefit 1, 2
If the patient has specific concerns about food cravings or eating behaviors despite normal BMI, consider evaluation for eating disorders or referral to behavioral health rather than pharmacotherapy 4