What are the contraindications for Contrave (bupropion/naltrexone)?

Contrave Contraindications

Contrave (naltrexone/bupropion) is absolutely contraindicated in patients with seizure disorders, current or prior bulimia or anorexia nervosa, uncontrolled hypertension, current opioid use, pregnancy, and use of MAO inhibitors within 14 days. 1, 2, 3

Absolute Contraindications

Neurological and Psychiatric

• Seizure disorders of any kind—the bupropion component significantly lowers seizure threshold 1, 2
• Current or prior diagnosis of bulimia or anorexia nervosa—higher incidence of seizures observed in these patients 1, 2
• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs—dramatically increases seizure risk 2

Cardiovascular

• Uncontrolled hypertension—both components can elevate blood pressure and heart rate 1

Opioid-Related

• Current opioid use including opioid analgesics, maintenance therapy (methadone), or partial agonists (buprenorphine)—naltrexone blocks opioid receptors 1, 3
• Acute opioid withdrawal—naltrexone will precipitate severe withdrawal 3
• Positive urine screen for opioids or failed naloxone challenge test 3

Drug Interactions

• MAO inhibitors (phenelzine, tranylcypromine, selegiline) used within 14 days—risk of hypertensive crisis 1, 2
• Reversible MAOIs (linezolid, intravenous methylene blue) 2

Pregnancy and Hypersensitivity

• Pregnancy or active attempts to conceive—topiramate component in similar medications is teratogenic; avoid in all women of childbearing potential without effective contraception 1
• Known hypersensitivity to bupropion, naltrexone, or any component—anaphylaxis and Stevens-Johnson syndrome reported 2

Critical Monitoring Requirements

Blood Pressure and Heart Rate

• Monitor periodically throughout treatment, especially during the first 12 weeks and dose escalation phases 1, 4

Neuropsychiatric Effects

• Black box warning: Risk of suicidal behavior and ideation in patients younger than 24 years with depression—monitor closely for mood changes during first few months 1
• Assess mental health status regularly, as both components affect central nervous system function 4

Efficacy Assessment

• Evaluate at 12 weeks: discontinue if less than 5% weight loss achieved, as continued use unlikely to provide meaningful benefit 1, 5

Common Pitfalls to Avoid

• Do not prescribe to patients with any condition predisposing to seizures beyond diagnosed epilepsy—this includes severe head trauma, CNS tumors, or metabolic disorders 4
• Do not combine with other medications containing bupropion (Wellbutrin, Zyban) or naltrexone 2
• Do not use in patients requiring chronic pain management with opioids—naltrexone will block analgesic effects 1, 3
• Alcohol consumption poses additional seizure risk and should be avoided, particularly abrupt cessation during treatment 4, 2