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

Contrave Contraindications

Contrave (naltrexone/bupropion) is absolutely contraindicated in patients with seizure disorders, eating disorders (bulimia or anorexia nervosa), uncontrolled hypertension, current opioid use, pregnancy, abrupt discontinuation of alcohol/benzodiazepines/barbiturates/antiepileptics, concurrent MAOI use, and known hypersensitivity to either component. 1, 2, 3

Absolute Contraindications

Neurological Contraindications

• Seizure disorders are an absolute contraindication because bupropion significantly lowers the seizure threshold 1, 2
• Any condition predisposing to seizures beyond diagnosed epilepsy, including severe head trauma, CNS tumors, or metabolic disorders, precludes Contrave use 1
• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs is contraindicated due to increased seizure risk 2

Psychiatric Contraindications

• Current or prior diagnosis of bulimia or anorexia nervosa is contraindicated due to higher incidence of seizures observed in these patients 1, 2, 4
• MAOI use (intended to treat psychiatric disorders) concomitantly or within 14 days of discontinuing Contrave is contraindicated due to hypertensive reaction risk 2
• Reversible MAOIs such as linezolid or intravenous methylene blue are contraindicated 2

Cardiovascular Contraindications

• Uncontrolled hypertension is an absolute contraindication because both naltrexone and bupropion can elevate blood pressure and heart rate 1, 5

Opioid-Related Contraindications

• Current opioid use of any kind—including opioid analgesics, maintenance therapy (methadone), or partial agonists (buprenorphine)—is contraindicated because naltrexone blocks opioid receptors 1, 3
• Current opioid dependence or patients in acute opioid withdrawal cannot receive Contrave 3
• Positive urine screen for opioids or failure of naloxone challenge test is a contraindication 3
• Chronic pain management requiring opioids precludes Contrave use as naltrexone will block analgesic effects 1

Reproductive Contraindications

• Pregnancy or active attempts to conceive is contraindicated due to potential teratogenic effects 1

Hypersensitivity Contraindications

• Known hypersensitivity to bupropion, naltrexone, or any component of the formulation is an absolute contraindication 2, 3

Critical Monitoring Requirements When Not Contraindicated

Cardiovascular Monitoring

• Blood pressure and heart rate must be monitored periodically throughout treatment, especially during the first 12 weeks and all dose escalation phases 1, 5

Psychiatric Monitoring

• Patients younger than 24 years with depression require close monitoring for mood changes during the first few months due to risk of suicidal behavior and ideation 1
• Mental health status requires regular assessment as both components affect central nervous system function 1, 5

Efficacy Assessment

• Evaluate weight loss at 12 weeks: discontinue treatment if less than 5% weight loss is achieved 1

Common Pitfalls to Avoid

• Do not prescribe Contrave to patients requiring chronic opioid analgesia, as the naltrexone component will completely block pain relief 1
• Do not overlook subclinical seizure risk factors beyond diagnosed epilepsy when screening patients 1
• Alcohol consumption during Contrave treatment is particularly problematic in patients with any seizure susceptibility, as both substances independently affect seizure risk 5