Contrave for weight loss: does it work?

Contrave is a prescription weight loss medication that’s used in tandem with a low-calorie diet and exercise. A combination of two other medications – bupropion and naltrexone – Contrave is FDA-approved for managing weight in people living with obesity. It’s also prescribed to overweight people with an existing medical condition like heart disease or diabetes. 

Obesity is a global epidemic that has steadily increased over the last 50 years. Not only does the condition raise the risk of developing other serious health problems, but people living with obesity often have a reduced quality of life and shorter life expectancy. It’s also the fifth leading cause of death worldwide.

Finding safe and healthy ways to manage weight is more important than ever, which is why we’ve seen an influx of FDA-approved weight loss medications like Contrave over recent years. If you’re considering Contrave, you might be wondering: does it actually work for weight loss?

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Contrave is a combination of two medications: naltrexone and bupropion. Naltrexone is known as an opioid antagonist and is typically used to treat alcohol and opioid use disorders. Bupropion is an antidepressant that is also used for smoking cessation. 

While neither medication on its own is approved for weight loss, the combination of the two is. Researchers don’t fully understand the mechanism behind why Contrave helps with weight loss, but it’s thought to work by reducing food cravings and promoting feelings of fullness. 

In 2011, the FDA initially rejected Contrave due to the lack of research on the drug’s potential heart-related side effects. The drug was officially approved in 2014 after further clinical trials were conducted and Contrave was determined to be safe and effective for weight reduction in people with obesity. 

Contrave is an extended-release tablet that’s a fixed combination containing 8 mg of naltrexone and 90 mg of bupropion. It can only be obtained through a prescription and is recommended for weight management in adults with:

• Obesity (BMI of 30 kg/m2 or greater)

• Overweight (BMI of 27 kg/m2 or more), plus a weight-related health problem like high blood pressure or high cholesterol

It’s important to note that Contrave – as with any other weight loss medication such as Ozempic and Wegovy – is shown to have the greatest effects when combined with lifestyle modifications like a reduced-calorie diet and increased physical activity.

Typical dosing for Contrave starts with taking one tablet in the morning for a week. Starting in week two, you’ll take another tablet in the evening. By week four, you’ll take four tablets daily (two in the morning, two in the evening) and continue that regimen. 

You should experience at least a 5% drop in weight after 12 weeks of treatment coupled with a low-calorie diet and exercise. Research reports that experiencing weight loss of between 5 and 10% is linked to quality of life improvements including better sleep, and a reduced risk for health complications like type 2 diabetes.

While Contrave has promising health benefits when used properly, it also comes with some cautions. People with a history of seizures, uncontrolled hypertension (high blood pressure), and suicidal thoughts and behaviors should avoid taking Contrave. 

Interestingly, neither naltrexone nor bupropion on their own is approved for weight loss. So, how exactly does Contrave work for reducing body weight?

Contrave is thought to work by stimulating and inhibiting brain areas responsible for appetite and energy expenditure. The exact mechanism of action is unknown, but the combination of naltrexone and bupropion seems to influence the brain’s reward centers involved in food intake, cravings, and mood. The medication could be especially beneficial for people who struggle with stress eating.

Studies have found that the effects of Contrave can be seen after four weeks of using the medication. After 16 weeks, roughly 45% of study participants experienced a 5% or greater reduction in body weight. While research shows promising results for early weight loss, there isn’t enough conclusive data yet on how effective Contrave is for long-term weight management. But there are some promising signs: Some trial data found that participants successfully maintained weight loss for 56 weeks. And although more research is needed, Contrave as a weight loss treatment in addition to lifestyle changes may increase the chances of maintaining weight loss for up to four years.

It’s important to note that weight loss medications on their own aren’t enough for weight loss, especially in the long run; treating obesity and overweight involves a comprehensive approach that includes exercise, dietary changes, and other lifestyle modifications like therapy. 

Unlike other weight loss medications like Qsymia, Contrave is not a controlled substance, scheduled drug, or stimulant. Therefore it doesn’t pose a risk for drug dependency. While Contrave shows a lot of promise, it also comes with some potentially serious side effects, which we’ll get into next.

The most common side effects of Contrave are nausea, constipation, and headache. Other common side effects you may experience include: 

• Dizziness 

• Dry mouth

• Diarrhea

• Insomnia

• Vomiting

More serious side effects of Contrave to watch out for include:

• Increases in heart rate and blood pressure

• Liver damage or impaired liver function

• Manic episodes or changes in mood

• Seizures

• Suicidal thoughts or behaviors

• Eye pain or vision problems (angle-closure glaucoma)

Allergic reactions to Contrave have also occurred. If you experience a rash, fever, itching, chest pain, swelling, or difficulty breathing, seek medical attention immediately. 

People with liver disease, seizure disorders, uncontrolled high blood pressure, or a history of eating disorders (like anorexia nervosa or bulimia) should avoid Contrave. 

Contrave also holds a warning for suicidal ideation and behaviors. If you experience depression, suicidal feelings, or any unusual or extreme changes in mood, seek help immediately, and speak with a medical professional who can suggest alternative weight loss medications. The National Suicide Prevention Lifeline is a free hotline available 24/7 to anyone in emotional distress. Call 988 for support and to be connected to resources.

Like many prescription drugs, Contrave has the potential to interact with other drugs or supplements you may be taking. According to the FDA, here are potential drug interactions to watch out for while taking Contrave:

• Monoamine oxidase inhibitors (MAOIs): These are a type of antidepressant. When used in combination with Contrave, it could cause sudden increases in blood pressure.

• CYP2B6 inhibitors and inducers: While these drugs have opposing effects in the body, taking either alongside Contrave could unknowingly increase or decrease bupropion levels in the body. Examples of CYP2B6 drugs to include ticlopidine, clopidogrel, ritonavir, lopinavir, and efavirenz – to name a few.

• Drugs metabolized by CYP2D6 enzymes: Bupropion specifically blocks an enzyme in the body called CYP2D6. This means any drug that’s metabolized by CYP2D6 (including antidepressants, antipsychotics, and beta blockers) should either be avoided or the dose reduced when taking Contrave.

• Medicines that contain opioids: People taking opioids or going through opiate withdrawal should avoid Contrave as it contains an opioid antagonist. Mixing these medications is dangerous and could lead to a fatal overdose.

• Dopaminergic drugs: Examples include drugs used to treat Parkinson’s disease including levodopa and amantadine. Since bupropion also has dopamine agonist effects, combining it with similar medications could lead to nervous system toxicity.

• Drugs that increase seizure risk: Use Contrave with caution if combined with certain medications like antidepressants and corticosteroids that can lower the seizure threshold.

The safety of Contrave combined with other weight loss medications and nutritional supplements hasn’t been evaluated. Speak with a healthcare professional before taking Contrave alongside other drugs.

How much Contrave costs depends on your health insurance and where you purchase it from. One potential downside is Contrave is not available in a generic version; this makes it potentially more costly as brand-name drugs are generally more expensive than their generic counterparts.

Without insurance, the cost of 120 tablets is roughly $668. The good news is, even without insurance, eligible patients can subscribe to the CurAccess Program, which is $99 or less (plus free shipping) for a monthly subscription.

Again, because there is no generic version, even with insurance Contrave can be pricey. Patients with insurance can cut costs by subscribing to the CurAccess Program or by applying for a Contrave Savings Coupon Card, which covers amounts over $199. 

Depending on your insurance, the coupon card could save you a lot more. The Contrave Savings card cannot be used if you’re a Medicaid beneficiary, however, recipients of other federal programs like Medicare Part D or TRICARE may be eligible.

Obesity remains a complex, prevalent disease that can be difficult to treat. Successful weight loss (and maintaining that weight loss) looks different for every person but usually requires a holistic approach focused on diet, lifestyle changes, and weight loss medications.

The benefits of drugs like Contrave are they’re safer and less costly than other medical interventions, such as bariatric surgery. That said, Contrave isn’t for everyone. GLP-1 receptor agonists are another popular class of medications effective in diabetes treatment and weight management. Here’s a look at some common alternatives to Contrave that work well for weight loss. 

Semaglutide (brand names Ozempic and Wegovy)

Semaglutide is an injectable drug FDA-approved to treat diabetes and obesity. It’s known as a GLP-1 agonist, which acts on the body to reduce appetite and make you feel full for longer. Studies have found that semaglutide successfully helps people with obesity decrease their body weight by up to 15%. Semaglutide is also found under the brand names Ozempic, Wegovy, and Rybelsus. Keep reading to learn more about Contrave vs. Wegovy, one of the most popular weight loss drugs on the market.

Liraglutide (brand names Saxenda and Victoza)

Liraglutide is another type of injectable GLP-1 agonist. While it’s typically used for type 2 diabetes, studies have found that it may also help with weight management in adolescents living with obesity. Again, lifestyle interventions combined with liraglutide were found to be more effective for weight loss than either medication or behavior changes alone. Liraglutide is available under the brand names Victoza and Saxenda.

Orlistat (brand names Alli and Xenical)

Orlistat is a lipase inhibitor, a drug that reduces how much fat your body absorbs from food. It’s FDA-approved (again in conjunction with diet and exercise) to treat obesity. Orlistat is available as a prescription-strength drug under the brand name Xenical, and in a lower-strength, over-the-counter version called Alli.

Phentermine/topiramate (brand name Qsymia)

Like Contrave, Qsymia is a combination medication made up of phentermine (an appetite suppressant) and topiramate (an anti-seizure drug). Qsymia is approved to treat obesity and works by reducing appetite. One word of warning is phentermine/topiramate is a controlled substance, meaning it has a high potential for abuse.

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If you’re interested in medication for treating overweight or obesity, you may have come across Wegovy in your research or on the news. Wegovy is FDA-approved as a long term treatment for those who struggle with obesity. It’s one of the most popular weight loss drugs on the market, so you may wonder–is Contrave or Wegovy right for you? Here’s what you need to know about Contrave vs. Wegovy.

Both Contrave and Wegovy are proven to be highly effective at helping patients lose weight and keep the weight off. However, some circumstances might make one medication a better option for you:

• Type 2 diabetes: Semaglutide, the active ingreadient in Wegovy and Ozempic can effectively manage type 2 diabetes. If you have overweight/obesity and type 2 diabetes, your provider may prescribe semaglutide.

• Depression: Contrave contains bupropion, a drug that can treat depression in higher doses. If you struggle with overweight/obesity associated with mood swings, your provider may prefer Contrave over Wegovy.

• Cravings: Both naltrexone and bupropion—the active ingredients in Contrave—can help control feelings of pleasure you get when eating. If you experience strong cravings and emotional eating, your provider may prescribe Contrave.

• Lack of satiety: If you experience lack of satiety (you’re unable to feel full when eating regular portion sizes), your provider may prescribe Wegovy to help you feel full longer.

If you’re searching for a weight loss medication, Ro’s Body Program can help eligible people get access to GLP-1s like Ozempic and Wegovy. Through the program, Ro connects you to a licensed medical professional who can go over your weight loss medication options. Whether you’re looking to lose weight or simply increase your confidence, Ro’s Body Program is a great way to get started on your weight loss journey.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

September 25, 2023

Written by

Anna Brooks

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.