Contrave

Contrave is an oral weight-management medication that combines two older drugs in one extended-release tablet: 8 mg of naltrexone, an opioid-receptor blocker, and 90 mg of bupropion, an antidepressant that also acts on the brain’s reward circuitry. Neither does much for weight alone; the pairing is the point.

It is taken twice daily after a gradual four-week build-up, and the label caps it at two tablets in the morning and two in the evening — no more than four a day. The label also sets a stopping rule most patients are never told about: response should be evaluated after 12 weeks at the maintenance dose, and if the patient has not lost at least 5% of baseline body weight, Contrave should be discontinued, because continued treatment is unlikely to produce meaningful results.

The safety profile is where Contrave differs most from a GLP-1. It carries a boxed warning for suicidal thoughts and behaviors, inherited from the bupropion component and the class-wide antidepressant warning. Bupropion can also cause seizures: the label reports an incidence of about 0.1% in Contrave clinical trials versus 0% on placebo. It is contraindicated in uncontrolled hypertension, in seizure disorder or a history of seizures, in current or prior anorexia nervosa or bulimia, with chronic opioid use, with other bupropion-containing products, and with abrupt withdrawal from alcohol, benzodiazepines, barbiturates or antiepileptic drugs. The label also warns not to take it with a high-fat meal, which raises seizure risk.

The common confusion is grouping Contrave with GLP-1 drugs because both are prescribed for weight. Mechanistically they are unrelated, the expected weight loss is smaller, and the contraindication list is longer and more likely to apply to you.

Worth asking your clinician: whether any of those contraindications fit your history, whether an antidepressant you already take conflicts, and what the 12-week checkpoint will look like. Our Contrave side-effect review and naltrexone evidence page go further.