TL;DR
- Contrave combines bupropion and naltrexone to curb appetite and cravings.
- Clinical trials show an average 5‑10% body‑weight loss after a year.
- Common side‑effects include nausea, constipation, and headache; serious risks are rare but include increased blood pressure.
- Start with a low dose, titrate up over four weeks, and pair with diet‑exercise guidance.
- Price ranges $150‑$200 per month; many insurers cover it with prior‑auth.
What Is Contrave and How Does It Work?
Contrave is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for chronic weight management in adults with a body‑mass index (BMI) of 30kg/m² or higher, or 27kg/m² with at least one weight‑related condition such as type2 diabetes or hypertension.
The brand name hides two well‑known drugs: bupropion, an antidepressant that also reduces appetite, and naltrexone, an opioid‑receptor antagonist that dampens reward‑center cravings. When taken together at low, steady doses, the two agents act synergistically to affect two brain pathways:
- The hypothalamus, which controls hunger signals. Bupropion stimulates pro‑opiomelanocortin (POMC) neurons, creating a feeling of fullness.
- The mesolimbic reward system, which drives food‑related pleasure. Naltrexone blocks the auto‑inhibitory feedback on POMC neurons, keeping the appetite‑suppressing signal active longer.
Because the combo targets both physiological hunger and emotional cravings, many users report fewer late‑night snack urges compared with diet alone.
“The bupropion‑naltrexone combination appears to modulate both homeostatic and hedonic pathways, offering a dual‑action approach to obesity treatment.” - Journal of Clinical Endocrinology & Metabolism, 2022.
Contrave is taken as two tablets daily-one in the morning, one in the evening-after meals. The medication comes in three strength levels (8mg/90mg, 16mg/180mg, 24mg/360mg) and follows a built‑in titration schedule to reduce gastrointestinal upset.
Effectiveness and Safety: What the Data Say
Four pivotal phase‑III trials (the COR‑I, COR‑II, COR‑III, and COR‑IV studies) enrolled more than 5,000 participants. Across the board, patients on Contrave lost more weight than those on placebo while following an 800-1,200kcal diet and a structured exercise plan.
| Study | Duration | Mean %Weight Loss (Contrave) | Mean %Weight Loss (Placebo) | Common Side‑Effects |
|---|---|---|---|---|
| COR‑I | 56weeks | 7.5% | 1.5% | Nausea, constipation |
| COR‑II | 56weeks | 8.1% | 1.8% | Headache, dry mouth |
| COR‑III | 56weeks | 5.9% | 1.2% | Dizziness, insomnia |
| COR‑IV | 56weeks | 9.2% | 2.0% | Vomiting, anxiety |
When you add the lifestyle component, a total of roughly 10% body‑weight loss becomes realistic for many patients. That translates to a 20‑lb drop for a 200‑lb adult-a change linked to lower blood‑pressure, improved glycemic control, and reduced risk of heart disease.
Safety is a top concern, so here’s a quick rundown of what clinicians watch for:
- Blood pressure & heart rate: Bupropion can raise both; your doctor should monitor them at baseline and every 2‑4weeks during titration.
- Seizure risk: The drug lowers the seizure threshold, especially in people with a prior seizure history or eating disorders.
- Psychiatric effects: Rarely, patients experience mood swings or worsening depression.
- Liver function: Naltrexone is processed by the liver; severe liver disease is a contraindication.
Serious adverse events (SAEs) were reported in less than 2% of trial participants, most commonly hypertension or suicidal ideation. In everyday practice, the rate aligns closely with those numbers, underscoring the need for regular follow‑up.
How to Use Contrave - Practical Tips, Costs, and Alternatives
Starting Contrave isn’t a “one‑pill‑and‑done” deal. The manufacturer designed a four‑week titration to let your stomach adjust:
- Week1‑2: 1 tablet of 8mg/90mg each morning (no evening dose).
- Week3‑4: 1 tablet morning, 1 tablet evening (both 8mg/90mg). This is the “low dose” stage.
- Week5‑6: Increase to 1 tablet of 16mg/180mg morning and 1 tablet of 8mg/90mg evening.
- Week7‑8: Full dose - two tablets of 16mg/180mg (morning+evening).
If nausea spikes, pause the dose increase and hold at the previous level for an extra week before trying again. Drinking plenty of water and eating a light snack when you take each tablet also helps.
Cost is a frequent question. As of September2025, the average wholesale price sits around $155 per 30‑day supply. Insurance coverage varies:
- Private plans: Many require prior authorization and a documented BMI≥30kg/m².
- Medicare PartD: Coverage is possible but often subject to a $50‑$75 co‑pay.
- Discount cards: Manufacturers offer a savings card that can shave $30‑$45 off the monthly bill.
When budgeting, remember you’ll also need regular labs (blood pressure, liver enzymes) and possibly a nutrition‑counseling session, which can add $50‑$150 per quarter.
Contrave isn’t the only prescription option. Here’s a quick look at the main alternatives and who they’re best suited for:
| Medication | Mechanism | Typical Weight Loss | Key Contra‑indications |
|---|---|---|---|
| Phentermine‑Topiramate (Qsymia) | Appetite suppressant + neuro‑modulator | ~10‑12% at 1year | Pregnancy, glaucoma |
| Liraglutide (Saxenda) | GLP‑1 receptor agonist | ~8‑10% at 1year | Medullary thyroid cancer, pancreatitis |
| Setmelanotide (Imcivree) | Melanocortin‑4 receptor agonist | ~15% in rare genetic obesity | Not indicated for common obesity |
For most people without a rare genetic form of obesity, Contrave offers a solid middle ground: modest weight loss with a well‑studied safety profile and a convenient twice‑daily dosing schedule.
Finally, a few pro‑tips that often get missed:
- Combine with a realistic diet plan: Aim for a 500‑calorie deficit rather than an extreme low‑calorie diet; severe restriction can magnify nausea.
- Track cravings: Use a simple journal to note when you feel a sudden urge; over time you’ll see patterns that the medication may be blunting.
- Stay active: Even a brisk 30‑minute walk 5days a week improves insulin sensitivity, making the drug work harder.
- Schedule follow‑ups: Your physician should reassess weight, vitals, and labs every 12weeks during the first year.
If after 6months you haven’t lost at least 5% of your initial weight, discuss discontinuation with your doctor-continuing a non‑effective therapy isn’t worth the cost or side‑effects.
Quick FAQ
- Can I take Contrave if I’m on antidepressants? Yes, but inform your prescriber; bupropion can interact with certain SSRIs.
- Is Contrave safe during pregnancy? No, it’s classified as pregnancy‑category C; it’s not recommended.
- What if I miss a dose? Skip the missed tablet and resume your regular schedule; don’t double up.
- Do I need a special diet? A balanced, calorie‑controlled diet works best; no need for bizarre food rules.
- How long can I stay on Contrave? Most trials lasted 56weeks; many clinicians continue up to 2years if benefits persist and side‑effects stay mild.
Next Steps for You
If you’re considering Contrave, start with a quick self‑screen:
- Calculate your BMI - you need ≥30kg/m² (or ≥27kg/m² with a comorbidity).
- Check for contraindications - history of seizures, eating disorders, or severe liver disease should halt use.
- Schedule a telehealth or in‑person appointment with a board‑certified physician.
- Ask about insurance coverage and potential savings cards before writing the prescription.
- Prepare a simple food‑and‑exercise log to bring to your first visit; it helps the doctor gauge baseline habits.
Remember, no pill works miracles on its own. Pairing Contrave with realistic lifestyle changes gives you the highest odds of reaching a healthier weight and keeping it off.
Comments (20)
LeAnn Raschke
Contrave sounds like a decent option if you're struggling with cravings. I’ve tried dieting alone and it’s just so hard to fight that late-night snack urge. The dual-action mechanism makes sense-targeting both hunger and reward pathways is smarter than just cutting calories.
Adorable William
Of course the FDA approved this. Big Pharma’s been pushing these ‘miracle’ pills for decades while ignoring the real issue: processed food is engineered to be addictive. They don’t want you to heal-they want you to stay dependent. Bupropion? That’s an antidepressant repurposed as a weight-loss tool. Classic.
And don’t get me started on the ‘titration schedule.’ That’s just a fancy way of saying, ‘We know this will wreck your stomach, so we’ll make you suffer slowly.’
Suresh Patil
In India, we have a saying: ‘The body remembers what the mind forgets.’ Contrave might help with cravings, but without mindful eating, it’s just a band-aid. I’ve seen friends take similar pills and lose weight fast-only to gain it all back because they never learned to eat with awareness.
Maybe the real solution isn’t a pill, but slowing down, chewing well, and eating with family. No drug can replace that.
Ram Babu S
I’ve been on this for 4 months now. Lost 18 lbs. Not magic, but it helped me stop mindless snacking. The nausea in week 2 was rough, but sticking to the titration and drinking water made it bearable. Still, it’s not a substitute for walking every day. That’s what really changed me.
Kyle Buck
The pharmacodynamic synergy between bupropion’s POMC neuron stimulation and naltrexone’s disinhibition of the mesolimbic pathway is a compelling model for obesity pharmacotherapy. However, the clinical significance of a 7.5–9.2% weight reduction must be contextualized against the risk-benefit profile, particularly regarding noradrenergic activation and potential for neuropsychiatric adverse events.
Longitudinal data beyond 56 weeks remains sparse. Are we treating obesity as a chronic disease, or simply delaying its progression with pharmacological scaffolding?
Amy Craine
For anyone considering this: don’t rush the titration. I increased too fast and ended up in the ER with severe nausea. Took a week off, went back to week 2 dose, and now I’m fine. Also, pair it with a nutritionist-this isn’t a magic pill, it’s a tool. Use it wisely.
Alicia Buchter
I tried it. Lost 12 lbs. Then gained back 15 because I started eating ‘healthy’ junk food like kale chips and ‘protein bowls’ that were just sugar bombs. The pill didn’t fix my relationship with food-it just made me feel like I could outsmart it. Spoiler: I couldn’t.
Also, the cost? Ridiculous. I’d rather pay for therapy than this.
MaKayla VanMeter
THIS IS A GOVERNMENT COVER-UP. BUPROPION WAS ORIGINALLY DESIGNED TO MAKE PEOPLE HAPPY-NOW THEY’RE USING IT TO MAKE THEM THIN?! 😱 THEY’RE STEALING OUR EMOTIONS TO SELL DIETS. 🤫💊
Doug Pikul
Contrave isn’t the answer for everyone, but it helped me break the cycle of emotional eating. I used to snack when I was stressed-now I just feel… indifferent. Not happy, not sad. Just calm. And that’s enough to make better choices. I’m not cured, but I’m in control. 🙌
anthony perry
Works. Nausea sucks. Worth it.
Sarah Major
Anyone who takes this is just giving up on discipline. You think a pill makes you better than someone who just eats less and moves more? Pathetic. You’re not sick-you’re lazy. And now you want the system to pay for your weakness?
Craig Venn
Contrave’s mechanism is solid but underutilized. Most providers don’t understand the neurobiology behind it-they just prescribe it like a diet pill. The real win is combining it with behavioral therapy. The POMC activation + reward modulation is the gold standard for binge eating disorder. We need more clinicians trained in this. Also, insurance should cover it without prior auth-this isn’t cosmetic, it’s metabolic.
Idolla Leboeuf
I’m from Louisiana and I ate my way through three generations of family gatherings. Contrave didn’t make me lose weight-it made me stop craving gumbo at 2am. That’s the real win. Now I cook healthier versions and still enjoy them. This isn’t about punishment. It’s about freedom.
Cole Brown
Just a heads-up: if you have anxiety, be careful. I didn’t, but my friend did-and the bupropion made her panic attacks way worse. Talk to your doctor. Don’t just read the internet and start taking it. This stuff is serious.
Danny Pohflepp
Let’s be honest-this is just another corporate scam. The FDA’s approval was rushed. The trials were funded by Orexigen, which went bankrupt because the drug barely worked. The 5-10% loss? That’s barely 10 pounds for most people. Meanwhile, the side effects? Nausea, constipation, insomnia-sounds like a bad hangover. And the cost? You’re paying $200 a month for a placebo with extra side effects.
Meanwhile, the real solution-whole foods, movement, sleep-is free. But it doesn’t make money for shareholders.
Halona Patrick Shaw
I took it for 3 months. Lost 14 lbs. Then my grandma passed away. I stopped. Gained back 20. The pill didn’t fix grief. It just gave me a few months of control. Now I eat to feel something again. I don’t regret it. I just wish I’d known that medicine doesn’t fix heartbreak.
Elizabeth Nikole
Anyone who says this is ‘safe’ hasn’t read the black box warnings. SUICIDAL IDEATION. SEIZURES. HYPERTENSION. And you’re just shrugging it off because you ‘lost 8 pounds’? You’re not a success story-you’re a cautionary tale waiting to happen.
And yes, I’m the one who had to go to the ER. 😌
Zach Harrison
Biggest mistake I made? Thinking the pill would make me not care about food. Turns out it just made me care less about bad food. I still craved pizza-but now I’d rather have grilled chicken. Small shift, huge difference. Also, walking after dinner helped more than the pill.
Terri-Anne Whitehouse
Oh great. Another ‘miracle’ drug for the obese. Because clearly, the problem is biology, not the fact that we live in a food desert with 7-11 as the only grocery store. You people are so obsessed with individual blame, you ignore systemic collapse.
Contrave won’t fix poverty. Or food apartheid. Or the fact that healthy food costs 3x more. But hey, at least you can feel smug while paying $200 a month.
Cole Brown
Hey, I just saw someone mention anxiety and bupropion. I had the same issue. My doc switched me to a lower dose and added a tiny bit of sertraline. It’s been fine since. Just don’t ignore the signs. Your mental health matters more than the scale.