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.
