Weight Loss & Metabolic Health
What Is Contrave?
Last reviewed: May 2026 · Haute MD Editorial Team
Contrave is an oral, twice-daily combination of bupropion (an antidepressant) and naltrexone (an opioid antagonist), FDA-approved for chronic weight management in adults with BMI ≥30, or ≥27 with comorbidities. It produces average weight loss of 5–9% over 56 weeks by targeting the brain's reward and hunger pathways, making it particularly useful for patients with food-craving and emotional-eating patterns.
How Contrave works
Bupropion stimulates POMC neurons in the hypothalamus, suppressing appetite, while naltrexone removes a feedback brake on those neurons, amplifying the effect. The combination also reduces reward-driven eating by acting on dopamine and opioid pathways involved in cravings. The result is reduced hunger plus reduced food preoccupation — a different mechanism than phentermine (pure appetite suppression) or GLP-1s (gastric emptying plus satiety hormones).
Effectiveness and best candidates
In the COR trials, patients on Contrave lost 5–9% of body weight at 56 weeks, with about half losing at least 5%. Patients with strong food cravings, emotional or binge eating, and comorbid depression or smoking-cessation goals often respond particularly well. Dosing escalates over 4 weeks to the full dose of 32 mg naltrexone / 360 mg bupropion daily. It is oral and roughly $80–200 per month, depending on coverage and savings programs.
Side effects and contraindications
Common side effects include nausea, constipation, headache, dizziness, insomnia, and dry mouth. Contraindications include uncontrolled hypertension, seizure disorder, eating disorders (anorexia or bulimia), chronic opioid use, MAO inhibitor use, and pregnancy. Blood pressure monitoring is recommended. Patients on opioid medications for pain cannot use Contrave; those needing opioids in the future must discontinue it first.
Frequently Asked Questions
Is Contrave better for emotional eating?
It is often considered a strong fit for patients with strong cravings or emotional/reward-driven eating, given its action on dopamine and opioid pathways.
Can I take Contrave if I'm on an antidepressant?
Combinations require physician judgment — it can be used with some antidepressants and not others. Always disclose your full medication list.
How does Contrave compare to GLP-1s?
Less weight loss on average than GLP-1s, but oral, cheaper, and a strong option for patients with significant cravings or who can't take GLP-1s.
Will Contrave help me quit smoking?
The bupropion component (also marketed as Zyban) is FDA-approved for smoking cessation and may help, though Contrave is not specifically dosed or labeled for that purpose.
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