Contrave tablets are taken by mouth as part of a clinician-guided plan for chronic weight management in adults with obesity or weight-related health risks. The combination acts on appetite and reward…
Contrave tablets are taken by mouth as part of a clinician-guided plan for chronic weight management in adults with obesity or weight-related health risks. The combination acts on appetite and reward pathways while diet and physical activity remain part of treatment.
Each tablet combines two ingredients that act on appetite and reward pathways while diet and physical activity remain part of treatment. How much to use and how often to take it depend on the purpose of treatment and are agreed with a doctor or pharmacist.
Contrave is an oral combination treatment for chronic weight management in adults with obesity or weight-related health risks.
Contrave contains two active substances with different pharmacological actions. Naltrexone is an opioid antagonist, while bupropion is a norepinephrine-dopamine reuptake inhibitor used in several prescription formulations.
Bupropion stimulates pathways involving pro-opiomelanocortin, or POMC, neurons in the hypothalamus. These neurons produce signals associated with reduced hunger. Naltrexone helps limit feedback inhibition from endogenous opioid signalling, allowing the appetite-suppressing signal to continue for longer.
The combination also acts on reward-related pathways in the brain. Food can activate reward circuits, especially when eating is driven by cravings rather than physical hunger. Contrave aims to reduce the reinforcing effect of food and make persistent cravings less dominant.
Bupropion affects norepinephrine and dopamine signalling. In the context of Contrave, this action supports POMC activity and may help reduce appetite. The same pharmacology can also produce activating effects, such as restlessness, dry mouth, anxiety, or insomnia.
Naltrexone blocks opioid receptors. In Contrave, this action is intended to modify the reward response linked to food and reinforce the appetite-reducing effect of bupropion.
The usual clinical criteria for anti-obesity pharmacotherapy include:
Contrave is not intended to replace nutrition or activity changes. Its role is to reduce appetite and food cravings sufficiently for those changes to become more manageable over time. The FDA prescribing information describes it as a long-term weight-management treatment used with diet and physical activity [1].
Several avoidable errors reduce tolerability or create preventable risks:
The Medsafe datasheet and product safety information should guide local prescribing decisions in New Zealand [2].
Contrave is not suitable for everyone. The treatment must be avoided or carefully reviewed in several situations because its ingredients can affect seizure risk, blood pressure, mood, liver function, and opioid activity.
Naltrexone also blocks opioid analgesics. This creates a major safety issue for anyone who may need codeine, tramadol, morphine, oxycodone, fentanyl, or another opioid for pain, anaesthesia, or cough suppression.
Tell every prescriber and anaesthetist that you take naltrexone before planned surgery or emergency treatment. Opioid pain relief may work poorly, and the treatment plan may need to change.
The most frequently reported problems involve the digestive system and nervous system. Nausea is common during dose escalation, while constipation, vomiting, dry mouth, headache, dizziness, diarrhoea, and sleep disturbance can also occur. Clinical trial data in the US prescribing information describe nausea as the leading adverse reaction, with several symptoms appearing most often during the first weeks [1].
People respond differently. One person may notice reduced hunger but develop constipation; another may experience dry mouth and insomnia without much nausea.
Nausea, constipation, vomiting, and diarrhoea can occur while the body adjusts to treatment. Gradual titration is used to improve tolerability.
Practical measures include:
Headache, dizziness, tremor, anxiety, irritability, and difficulty sleeping may occur. Dizziness can be worse when standing quickly, during dehydration, or after vomiting. Insomnia is more likely if doses are taken late in the day.
A small but useful detail is that dry mouth can lead people to sip sugary drinks throughout the day. That may undermine weight-management goals and increase dental exposure to sugar. Water, sugar-free gum, and regular dental care are more suitable options.
Bupropion-containing medicines carry warnings about changes in mood, suicidal thinking, agitation, and manic symptoms. These risks require prompt clinical attention, especially after starting treatment or changing the dose. A new or worsening depressed mood, unusual impulsivity, severe agitation, or thoughts of self-harm should be treated as an urgent medical problem.
Seizures are uncommon but potentially serious. Heavy alcohol intake and sudden alcohol withdrawal can both increase seizure risk.
Blood pressure and heart rate can rise. Naltrexone can also cause liver injury, so unusual tiredness, dark urine, pale stools, yellowing of the skin, or persistent pain under the right ribs require prompt medical review.
Angle-closure glaucoma is another rare concern. Severe eye pain, blurred vision, halos around lights, headache, or nausea with visual symptoms requires urgent assessment.
Weight-management medicines differ by target, route, and risk profile. Comparing treatment categories is more useful than assuming that one option suits every person.
| Treatment category | Main action and route | Key limitation |
|---|---|---|
| Contrave | Oral naltrexone plus bupropion acting on appetite and reward pathways | Seizure, opioid, blood-pressure, mood, and insomnia concerns |
| GLP-1 receptor agonist therapy | Injectable or oral hormone-based treatment that increases satiety and slows gastric emptying | Digestive reactions, administration requirements, and suitability limits |
| Lipase inhibitor therapy | Oral treatment that reduces intestinal absorption of dietary fat | Oily stools, urgency, and reduced absorption of fat-soluble vitamins |
Contrave may suit an adult who prefers tablets and whose main difficulty involves appetite, cravings, or reward-driven eating. It may be unsuitable for someone using opioid pain relief, with uncontrolled hypertension, or with a seizure risk.
GLP-1 receptor agonist treatment works through a different hormonal pathway. It often produces early fullness and slower gastric emptying, while Contrave acts more directly on central appetite and reward signalling. Injection aversion, gastrointestinal tolerance, medical history, and the need for ongoing monitoring can influence the choice.
Peripheral fat-absorption treatment works in the intestine rather than through the central nervous system. It avoids bupropion-related seizure risk but may cause bowel urgency and oily stool leakage, especially after high-fat meals.
In clinical practice, prescribers usually treat Contrave as one part of a structured weight-management plan rather than as a standalone appetite solution. The response is judged through several measures: appetite control, craving intensity, eating patterns, weight trajectory, blood pressure, sleep, mood, and adverse effects.
A physician will usually want to know about opioid use before treatment begins. This includes occasional codeine for dental pain, cough medicines containing opioids, medicines used after surgery, and non-prescription products obtained for pain. The timing and amount of opioid exposure matter. Naltrexone can change the response to opioid analgesics. The prescriber may need to plan alternatives before an operation.
People with diabetes may need closer glucose monitoring if their food intake changes substantially. Anyone with bipolar disorder, depression, hypertension, liver disease, or a history of seizures requires a more individualised risk assessment.
A practical prescribing point is that early nausea does not always mean the treatment must stop, but severe vomiting, dehydration, mood changes, or neurological symptoms are different. Those problems require clinical review rather than simply waiting for them to pass.
Do not take an extra tablet to compensate for a missed dose. The FDA label (2021) advises against doubling doses because excessive bupropion exposure can increase seizure risk. The correct next step depends on when the missed dose occurred and the regimen prescribed for you.
Some people notice reduced cravings or earlier fullness during the first few weeks, while measurable weight change often takes longer. Response should be assessed across appetite, food intake, activity, tolerability, and weight rather than one isolated day. The EMA’s 2015 review of naltrexone and bupropion treatment emphasises planned follow-up and continuation only when clinically meaningful benefit is achieved [3].
Contrave should not be combined casually with opioid analgesics such as codeine, tramadol, morphine, oxycodone, or fentanyl. Naltrexone can block opioid effects and may trigger withdrawal in someone who is physically dependent. Medsafe safety information (2023) supports checking opioid exposure before treatment and before surgery or emergency pain management.
Discuss seizures, eating disorders, high blood pressure, liver disease, mood disorders, bipolar symptoms, pregnancy, alcohol use, opioid exposure, and every medicine or supplement being taken. Bupropion-containing medicines must be identified to prevent duplicate therapy. The WHO approach to medicine safety (2019) supports a complete medication history when treatment can affect the central nervous system and cardiovascular system [4].
Contrave combines naltrexone and bupropion to influence central appetite and reward pathways. GLP-1 receptor agonists act through hormone receptors involved in satiety, gastric emptying, and glucose regulation, and many are administered by injection. The choice depends on medical history, treatment goals, adverse-effect tolerance, route preference, and the need to avoid specific contraindications, as reflected in the EMA’s 2015 obesity-treatment assessments.
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Based on 5 reviews
The first week brought nausea and a dry mouth, especially after the morning tablet. By the fourth week my evening snacking had dropped, and keeping regular meals made the treatment easier.
Lower Hutt 4 weeks 1 Nov 2026I noticed fewer cravings after several weeks, but sleep became difficult when I took the later dose too late. Moving the timing earlier helped, although I still had occasional headaches.
Oamaru Several weeks 6 Oct 2026My appetite was lower, but constipation became annoying and I underestimated how much water I needed. The medicine was not suitable during a period when I needed opioid pain relief.
Ashburton During treatment 13 Oct 2026I stopped during the early dose increase because of vomiting and dizziness. The weight change was not enough to justify pushing through those symptoms without another review.
Whangārei During dose increase 19 Oct 2026After about a month I found it easier to leave food on the plate. I also had dry mouth and mild irritability at first, so regular sleep and avoiding late doses mattered.
Hamilton About 1 month 25 Oct 2026
