Contrave: Clinically Proven Weight Management with Dual-Action Therapy
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Synonyms | |||
Contrave represents a significant advancement in pharmacological weight management, combining two well-established medications into a single, optimized formulation. This prescription-only treatment is specifically designed for adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related comorbidity, serving as an adjunct to reduced-calorie diet and increased physical activity. Its unique mechanism targets both appetite control and reward-based eating behaviors through complementary neuropathways, offering a scientifically-backed approach to sustainable weight loss. Clinical trials demonstrate consistent efficacy, with a substantial proportion of patients achieving clinically meaningful weight reduction when used as part of a comprehensive weight management strategy.
Features
- Dual-active formulation containing naltrexone HCl and bupropion HCl in extended-release tablets
- FDA-approved for chronic weight management in appropriate patient populations
- Gradual dose escalation over four weeks to optimize tolerability
- Manufactured under strict pharmaceutical quality standards
- Available in blister packs with clear weekly titration guidance
- Compatible with long-term use under medical supervision
Benefits
- Sustained Weight Reduction: Clinical studies show average weight loss of 5-10% of initial body weight over 56 weeks when combined with lifestyle modification
- Appetite Regulation: Dual mechanism reduces hunger cues and decreases food cravings through opioid receptor antagonism and dopamine/norepinephrine reuptake inhibition
- Improved Metabolic Parameters: Associated with reductions in waist circumference and improvements in cardiometabolic risk factors
- Behavioral Modification Support: Helps address reward-based eating patterns and emotional eating components
- Maintenance of Weight Loss: Demonstrated efficacy in maintaining reduced weight through continued therapy
- Quality of Life Enhancement: Meaningful improvements in weight-related quality of life measures and patient-reported outcomes
Common use
Contrave is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with initial body mass index (BMI) of 30 kg/m² or greater (obesity), or 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia. Treatment should be initiated in patients who have demonstrated commitment to concomitant lifestyle modifications and who understand the necessity of long-term behavioral changes. The medication is typically prescribed after other weight loss attempts have proven insufficient, and requires regular medical monitoring to assess efficacy and safety.
Dosage and direction
The recommended dosage involves a gradual titration schedule to minimize adverse effects and improve tolerability:
- Week 1: One tablet daily in the morning
- Week 2: One tablet twice daily (morning and evening)
- Week 3: Two tablets in the morning and one tablet in the evening
- Week 4 and maintenance: Two tablets twice daily (morning and evening)
Tablets should be swallowed whole and not crushed, chewed, or divided. Maximum daily dose should not exceed two tablets twice daily (32 mg naltrexone/360 mg bupropion). Administration with food may reduce the incidence of nausea. Dose escalation should only proceed if previous doses were well-tolerated. If treatment is interrupted for more than three days, re-initiation should follow the original titration schedule.
Precautions
- Suicidal Thoughts and Behaviors: Monitor for emergence or worsening of depression, anxiety, agitation, or unusual changes in behavior
- Neuropsychiatric Reactions: May cause anxiety, insomnia, and other neuropsychiatric symptoms; assess risk-benefit in patients with psychiatric disorders
- Seizure Risk: Contraindicated in patients with seizure disorders or conditions that lower seizure threshold
- Blood Pressure Monitoring: Regular monitoring recommended due to potential increases in blood pressure and heart rate
- Hepatic Impairment: Use with caution in patients with hepatic impairment; not recommended in severe hepatic impairment
- Renal Impairment: Use with caution in patients with renal impairment; not recommended in end-stage renal disease
- Elderly Patients: Consider increased sensitivity and potential for decreased hepatic, renal, or cardiac function
- Pregnancy and Nursing: Not recommended during pregnancy or breastfeeding due to potential risks to fetus/infant
Contraindications
- Uncontrolled hypertension
- Seizure disorder or history of seizures
- Use of other bupropion-containing products
- Current or prior diagnosis of bulimia or anorexia nervosa
- Concomitant use of monoamine oxidase inhibitors (MAOIs) within 14 days
- Chronic opioid or opioid agonist therapy, or patients experiencing acute opioid withdrawal
- Known hypersensitivity to naltrexone, bupropion, or any component of the formulation
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
Possible side effects
Common (≥5% incidence):
- Nausea (32.5%)
- Constipation (19.2%)
- Headache (17.6%)
- Vomiting (10.7%)
- Dizziness (9.9%)
- Insomnia (9.2%)
- Dry mouth (9.1%)
- Diarrhea (8.3%)
Less common but clinically significant:
- Increased blood pressure and heart rate
- Anxiety and agitation
- Tremor
- Tinnitus
- Hyperhidrosis
- Taste disturbance
- Allergic reactions
Serious but rare:
- Seizures (approximately 0.1%)
- Angle-closure glaucoma
- Hepatotoxicity
- Hypomania or mania
- Stevens-Johnson syndrome
Drug interaction
- MAOIs: Contraindicated due to risk of hypertensive crisis
- Opioids: Reduces efficacy of opioid analgesics and may precipitate withdrawal in dependent patients
- CYP2D6 inhibitors: May increase bupropion exposure (e.g., paroxetine, fluoxetine)
- Drugs that lower seizure threshold: Increased risk of seizures (e.g., antipsychotics, antidepressants, systemic corticosteroids)
- Digoxin: Possible decreased digoxin levels
- Alcohol: Increased risk of neuropsychiatric events; avoid excessive alcohol consumption
- Diabetes medications: May require adjustment of antidiabetic medications due to weight loss
Missed dose
If a dose is missed, patients should not take an extra dose to make up for the missed dose. They should take the next dose at the regular time and continue with the regular dosing schedule. Doubling doses increases the risk of adverse effects, particularly seizures. If multiple doses are missed, consultation with a healthcare provider is recommended before resuming therapy, as retitration may be necessary.
Overdose
Overdose experience is limited but may include symptoms related to the individual components. Bupropion overdose may cause seizures, hallucinations, tachycardia, and cardiac arrest. Naltrexone overdose may cause injection site reactions (if applicable) and abdominal pain. In case of suspected overdose, immediate medical attention is required. Treatment is supportive and symptomatic, with ECG monitoring recommended for at least 48 hours. There is no specific antidote; activated charcoal may be considered if ingestion was recent.
Storage
Store at room temperature (20-25°C/68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep in original blister packaging until time of use to protect from moisture. Keep out of reach of children and pets. Do not use if packaging is damaged or tablets appear compromised. Properly dispose of unused medication through take-back programs or according to FDA guidelines.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Contrave is available by prescription only and should be used under appropriate medical supervision. Individual results may vary. Patients should consult with their healthcare provider before starting or changing any treatment regimen. The full prescribing information contains complete details regarding uses, warnings, and precautions.
Reviews
Clinical trial data demonstrates that approximately 42% of patients achieved ≥5% weight loss compared to 17% with placebo at 56 weeks. Pooled analysis shows mean weight loss of 4-5% greater than placebo across studies. Real-world evidence suggests similar efficacy in clinical practice when combined with comprehensive lifestyle intervention. Patient-reported outcomes indicate improvements in weight-related quality of life measures and satisfaction with treatment among responders. Long-term extension studies support maintenance of weight loss with continued therapy under medical supervision.