Contrave is a prescription medication used for chronic weight management in adults with obesity or overweight. It combines two active ingredients, naltrexone and bupropion, in an extended-release tablet. The FDA approved it specifically for adults with a BMI of 30 or greater, or a BMI of 27 or greater when at least one weight-related health condition is also present, such as high blood pressure, type 2 diabetes, or high cholesterol. It’s meant to be used alongside a reduced-calorie diet and increased physical activity, not as a standalone solution.
How Contrave Works
Contrave pairs two medications that each affect the brain differently. Naltrexone is best known for treating alcohol and opioid dependence. It blocks opioid receptors in the brain, which play a role in the reward signals you get from eating. Bupropion is an antidepressant that also affects appetite-regulating areas of the brain. On their own, neither drug produces significant weight loss. Together, they appear to reduce hunger and cravings by acting on both the appetite control center and the reward pathways that drive eating behavior.
The combination targets two sides of the same problem: the physical hunger signals that tell your body it needs food and the reward-driven desire that makes certain foods hard to resist even when you’re not hungry. This dual approach is what differentiates Contrave from single-ingredient weight loss medications.
Who Qualifies for Contrave
The FDA sets clear BMI thresholds for Contrave eligibility. If your BMI is 30 or higher, you qualify based on weight alone. If your BMI falls between 27 and 29.9, you need to have at least one weight-related condition to be eligible. The qualifying conditions include hypertension, type 2 diabetes, and dyslipidemia (abnormal cholesterol or triglyceride levels).
Contrave is approved only for adults. It is not intended for cosmetic weight loss or for people who are mildly overweight without related health concerns.
What to Expect When Starting
Contrave uses a gradual dose increase over the first few weeks rather than starting at the full dose right away. This step-up approach helps your body adjust and reduces the chance of side effects, particularly nausea, which is one of the most commonly reported issues early on. The dose typically reaches its maintenance level by week four.
Most prescribers evaluate your progress after about 12 to 16 weeks on the full dose. If you haven’t lost a meaningful percentage of your body weight by that point, continuing the medication is unlikely to produce better results, and stopping is generally recommended.
Common Side Effects
The most frequently reported side effects are nausea, constipation, headache, vomiting, dizziness, trouble sleeping, dry mouth, and diarrhea. Nausea tends to be the most common complaint and is usually worst during the first few weeks as the dose is being increased. For many people, it fades as the body adjusts.
Contrave contains bupropion, which carries a boxed warning related to an increased risk of suicidal thoughts and behavior in young adults taking antidepressants. While Contrave is a weight management drug rather than an antidepressant, this warning applies because of the bupropion component. Mood changes, agitation, or unusual behavior while taking Contrave warrant prompt medical attention.
Important Restrictions
Several medical conditions make Contrave unsafe. Because bupropion lowers the seizure threshold, people with a seizure disorder or a history of seizures should not take it. The same applies to anyone with an eating disorder such as bulimia or anorexia nervosa, as these conditions already increase seizure risk. People going through abrupt withdrawal from alcohol or sedatives are also at higher risk.
The naltrexone component blocks opioid receptors, which creates a serious interaction with opioid medications. If you take prescription opioid painkillers, use opioid-based cough medicines, or are on medication-assisted treatment for opioid dependence, Contrave can trigger sudden withdrawal symptoms. You need to be completely off opioids for a period of time before starting the medication. This also means that if you need emergency pain treatment while on Contrave, opioid-based painkillers may not work as expected, something to communicate to any emergency medical provider.
Contrave should also be avoided by anyone taking MAO inhibitors (a type of antidepressant) or anyone with uncontrolled high blood pressure.
Why High-Fat Meals Matter
One practical detail that often gets overlooked: Contrave should not be taken with a high-fat meal. When taken alongside fatty food, the body absorbs dramatically more of both active ingredients. In clinical testing, a high-fat meal nearly quadrupled peak blood levels of naltrexone (a 3.7-fold increase) and nearly doubled peak levels of bupropion (1.8-fold increase). This spike in absorption raises the risk of side effects, including seizures. Taking the medication with a lighter meal or on an empty stomach keeps drug levels in the intended range.
How Contrave Compares to Newer Options
Contrave entered the market in 2014 and was one of the few FDA-approved weight loss medications for several years. Since then, injectable medications like semaglutide and tirzepatide have arrived, producing significantly greater average weight loss in clinical trials. Those newer drugs work through a different mechanism, mimicking gut hormones that regulate appetite and blood sugar.
Contrave remains a relevant option for people who prefer an oral medication over injections, who don’t qualify for or can’t tolerate the newer injectables, or whose insurance covers it more favorably. The average weight loss with Contrave is more modest, typically in the range of 5 to 10 percent of body weight over a year when combined with diet and exercise changes. For many people, that level of loss is enough to meaningfully improve blood pressure, blood sugar, and cholesterol levels.