Contrave

Combination product

Pronunciation: nal-TREX-oen and byoo-PROE-pee-on (KON-trayv)

Combination of Naltrexone and Bupropion.

Each component keeps its own pharmacology page; the combination itself adds no new mechanism.

Contrave mascot — mnemonic cartoon — Visual mnemonic: Contrave mascot
**Count Rave**

Components (2)

Naltrexone ballicule — decagon mechanism diagram — Naltrexone

Bupropion ballicule — decagon mechanism diagram — Bupropion

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Suicidal thoughts and behaviors: increased risk in children, adolescents, and young adults taking antidepressants; monitor for worsening/emergence of suicidal thoughts and behaviors; not approved for pediatric use.

FDA dosing	Population	Start	Target	Max
Chronic weight management (obesity, or overweight with ≥1 weight-related comorbidity), with reduced-calorie diet and increased activity	Adults	1 tablet (8 mg/90 mg) QAM week 1, escalate weekly	2 tablets BID (32 mg/360 mg per day) from week 4	32 mg/360 mg per day (2 tablets twice daily)

Titration Escalate one tablet per week to reach maintenance at the start of Week 4

Renal Moderate or severe impairment: max 2 tablets/day (1 each morning and evening); not recommended in end-stage renal disease

Hepatic Moderate impairment: max 2 tablets/day (1 each morning and evening); not recommended in severe hepatic impairment

Total daily dose should not exceed 32 mg/360 mg (two tablets twice daily); no more than two tablets at one time

Instructions

Take in the morning and evening; do not cut, chew, or crush
Do not take with a high-fat meal (increases exposure and seizure risk)
Allow at least 14 days between an MAOI and Contrave in either direction
Max 2 tablets/day with CYP2B6 inhibitors (e.g., ticlopidine, clopidogrel)
Evaluate response after 12 weeks at maintenance; discontinue if <5% baseline weight lost

Available strengths

ER tab 8/90 mg

Contraindications

Uncontrolled hypertension
Seizure disorder or a history of seizures
Use of other bupropion-containing products
Bulimia or anorexia nervosa, which increase the risk for seizure
Chronic opioid or opiate agonist (e.g., methadone) or partial agonist (e.g., buprenorphine) use, or acute opiate withdrawal
Patients undergoing an abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs
Concomitant administration of monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping an MAOI (including linezolid or intravenous methylene blue), because of increased risk of hypertensive reactions

Cautions

Suicidal behavior and ideation — monitor for depression/suicidal thoughts
Neuropsychiatric adverse events
Seizures (dose-related)
Increase in blood pressure and heart rate — monitor
Hepatotoxicity (naltrexone component)
Angle-closure glaucoma
Risk of hypoglycemia in type 2 diabetes on antidiabetic therapy — monitor glucose
Vulnerability to opioid overdose

Adverse reactions

Nausea
Constipation
Headache
Vomiting
Dizziness
Insomnia
Dry mouth
Diarrhea

Pregnancy Weight loss offers no benefit in pregnancy and may cause fetal harm — discontinue when pregnancy recognized; individual components not shown to increase major birth defect risk

Lactation Bupropion, naltrexone, and metabolites present in human milk; seizures reported in breastfed infants (bupropion); weigh benefits vs. risk

Cost

Contrave

Strength		#/mo	generic $/mo	CostPlus
8/90 mg	ER tab	4 q-wk		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Contrave is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Part D rank #324.

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