What to Expect With Contrave

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Contrave is one of the few weight loss pills approved by the FDA and available in Canada specifically for treating obesity.

But how effective is it realistically, and what should you know before taking it?

I manage weight loss patients who have used, and are currently using Contrave, and from all their experiences, I am here to shed some light into what you might expect if you try it yourself.

What is Contrave?

Contrave is a combination drug of both Bupropion and Naltrexone.

Bupropion itself is mostly used as an antidepressant, actually one of the few that don’t seem to cause weight gain.

Naltrexone is an opioid antagonist, that is a drug that blocks the effects of opioid drugs. its used by itself often to help recovering opioid addicts or alcoholics, to reduce their addiction to those substances.

Now this may seem like a somewhat strange combination for a drug used for weight loss, but it all started when researchers initially noticed that both drugs, individually, seemed to cause weight loss as a side effect.

After combining the two, they came up with Contrave, and after studies showed that both worked synergistically to help with weight loss, the FDA finally approved its use in 2014.

You’d be surprised how many uses for drugs are discovered by simply observing and using their side effects.

I mean, Thats how the popular hair loss drug minoxidil, also known as Rogaine, was discovered.

Actually it was initially used to see if it would help with ulcers, which it didn’t. But it sure had an interesting side effect of hair growth. But I digress.

Contrave vs bupropion

Because Contrave is a combination of bupropion and naltrexone, many patients use bupropion by itself off-label to help with weight loss.

Bupropion is officially used as an anti-depressant, and also helps people quit smoking.

While Contrave is expected to be more effective than bupropion for weight loss, many of my patients report that bupropion works quite effectively as an alternative to Contrave, especially in helping with emotional and stress eating.

Bupropion also tends to be much easier to obtain and is far cheaper than Contrave, adding to its popularity as a Contrave alternative.

How does it work?

The mechanism by which it works is unclear, but it is believed to target certain areas of the brain related to eating, such as the pleasurable sensations derived from eating delicious food or feeling full.

It seems to focus on reducing the brain’s feeding habits, rather than by increasing fullness signals.

The end result is people may end up eating less and lose weight as a result.

Side effects

Headaches and dizziness are some of the most common issues I’ve observed. It can even become debilitating to the point of causing some people to nearly pass out.

Nausea is also common, alongside other gastrointestinal issues like constipation, stomach pain, or vomiting.

From research studies, an outline of the common and rare side effects associated with Contrave is as follows:

Common side effects (reported in more than 1% of patients):

• Nausea (31-40%)
• Constipation (17-26%)
• Headache (13-22%)
• Vomiting (10-16%)
• Dizziness (9-13%)
• Insomnia (8-12%)
• Dry mouth (7-12%)
• Diarrhea (6-11%)
• Anxiety (6-10%)
• Fatigue (5-9%)
• Increased blood pressure (5-8%)
• Hot flush (4-7%)
• Nasopharyngitis (3-7%)
• Sinusitis (3-6%)
• Urinary tract infection (3-6%)

Rare side effects (reported in less than 1% of patients):

• Seizures (frequency unknown)
• Hypersensitivity reactions (frequency unknown)
• Liver injury (frequency unknown)
• Serotonin syndrome (frequency unknown)
• Suicidal thoughts or behavior (frequency unknown)

It’s important to note that Contrave contains a combination of two medications: bupropion and naltrexone. Both of these medications have the potential to cause serious side effects, including seizures, liver injury, and suicidal thoughts or behavior.

As a result, Contrave is contraindicated in patients with a history of seizures or eating disorders, as well as those taking certain medications or with certain medical conditions.

Drinking alcohol on Contrave

There are some concerns around seizure risks with drinking alcohol while on Contrave, but this risk appears to only be the case if you were a heavy drinker beforehand, then suddenly stopped drinking while on Contrave, since sudden alcohol withdrawal is well known to increase seizure risks.

Having a few drinks by itself while on Contrave, does not appear to increase seizure risks, based on the available evidence.

However, some people who do drink alcohol while on Contrave, report that it makes them feel sick, or that the alcohol doesn’t seem to have the same effect. And even though many people are still able to drink small amounts on Contrave without feeling any side effects, I recommend just staying away from alcohol while on the drug.

So if you tend to binge drink, or drink heavily throughout the week, you will need to work closely with your doctor first to see if it is safe for you to use.

Contrave diet plan

Although there is no specific diet you need to follow with Contrave, you will still need to have an effective weight loss diet you are already following, or plan to follow.

Your selected diet should also be effective at managing hunger properly, since Contrave doesn’t seem to be too effective at suppressing hunger.

Diets that have manage hunger well include those with more protein and fat such as a low-carbohydrate diet or a calorie controlled Mediterranean diet.

I recommend following a stricter dietary routine, since Contrave can help you to more easily follow and make the right dietary decisions during your diet.

Contrave may also be useful for diets that involve some form of intuitive eating, such as listening closely to your body’s hunger signals before eating, as it can help to curb impulsive snacking and eating.

How effective is Contrave?

In one clinical trial involving adults who were overweight or obese, participants who took Contrave for 56 weeks lost an average of 4.1% of their initial body weight, compared to an average weight loss of 1.0% in the placebo group.

In another clinical trial, participants who took Contrave for 56 weeks lost an average of 6.1% of their initial body weight, compared to an average weight loss of 1.3% in the placebo group.

From my experience, it definitely does not work for everyone, but in the patients I’ve observed in practice for which it does work, it works mostly like an appetite and craving suppressant.

It’s kind of a different type of appetite suppressant, in that, it seems to be more effective at suppressing cravings, rather than hunger.

Check out my article for a more detailed breakdown between the two, but the difference between cravings and hunger is kind of like the difference between wanting to eat, and needing to eat.

Cravings are a desire to eat, your body may not need it, but still you want to eat it. Hunger is your body telling you it needs to eat, to function properly.

Contrave seems to reduce this desire to eat, however, you are still able to eat normally if you wished to. Also, if you’re actually hungry, Contrave may not do much to reduce that hunger.

I do notice that it sometimes takes a few weeks to actually take effect, so, unlike some of the other weight loss tools that start working right away, you might have to take it for a while before anything happens.

Also, I find that rebound craving and appetite increases can be very strong upon discontinuing the drug, especially for those who found the drug to be very effective.

Should you try it?

Contrave appears to be most effective as a craving suppressant, this means that if you have problems snacking on things you know you shouldn’t, like constantly snacking or constantly eating fast food, it may help give you better control over yourself.

If you’re an emotional eater, and tend to reward yourself with food, or eat as a way to soothe negative emotions, Contrave may help you break this emotional connection with your food, and might allow you to look at food as a form of nutrition, rather than a form of comfort.

If you do decide you’d like to use it, keep in mind these 4 things:

1. You will need to be screened thoroughly by your doctor, since Contrave interacts with and causes problems with numerous drugs and health conditions, particularly neurological or psychiatric issues.
2. Even if Contrave is safe for you to use, A lot of people starting Contrave are not willing to continue it for long due to the heavy side effects they experience. If you’re just starting out, the doses are usually titrated up slowly to help reduce these effects. Also many of the side effects do tend to settle down or even go away after the first few weeks. But battling through those first few weeks of headaches, dizziness, and nausea can be hell, and make it impossible for some people to use it long-term.
3. When you stop taking the drug, you may find that the strong cravings will return, and if you failed to implement any longer term dietary or lifestyle habits to deal with cravings and emotional eating, you might find yourself regaining the weight much faster than you lost it.
4. If you’re unsure about Contrave, consider trying bupropion first if you have the chance to do so, since it might tell you if Contrave would be effective for you in the first place, and would be much easier and cheaper to obtain.

Summary

Overall, Contrave may be helpful for emotional overeaters and people with strong cravings to overcome these issues and more easily follow a weight loss diet.

The first few weeks of taking it will likely be the most difficult part, since the adverse effects are worst during that time, and the drug may not be working yet.

Don’t forget to continually build good dietary and lifestyle habits while you’re on Contrave, for example by taking steps to reduce your idle snacking, especially since the drug should help make it easier for you to initially implement those steps, and transition them over time into lifelong habits.

Learn more about

• Saxenda vs Contrave vs Xenical
• 5 Things To Know Before Starting Weight Loss Medication
• Other weight loss medications

See also

• 
  Comparing Weight Loss Drugs in 2024
  Ozempic and Mounjaro are highly effective at treating obesity, however there are many other approved and off-label options that also work.
• 
  Bupropion vs Contrave vs Naltrexone
  Contrave is a synergistic combination of buproprion and naltrexone, which can be replicated to some degree using the generics individually.
• 
  New Obesity Drugs in 2024
  New obesity drugs target more than just GLP-1 and do much more than suppress appetite for a more nuanced approach to weight loss.
• 
  Mounjaro: Who Loses the Most Weight?
  White or Asian younger women who use metformin and have lower sugar and lipid levels tend to experience more weight loss with Mounjaro.
• 
  How does Oforglipron compare?
  Orforglipron, Semaglutide, and Danuglipron are oral GLP-1 agonists that are all similar enough that cost may end up being the winning factor.