What is Contrave?
Contrave combines two well-established medications in a single tablet:
- Naltrexone (8mg per tablet): An opioid antagonist used to treat alcohol and opioid addiction. In Contrave, it blocks the brain's opioid receptors that are involved in the reward response to food — reducing the pleasurable "hit" you get from eating calorie-dense foods.
- Bupropion (90mg per tablet): An antidepressant (also marketed as Wellbutrin/Zyban). It acts on dopamine and norepinephrine pathways to reduce appetite and cravings. It's also used for smoking cessation.
The combination targets the hypothalamus (appetite regulation) and the mesolimbic dopamine system (reward and motivation) — areas of the brain that GLP-1 medications don't directly target.
Who is Contrave best for?
- Emotional eaters: People who eat in response to stress, boredom, sadness, or other emotions
- Binge eaters: Those who experience episodes of uncontrolled eating
- Craving-driven eaters: People who find specific foods (chocolate, chips, fast food) irresistible
- People who prefer tablets: No injections required — Contrave is an oral tablet
- People who can't tolerate GLP-1 medications: Different mechanism means different side effects
- Patients with co-existing depression: The bupropion component may have mood benefits
Expected results
Clinical trials (COR programme) showed 5–10% average body weight loss over 56 weeks, with significant reductions in food cravings and binge eating episodes. About 50% of participants lost at least 5% of body weight.
Weight loss with Contrave is less dramatic than GLP-1 medications (15–21%), but for craving-driven eaters who don't respond well to appetite suppression alone, it can be highly effective.
Dosage schedule
Contrave uses a 4-week dose escalation:
| Week | Morning | Evening | Total tablets/day |
|---|---|---|---|
| 1 | 1 tablet | — | 1 |
| 2 | 1 tablet | 1 tablet | 2 |
| 3 | 2 tablets | 1 tablet | 3 |
| 4+ | 2 tablets | 2 tablets | 4 (full dose) |
Side effects
- Nausea: Most common, especially in the first 2–4 weeks. Usually resolves.
- Headache: Common initially.
- Constipation: Increase fibre and water.
- Insomnia: Take the evening dose earlier if this occurs.
- Dizziness: Usually mild and transient.
- Dry mouth.
Important warnings:
- Seizure risk: Bupropion lowers the seizure threshold. Do not take if you have a seizure disorder or are at high risk of seizures. Limit alcohol consumption.
- Do not take with opioid medications: Naltrexone blocks opioid receptors. This includes prescription painkillers.
- Suicidal ideation: Bupropion carries a black-box warning about increased risk of suicidal thoughts in young adults. Discuss with your doctor.
Cost
Contrave costs approximately $250–$330 per month on private prescription. It is not PBS-listed.