Contrave for Weight Loss:
Results, Safety and Better Alternatives
Contrave is an FDA-approved oral weight-management medication combining naltrexone and bupropion. It may help selected adults manage hunger and cravings, but it is less effective on average than phentermine/topiramate, Wegovy or Zepbound.
W8MD physicians help patients compare expected benefit with blood pressure, seizure risk, opioid use, eating history, mood, previous medications, insurance and sustainable cost.
Contrave at a glance
Contrave contains 8 mg naltrexone and 90 mg bupropion in each extended-release tablet. It is used with a reduced-calorie diet and increased physical activity for chronic weight management in adults with obesity, or adults with overweight plus at least one weight-related condition. The full maintenance dose is usually two tablets twice daily after a four-week escalation.
Across pivotal studies, average loss was generally around 5% to 6% of starting weight after approximately one year, compared with about 1% to 2% with placebo, although results varied with study intensity and analysis. Contrave can be useful for an appropriate patient, but it is not suitable for people using opioids, with uncontrolled hypertension, seizure history, certain eating disorders or several other contraindications.
What are naltrexone and bupropion?
Naltrexone
An opioid antagonist used separately for alcohol- and opioid-use disorders. In Contrave it contributes to central appetite and reward-pathway effects. It blocks opioid medicines and can precipitate withdrawal in an opioid-dependent patient.
Bupropion
A medicine used separately for depression and smoking cessation. It affects norepinephrine and dopamine pathways. Contrave is not approved to treat depression or to help people stop smoking.
Hunger and cravings
The exact neurochemical mechanism producing weight loss is not fully understood. Some patients report better control of hunger, cravings, reward-driven eating or persistent thoughts about food.
How effective is Contrave?
In COR-I, participants receiving naltrexone/bupropion lost about 6.1% of starting weight at 56 weeks versus 1.3% with placebo in the primary analysis. About 48% achieved at least 5% loss versus 16% with placebo. A more intensive behavioral program in COR-BMOD produced about 9.3% average loss with medication versus 5.1% with placebo, illustrating that program intensity matters.
People who discontinue medication or do not complete a study tend to lower the intention-to-treat average. More importantly, individual response varies widely. W8MD does not promise a fixed number of pounds per week.
Contrave vs. phentermine/topiramate, Wegovy and Zepbound
Trial averages below are useful for broad counseling but are not a perfect ranking. The studies enrolled different populations, lasted for different periods and used different behavioral programs.
| Option | Route and mechanism | Approximate average trial result | Potential advantages | Important limitations |
|---|---|---|---|---|
| Contrave naltrexone/bupropion ER |
Oral; opioid-antagonist plus norepinephrine/dopamine activity | About 5%–6% at 56 weeks in standard pivotal programs |
Not a controlled substance; oral; may fit patients troubled by hunger or reward-driven cravings | Four tablets/day at maintenance; boxed antidepressant suicidality warning; opioid conflict; seizure and blood-pressure concerns |
| Phentermine/topiramate ER Qsymia |
Once-daily oral sympathomimetic plus antiepileptic combination | About 8%–11% at 56 weeks at commonly discussed maintenance doses |
Greater average loss than Contrave; oral; often less costly than injectable therapy | Pregnancy and birth-defect risk, heart rate, mood/cognition, glaucoma and hyperthyroidism; controlled-substance component; taper high dose |
| Phentermine alone | Oral sympathomimetic appetite suppressant approved for short-term use | Modest-to-moderate short-term loss long-term randomized evidence is less robust |
Generic, inexpensive, fast appetite effect for selected patients | Not equivalent to FDA-approved long-term Qsymia; pulse, blood pressure, insomnia, anxiety, interactions and misuse risk |
| Wegovy semaglutide |
GLP-1 receptor agonist; weekly injections and a current daily tablet option for adults | 14.9% at 68 weeks with the established 2.4 mg weekly injection in STEP 1 |
Much greater average loss; multiple formulations; established cardiovascular-risk-reduction indication for a defined adult population | GI effects, titration, contraindications, access and long-term cost; current product-specific administration matters |
| Zepbound tirzepatide |
Dual GIP/GLP-1 receptor agonist; weekly injection | 15%–20.9% at 72 weeks across maintenance doses in SURMOUNT-1 |
Largest average loss in these pivotal programs; approved for moderate-to-severe OSA in adults with obesity | GI effects, titration, contraindications, access and cost; not combined with another incretin medicine |
In the 2025 SURMOUNT-5 direct trial—not a Contrave trial—tirzepatide produced 20.2% average loss versus 13.7% with semaglutide 1.7/2.4 mg at 72 weeks. That study did not test Contrave, phentermine/topiramate or the newer 7.2 mg Wegovy injection.
Who might consider Contrave?
A W8MD clinician might discuss Contrave with an adult who meets the product’s weight-related indication, wants an oral non-GLP-1 option, does not use opioids, has no seizure or eating-disorder contraindication, has acceptable blood pressure and understands the likely benefit and risks.
Meeting a BMI threshold does not by itself mean Contrave is appropriate. The medication list, blood pressure, neurologic history, mental-health history, alcohol or sedative use, kidney and liver function, planned procedures, pregnancy status and cost all matter.
Who should not take Contrave?
- People with uncontrolled hypertension
- People with a seizure disorder or history of seizures
- People using another bupropion-containing medicine such as Wellbutrin or Zyban
- People with current or prior anorexia nervosa or bulimia nervosa
- People dependent on chronic opioids, using opioid agonists or partial agonists such as methadone or buprenorphine, or in acute opioid withdrawal
- People abruptly discontinuing alcohol, benzodiazepines, barbiturates or antiseizure medicines
- People using an MAO inhibitor or within the required separation period
- People with a known allergy to naltrexone, bupropion or another component
- Pregnant patients, because weight loss offers no benefit during pregnancy and may cause fetal harm
Contrave dosing and the 16-week decision point
| Week | Morning | Evening | Total daily tablets |
|---|---|---|---|
| Week 1 | 1 tablet | None | 1 |
| Week 2 | 1 tablet | 1 tablet | 2 |
| Week 3 | 2 tablets | 1 tablet | 3 |
| Week 4 onward | 2 tablets | 2 tablets | 4 |
Tablets are swallowed whole and should not be cut, chewed or crushed. Contrave should not be taken with a high-fat meal because exposure increases and seizure risk may rise. If a dose is missed, wait for the next scheduled dose rather than doubling it.
The adult label directs clinicians to evaluate response after 12 weeks on the maintenance dose—16 weeks after starting. If at least 5% of baseline weight has not been lost, Contrave should be discontinued because meaningful sustained loss is unlikely with continued treatment.
Kidney or liver impairment may require a lower maximum dose, and severe impairment may make treatment inappropriate. Follow the individual prescription, not an online schedule.
Side effects and monitoring
Common effects
Nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth and diarrhea are among the most common reactions. Slow escalation and practical nutrition planning may improve tolerability.
Blood pressure and pulse
Contrave can raise blood pressure and heart rate. Measurements should be obtained before treatment and monitored, especially during early treatment and in people with controlled hypertension.
Mood and behavior
The label carries a boxed warning related to suicidal thoughts and behaviors from its bupropion component. Monitor for new or worsening mood, agitation, unusual behavior or suicidal thinking and obtain prompt help.
Seizure risk
Risk is dose-related and affected by medical conditions, interacting drugs, eating disorders, alcohol/sedative withdrawal and high-fat meals. Never exceed or compress the prescribed dose.
Liver and allergy reactions
Naltrexone exposure has been associated with hepatitis and clinically significant liver dysfunction. Bupropion has postmarketing reports including serious hypersensitivity and DRESS.
Diabetes medicines
Weight loss can increase hypoglycemia risk for patients using insulin or insulin secretagogues. Glucose monitoring and medication adjustment may be needed.
How W8MD chooses among pills and injections
- Hunger pattern: constant hunger, reward-driven cravings, evening eating or low satiety may suggest different strategies.
- Medical conditions: cardiovascular disease, diabetes, hypertension, sleep apnea, PCOS, fatty liver and migraine history can change priorities.
- Medication conflicts: opioids strongly affect Contrave suitability; anxiety, insomnia, seizure risk and blood pressure affect oral stimulant choices.
- Prior experience: why a patient stopped—lack of effect, nausea, insomnia, mood symptoms, coverage or cost—helps guide the next choice.
- Diet preference: W8MD can build a reduced-calorie plan around lower-carbohydrate, Mediterranean-style, vegetarian, culturally familiar or structured meal-replacement patterns.
- Insurance and total cost: the best theoretical medicine is not useful if it cannot be obtained or continued.
- Maintenance: medication selection should include a plan for plateaus, coverage changes and possible weight regain after discontinuation.
Affordable medical weight loss in NYC and Philadelphia
Traditional weight-loss pills
$60 biweeklyPublished W8MD program price with insurance for qualifying visits; may include up to two prescribed appetite-suppressant medicines when appropriate.
$110 biweeklyPublished program price without insurance.
Semaglutide-based
$29.99/week and upWith insurance accepted for qualifying medical visits.
$59.99/week and upPublished self-pay starting price.
Tirzepatide-based
$45/week and upWith insurance accepted for qualifying medical visits.
$69.99/week and upPublished self-pay starting price.
Evaluation required. The pill-program figures are not a quote for brand-name Contrave or Qsymia and do not mean every medication is included. GLP-1 figures are starting prices, not prices for Wegovy or Zepbound specifically. Product, dose, pharmacy, availability, visits, supplies, laboratory work, copays, deductibles and total cost vary. Compounded medicines are not FDA approved or generic versions of approved brands. Confirm the exact product and complete price before treatment.
Insurance and prior authorization
Some plans cover Contrave or another oral obesity medicine but exclude GLP-1 drugs; other plans prefer Wegovy or Zepbound after prior authorization. Some cover physician visits while excluding all anti-obesity medications. W8MD can review the clinical requirements and may submit documentation when an appropriate medication is covered, but the insurer or pharmacy-benefit manager makes the final decision.
Patients from New Jersey and nearby areas may be served through the active Brooklyn or Northeast Philadelphia offices, or by telehealth when clinically appropriate and legally permitted. W8MD does not currently list an active New Jersey office in this article.
“Fantastic program! Truly a life changer!”
D.M. — published W8MD patient story
D.M. reported losing 87 pounds in ten months, later reaching approximately 100 pounds lost and maintaining the result for years. The patient described markedly reduced hunger and cravings with W8MD’s combined medical and nutrition program. This individual result is not attributed specifically to Contrave and does not predict another patient’s outcome.
Active W8MD offices serving NYC, New Jersey and Philadelphia
W8MD Weight Loss, Sleep & MedSpa
2632 East 21st Street, Suite L3
Brooklyn, NY 11235
Serving Brooklyn, Queens, Manhattan, Staten Island, the Bronx, Long Island and nearby New Jersey communities.
Request a Brooklyn appointmentPoly-Tech Sleep & W8MD
1718 Welsh Road, 2nd Floor, Suite C
Philadelphia, PA 19115
Serving Northeast and Greater Philadelphia, Bucks and Montgomery counties, South Jersey and Delaware.
Request a Philadelphia appointmentRelated W8MD and encyclopedia resources
Frequently asked questions
Is Contrave a stimulant or controlled substance?
No. Contrave is not a sympathomimetic stimulant and is not federally scheduled as a controlled substance. Its bupropion component can still cause insomnia, agitation, blood-pressure changes and other important effects.
Is Contrave the same as Wellbutrin?
No. Contrave contains both naltrexone and bupropion in a specific extended-release weight-management product. Wellbutrin contains bupropion and is used for depression. Contrave should not be combined with another bupropion-containing product.
Can I take Contrave if I use opioid pain medicine?
Generally no. Chronic opioid use is a contraindication because naltrexone blocks opioid effects and can precipitate withdrawal. Pain and procedure planning require coordination with the prescribing clinicians.
Is Contrave better than phentermine?
There is no universal winner. Contrave is noncontrolled and may suit certain craving patterns, but it conflicts with opioids and carries seizure, mood and blood-pressure considerations. Phentermine often has a faster appetite effect and lower price but is a controlled sympathomimetic approved for short-term use with cardiovascular and insomnia concerns.
Is Contrave as effective as Wegovy or Zepbound?
Not on average in their separate pivotal trials. Contrave generally produced about 5% to 6% loss, while Wegovy 2.4 mg produced 14.9% and Zepbound produced up to 20.9% across studied maintenance doses. Cross-trial results are not guarantees.
Can Contrave be taken with a high-fat meal?
No. The label instructs patients not to take Contrave with a high-fat meal because drug exposure increases and seizure risk may rise.
Can I drink alcohol while taking Contrave?
Discuss alcohol honestly with the prescriber. Excess use can increase risks, and suddenly stopping heavy alcohol consumption is a contraindication because it may provoke seizures. Do not rely on a generic “safe number of drinks.”
When should Contrave be stopped for lack of effect?
Response is assessed after 12 weeks at the maintenance dose, which is 16 weeks after initiation. The label recommends stopping if at least 5% of baseline weight has not been lost.
Does insurance cover Contrave?
Coverage varies. Some plans cover Contrave, require prior authorization or prefer another medicine; others exclude obesity drugs. Medical-visit coverage and pharmacy coverage are separate.
Clinical sources
- FDA prescribing information: Contrave
- DailyMed: current Contrave drug information
- COR-I trial: naltrexone/bupropion
- COR-BMOD trial: naltrexone/bupropion plus intensive behavior modification
- CONQUER trial: phentermine/topiramate
- STEP 1 trial: semaglutide 2.4 mg
- SURMOUNT-1 trial: tirzepatide
- SURMOUNT-5: tirzepatide versus semaglutide
Medical, insurance and pricing notice: This article provides general education and is not a diagnosis, prescription, individualized dosing instruction, insurance determination or price guarantee. Evaluation is required. Eligibility, response, contraindications, adverse effects, medication availability, insurance and total cost vary. Review the current label and Medication Guide with a qualified prescriber. Weight-loss medication is not used during pregnancy. Seek urgent help for a seizure, severe allergic reaction, suicidal thoughts or another emergency; call 911 when appropriate. Confirm all advertised prices directly with W8MD. Editorial review: August 14, 2026.
Comments
Post a Comment