Evidence reviewed
Combination medication
Contrave (Naltrexone + Bupropion)
An FDA-approved combination of low-dose naltrexone (8 mg) and bupropion (90 mg) for chronic weight management in adults with obesity or overweight with weight-related conditions. Not for addiction treatment.
What is Contrave?
Contrave is a prescription medication that combines two active ingredients: naltrexone hydrochloride (8 mg) and bupropion hydrochloride (90 mg) in a single extended-release tablet. It was approved by the FDA in September 2014 for chronic weight management in adults.
Contrave is not for addiction treatment. It contains a much lower dose of naltrexone (8 mg per tablet, totalling 32 mg per day at full dose) than the 50 mg used for alcohol and opioid dependence. The bupropion component is an antidepressant (aminoketone class) that is also used for smoking cessation. The combination targets brain pathways involved in appetite and food cravings — not the same mechanism used in addiction treatment.
Contrave is indicated for adults with: - A BMI of 30 kg/m² or greater (obese), OR - A BMI of 27 kg/m² or greater (overweight) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidaemia
It must be used alongside a reduced-calorie diet and increased physical activity. It is not approved for use in children or adolescents under 18.
How Contrave works
The exact mechanism is not fully understood, but research suggests two complementary effects.
Appetite regulation (hypothalamus)
Bupropion appears to stimulate pro-opiomelanocortin (POMC) neurons in the hypothalamus, which release alpha-MSH — a hormone that reduces appetite and increases energy expenditure. Naltrexone blocks a feedback mechanism that would normally shut off this effect, prolonging the appetite-suppressing signal.
Food reward reduction (mesolimbic system)
The dopamine-driven reward system in the brain releases dopamine when you eat pleasurable foods. This system can drive overeating and food cravings. Contrave appears to modulate this reward pathway — particularly reducing cravings for high-fat, high-sugar foods — by affecting how dopamine and endogenous opioids interact in the mesolimbic circuit.
Contrave dosing schedule (standard titration)
| Morning dose | Evening dose | |
|---|---|---|
| Week 1 | 1 tablet | None |
| Week 2 | 1 tablet | 1 tablet |
| Week 3 | 2 tablets | 1 tablet |
| Week 4 onward | 2 tablets | 2 tablets |
Contrave: key facts
Data from FDA labelling and clinical trials.
- Full daily dose
- 32/360
- FDA approval year
- 2014
- Per tablet strength
- 8/90
- Brand only
- No generic
32 mg naltrexone + 360 mg bupropion daily (4 tablets taken as 2 morning, 2 evening)
Approved September 2014 for chronic weight management
Each extended-release tablet contains 8 mg naltrexone HCl + 90 mg bupropion HCl
Contrave is not available as a generic. Manufacturer savings programs available
Common questions about Contrave
How is Contrave different from standalone naltrexone?
Contrave combines naltrexone with bupropion and is approved for chronic weight management. Standalone naltrexone products used in addiction treatment have different doses, indications, labels, and contraindication checks. They are not interchangeable.
What does the trial evidence show?
Pivotal trials found greater average weight loss and more 5% responders than placebo. Individual response varies, discontinuation was substantial, and the FDA label uses a 16-week evaluation and stopping rule.
Is cardiovascular safety established?
No. The FDA label says the effect on cardiovascular morbidity and mortality has not been established. The LIGHT outcomes trial ended early after interim-data disclosure and did not provide a definitive assessment.
Can Contrave be used with opioids?
Chronic opioid use is contraindicated. The label gives opioid-free interval and overdose warnings; transitions from buprenorphine or methadone may require particular caution. Follow the current label and prescriber plan.
How much does Contrave cost?
There is no stable universal price. Market, insurance, pharmacy, assistance eligibility, and pack size matter. Obtain a current itemised quote rather than relying on coupon or cash-price estimates.
Important: Contrave is not for addiction treatment
Contrave contains a much lower dose of naltrexone than the 50 mg used for alcohol and opioid dependence. If you are seeking naltrexone for addiction treatment, please refer to the naltrexone medication guide and your country's treatment page.