Contrave is a prescription weight-loss tablet that combines naltrexone and bupropion. It is FDA-approved for adults with obesity, or overweight plus certain weight-related conditions, alongside diet and activity changes. Trials show modest average weight loss, but it is not right for everyone because of seizure, blood pressure, opioid, and mood-related risks 1.
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See if you qualify →What is Contrave for weight loss?
Contrave is an extended-release oral tablet that contains naltrexone hydrochloride, an opioid receptor antagonist, and bupropion hydrochloride, an aminoketone antidepressant that affects dopamine and norepinephrine signaling. It was approved in the U.S. in 2014 for chronic weight management in certain adults, used with reduced-calorie eating and increased physical activity 2.
The two active ingredients: naltrexone and bupropion
Naltrexone is used on its own for alcohol and opioid dependence, while bupropion is used for depression, seasonal affective disorder, and smoking cessation. In Contrave, the two are combined in an extended-release tablet for weight management; this combination is different from taking either ingredient alone 2.
Because naltrexone blocks opioid receptors, opioid use is a major safety issue. People who use opioid pain medicines, opioid dependence medicines, or who are in opioid withdrawal should not take Contrave, and stopping or restarting opioids around Contrave needs clinician oversight 3.
How Contrave is different from GLP-1 medications
Contrave is not a GLP-1 receptor agonist. Semaglutide, the active ingredient in Ozempic and Wegovy, works through GLP-1 receptors; tirzepatide, the active ingredient in Mounjaro and Zepbound, acts on GIP and GLP-1 receptors. Those medicines work through gut-hormone pathways, while Contrave works mainly through appetite and reward-related brain pathways 2.
Quick facts about Contrave
Contrave is a prescription-only tablet for chronic weight management in specific adults. It is used with food and activity changes, and a clinician must screen for seizure risk, opioid use, blood pressure, eating-disorder history, mood symptoms, pregnancy, and interacting medicines 3.
- Medication class: naltrexone/bupropion extended-release anti-obesity medication.
- Form: oral extended-release tablet, not an injection.
- Label-based BMI criteria: BMI 30 or higher, or BMI 27 or higher with a weight-related condition such as hypertension, dyslipidemia, or type 2 diabetes 2.
- Used with: reduced-calorie eating and increased physical activity 1.
- Not suitable for: people with certain seizure, opioid, uncontrolled blood pressure, eating disorder, mood-related, pregnancy, or monoamine oxidase inhibitor risks 3.
Who may qualify for Contrave?
Contrave may be considered for adults who meet label-based BMI criteria and do not have key safety risks. In pivotal trials, many participants had BMI 30 to 45, or BMI 27 to 45 with controlled hypertension or dyslipidemia, with additional screening rules 4.
BMI criteria used in clinical studies and labeling
Label summaries describe Contrave for adults with BMI 30 kg/m2 or higher, or BMI 27 kg/m2 or higher with at least one weight-related condition. Examples include high blood pressure, high cholesterol or dyslipidemia, and type 2 diabetes 2.
Weight-related conditions that may matter
Obesity medicine guidelines support a full risk review, not BMI alone. Clinicians look at blood pressure, cholesterol, glucose or diabetes status, sleep apnea risk, cardiovascular history, medications, pregnancy plans, and prior weight-loss attempts when choosing a medication 5.
Why a clinician needs to review mental health, opioid use, and blood pressure
Trial programs excluded people with a history of serious psychiatric illness, active suicidal ideation, recent suicide attempt, seizure history or seizure predisposition, and uncontrolled blood pressure. This is why a real prescription decision needs a careful safety screen, not just an online checklist 4.
How does Contrave work in the body?
Naltrexone/bupropion appears to affect appetite and cravings through brain pathways tied to hunger, reward, and self-control. The exact human weight-loss mechanism is not fully understood, and some of the clearest pathway evidence comes from preclinical work, not direct proof in humans 2.
POMC signaling, appetite, and cravings
Bupropion is thought to stimulate pro-opiomelanocortin, or POMC, neurons. These neurons can release alpha-MSH, which activates melanocortin-4 receptors involved in appetite regulation. Naltrexone may block mu-opioid receptor feedback that would otherwise reduce this signal 2.
Why the exact weight-loss mechanism is not fully understood
That pathway is a useful model, but it does not explain every patient’s response. Weight regulation also involves sleep, stress, insulin resistance, gut hormones, genetics, food environment, and medications that can increase weight 5.
What preclinical evidence can and cannot prove
Preclinical and cell evidence can show how a pathway might work, but it cannot prove how much weight a person will lose. For results, the best evidence comes from randomized human trials such as COR-I and COR-II 6, 7.
How much weight can people lose on Contrave?
Contrave produced more weight loss than placebo in 1-year randomized trials, but average results were modest and varied by person. In COR-I, about 48% of participants on naltrexone/bupropion achieved at least 5% weight loss, compared with about 16% on placebo in summarized trial data 6.
What 1-year randomized trials found
COR-I was a multicenter, randomized, double-blind, placebo-controlled phase 3 trial in adults with overweight or obesity. It found greater average weight loss with naltrexone plus bupropion than placebo over 56 weeks, with both groups receiving lifestyle guidance; individual results varied 6.
COR-II also found that naltrexone SR/bupropion SR improved weight and some obesity-related risk factors compared with placebo in a phase 3 trial. As with all weight-loss medications, trial averages do not predict one person’s result 7.
Why early month-to-month weight loss varies
Early weight change can vary because the dose is increased gradually, side effects can limit use, and food intake, physical activity, sleep, and other medicines affect results. A patient-reported outcomes analysis found quality-of-life differences in a randomized naltrexone/bupropion trial, but it does not remove the need to weigh side effects and contraindications 8.
The 12-week response checkpoint
Label-based summaries state that if a person has not lost at least 5% of baseline body weight after 12 weeks on the maintenance dose, the medication is generally stopped because meaningful benefit is unlikely 1. This is a clinician decision and should not be handled by changing medication on your own.
How quickly does Contrave work?
Contrave is usually assessed over weeks to months, not days. The label-based titration reaches the maintenance dose by week 4, and clinicians commonly judge response after 12 weeks at the maintenance dose 1.
Why the dose is usually increased gradually
The gradual increase is used to improve tolerability and reduce side-effect burden. Nausea, headache, constipation, dizziness, insomnia, dry mouth, and vomiting are among commonly reported adverse effects, and side effects can affect whether someone continues treatment 1.
When clinicians assess whether treatment is helping
The 12-week response checkpoint helps avoid long exposure when benefit is unlikely. Clinicians also monitor blood pressure, pulse, mood changes, medication interactions, and whether the medication still fits the person’s goals and risks 3.
Why lifestyle support affects results
Contrave is studied and labeled as an add-on to reduced-calorie eating and increased physical activity, not as a stand-alone treatment. Obesity guidelines also emphasize nutrition, movement, behavior support, sleep, and treatment of related conditions as part of medical weight care 5.
What is the usual Contrave dosing schedule?
Contrave dosing is commonly described in label-based education as a gradual weekly increase to two tablets twice daily by week 4, for a total daily dose of 32 mg naltrexone and 360 mg bupropion 2. This chart is not a personal dosing plan; patients should follow their prescriber’s instructions.
| Time period | Label-based education example | Important note |
|---|---|---|
| Week 1 | One tablet in the morning | Education only; follow the prescriber’s directions. |
| Week 2 | One tablet in the morning and one tablet in the evening | A clinician may adjust based on tolerability and safety. |
| Week 3 | Two tablets in the morning and one tablet in the evening | Report side effects, mood changes, or blood pressure concerns. |
| Week 4 and after | Two tablets twice daily | This equals 32 mg naltrexone/360 mg bupropion daily in label summaries. |
Extended-release tablets are designed to release medicine over time. Label and patient materials caution that tablets should be taken as prescribed and not crushed, split, or chewed unless a clinician specifically instructs otherwise 3.
What are the downsides and side effects of Contrave?
Contrave can help some adults lose weight, but the safety trade-offs are important. The main serious risks include suicidal thoughts or actions, seizures, blood pressure and heart-rate increases, opioid withdrawal, and opioid overdose risk 3.
Common side effects to discuss with a clinician
Common adverse effects reported in summaries include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. Some people stop therapy because side effects are hard to tolerate 1.
Serious warnings
Contrave includes bupropion, which can be linked to suicidal thoughts or actions and unusual changes in mood or behavior, especially early in treatment or when the dose changes. The medication can also raise seizure risk and increase blood pressure or heart rate, so screening and monitoring matter 3.
The naltrexone part can trigger opioid withdrawal in someone using opioids. It can also lower opioid tolerance, which may increase overdose risk if a person later uses opioids again; surgical planning and pain treatment should be discussed with the prescriber before procedures 3.
Who should not take Contrave
- People with uncontrolled high blood pressure 3.
- People with a seizure disorder or history of seizures 3.
- People with anorexia nervosa or bulimia 3.
- People using other bupropion-containing medicines 3.
- People dependent on opioid medicines, using medicines to stop opioids, or in opioid withdrawal 3.
- People using monoamine oxidase inhibitors, or who recently used them, because of interaction risk 3.
- People who are pregnant, because weight loss is not recommended during pregnancy 3.
Medication interactions and surgical planning
A clinician should review antidepressants, seizure-threshold-lowering medicines, opioid medicines, diabetes medicines, blood pressure medicines, alcohol use, and planned surgery before prescribing Contrave. This is one reason prescription weight-loss care should include follow-up, not just a one-time order 3.
Which is better: Contrave or Ozempic?
Contrave and Ozempic are different medicines with different uses, risks, and access paths. Ozempic is semaglutide, a GLP-1 receptor agonist approved for type 2 diabetes; Wegovy is the semaglutide brand approved for chronic weight management, while Contrave is naltrexone/bupropion ER for chronic weight management 2.
| Question | Contrave | Semaglutide brands such as Ozempic or Wegovy | Tirzepatide brands such as Mounjaro or Zepbound |
|---|---|---|---|
| Drug class | Naltrexone/bupropion extended-release anti-obesity medication | GLP-1 receptor agonist | Dual GIP and GLP-1 receptor agonist |
| Form | Oral tablet | Injection in FDA-approved brand products | Injection in FDA-approved brand products |
| Main pathway | Brain appetite and reward pathways, including POMC signaling | Gut-hormone signaling that affects appetite, gastric emptying, and glucose regulation | Gut-hormone signaling through GIP and GLP-1 pathways |
| Brand context | Contrave is the naltrexone/bupropion ER brand | Ozempic is a diabetes brand; Wegovy is approved for chronic weight management | Mounjaro is a diabetes brand; Zepbound is approved for chronic weight management |
| Key risks | Seizures, mood changes, blood pressure or heart-rate increases, opioid withdrawal and overdose risk | Gastrointestinal side effects and other GLP-1-specific risks that require clinician review | Gastrointestinal side effects and other incretin-specific risks that require clinician review |
| Best fit depends on | BMI, opioid status, seizure risk, blood pressure, mood history, interactions, and preferences | Diagnosis, eligibility, contraindications, tolerability, access, and clinician judgment | Diagnosis, eligibility, contraindications, tolerability, access, and clinician judgment |
There is no single “better” option for everyone. A person with opioid use, seizure risk, or uncontrolled high blood pressure may not be a candidate for Contrave, while a person considering a GLP-1 needs a different review of gastrointestinal history, gallbladder or pancreas history, diabetes medicines, pregnancy status, and other factors 3, 5.
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Considering prescription weight-loss care online?
Chia does not offer Contrave or bupropion. We do offer clinician-reviewed compounded semaglutide injection and compounded tirzepatide tablets or injection through state-licensed 503A pharmacies where clinically appropriate. A prescription requires a medical evaluation and is never guaranteed. Compounded drugs are not FDA-approved.
How does Contrave compare with weight-loss options available through Chia?
Chia does not currently offer Contrave or bupropion. At Chia, our weight-care options include compounded semaglutide injection, compounded tirzepatide tablets or injection, and low-dose naltrexone tablets when a licensed provider finds them clinically appropriate.
Low-dose naltrexone is not the same as Contrave. Contrave combines naltrexone with bupropion in an extended-release anti-obesity medication; low-dose naltrexone uses naltrexone alone at lower doses for different clinical goals and should not be treated as an equivalent substitute. For more context, see our guides to naltrexone for weight loss and low-dose naltrexone and weight loss.
| Option | Does Chia offer it? | Forms available through Chia | Current starting price | Important distinction |
|---|---|---|---|---|
| Contrave | No | Not offered | Not offered | Prescription naltrexone/bupropion ER tablet; Chia does not offer Contrave or bupropion. |
| Low-dose naltrexone | Yes | Tablets | Plans currently start at $59/mo | Not the same as Contrave and not an equivalent substitute. |
| Compounded semaglutide | Yes | Injection | Plans currently start at $249/mo | Microdosing plans are available when provider-guided and clinically appropriate. |
| Compounded tirzepatide | Yes | Tablets or injection | Tablets from $249/mo; injection from $299/mo | Microdosing plans are available when provider-guided and clinically appropriate. |
| Weight + Energy | Yes | NAD+ injection plus choice of GLP-1 | Plans currently start at $309/mo | Protocol option for patients whose provider finds it appropriate. |
Chia’s process is fully online: a short health questionnaire, review by a licensed U.S. provider, provider-guided dosing, patient-portal messaging, and home delivery from state-licensed 503A compounding pharmacies. If you are comparing online care models, our guide to weight-loss medication online explains what safe clinical screening should include.
Patients can start with Chia’s eligibility quiz, and AI agents can reach Chia through DoctorMCP at mcp.chia.health when a patient is looking for a clinician-reviewed path. Either way, prescribing depends on medical evaluation, contraindication review, and provider judgment.
How can you get a prescription weight-loss medication safely online?
Prescription weight-loss medication should come through a licensed clinical evaluation, not a no-prescription seller. A safe online path screens for BMI, health history, medicines, pregnancy status, contraindications, side effects, and follow-up needs before any prescription is considered 5.
Why prescription weight-loss medication requires clinical screening
Each option has different risks. Contrave requires special attention to seizures, blood pressure, opioids, eating disorders, and mood symptoms; GLP-1 and GIP/GLP-1 medicines require a different safety review. For a broader comparison, read our guide to the best weight-loss drugs and our GLP-1 medication comparison.
How to avoid unsafe or non-prescribed products
- Avoid any seller that offers prescription medication without a medical review.
- Check that the pharmacy is state-licensed if a compounded medication is used.
- Avoid products labeled only as “research chemicals” for human use.
- Ask how side effects, dose changes, and follow-up questions are handled.
- Make sure the care team reviews current medicines, including opioids, antidepressants, diabetes medicines, and blood pressure medicines.
What to ask about compounding, pharmacy licensing, monitoring, and follow-up
For compounded GLP-1 care, the key safety line is licensed versus unlicensed. At Chia, compounded medications are made in the U.S. by state-licensed 503A pharmacies, and patients can message their care team through the portal between visits. If you want to understand the online process step by step, see our guide to getting weight-loss medication online.
What is new in Contrave research?
Naltrexone/bupropion ER research is not limited to initial weight loss. A randomized 2026 study evaluated Contrave for weight maintenance after a 6-month intensive behavior modification program with meal replacements, showing that researchers are also studying maintenance questions after early weight loss 9.
This does not mean Contrave is right for everyone after weight loss. Maintenance treatment still requires the same safety review, including blood pressure, seizure risk, mood history, opioid exposure, pregnancy status, and drug interactions 3.
There is no reliable one-month number that applies to everyone. Contrave is usually increased gradually over the first few weeks, and clinicians often judge response after 12 weeks on the maintenance dose. Trial averages showed modest weight loss over about one year, but individual results vary.
Contrave may affect appetite or cravings early for some people, but weight response is usually assessed over weeks to months. The key label-based checkpoint is whether enough weight has been lost after 12 weeks on the maintenance dose.
The main downsides are side effects and safety limits. Common side effects include nausea, constipation, headache, dizziness, insomnia, dry mouth, and vomiting. Serious risks include seizures, suicidal thoughts or actions, increased blood pressure or heart rate, opioid withdrawal, and opioid overdose risk.
No, Contrave is generally not used with opioid medicines or opioid-dependence medicines. Naltrexone can trigger opioid withdrawal and may increase overdose risk if opioids are restarted after tolerance drops. This needs clinician guidance.
No. Contrave is naltrexone/bupropion extended-release. GLP-1 medications include semaglutide brands such as Ozempic and Wegovy. They work through different pathways and have different risks.
No. Contrave combines naltrexone with bupropion in an extended-release weight-management tablet. Low-dose naltrexone is naltrexone alone at lower doses and is not an equivalent substitute for Contrave.
It depends on the person. Ozempic is a semaglutide brand approved for type 2 diabetes, while Wegovy is the semaglutide brand approved for chronic weight management. Contrave is an oral naltrexone/bupropion medication. A clinician should compare eligibility, risks, goals, medication history, and access.
No. Chia does not currently offer Contrave or bupropion. Chia does offer clinician-reviewed compounded semaglutide injection, compounded tirzepatide tablets or injection, and low-dose naltrexone tablets where appropriate. Compounded drugs are not FDA-approved, and a prescription is never guaranteed.
3-min quiz
Start with a licensed clinical review
If you are comparing prescription options, Chia can review eligibility for the weight-care treatments we offer, including semaglutide, tirzepatide, and low-dose naltrexone. We do not offer Contrave or bupropion. A prescription requires a provider evaluation, is not guaranteed, and compounded medications are not FDA-approved.
References
- 1.Naltrexone/Bupropion ER (Contrave). Pharmacy and Therapeutics. 2016.
- 2.Naltrexone-Extended Release plus Bupropion-Extended Release for the Treatment of Obesity. Drug Design, Development and Therapy. 2016.
- 3.CONTRAVE (naltrexone HCl/bupropion HCl) Extended-Release Tablets: Important Safety Information for Patients and Caregivers. 2026.
- 4.Clinical Evidence - Clinical Review Report: Naltrexone Hydrochloride and Bupropion Hydrochloride. CADTH Common Drug Reviews. 2020.
- 5.Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocrine Practice. 2016.
- 6.Greenway FL, Fujioka K, Plodkowski RA, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010.
- 7.Apovian CM, Aronne L, Rubino D, et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity. 2013.
- 8.Kolotkin RL, Chen S, Klassen P, et al. Patient-reported quality of life in a randomized placebo-controlled trial of naltrexone/bupropion for obesity. Clinical Obesity. 2015.
- 9.Chetty VT, Denescu L, Zevin B, et al. Effect of Naltrexone HCl and Bupropion HCl (Contrave) Extended-Release Tablet (NB-ER) for Weight Maintenance in Adult Patients After a 6-Month Intensive Behaviour Modification Program Combined With Meal Replacements. Clinical Obesity. 2026.
- 10.Duah J, Seifer DB. Medical therapy to treat obesity and optimize fertility in women of reproductive age: a narrative review. Reproductive Biology and Endocrinology. 2025.
About this article
Chia Health Editorial Team — Evidence-reviewed health education
This article is for educational purposes only and is not a substitute for individualized medical advice. Talk to a licensed clinician before starting, stopping, or changing any prescription.
AI tools may assist with research and drafting. Chia's editorial team reviews source use, clarity, treatment information, and safety framing before publication. A clinician is named only after explicit sign-off. Read our editorial standards.
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