How to use Contrave

Considerations before taking Contrave

A medical doctor will assess the following carefully before recommending therapy with Contrave for weight-loss:

• Known allergies to any active and non-active ingredients in the medication
• Known allergies to any medications similar to Contrave
• Known allergies to any compounds, foods or other substances and what type of reaction/s is experienced (e.g. skin rash, shortness of breath, cough, swelling of the throat, face, lips or tongue etc.)
• Past seizure experiences
• Use of alcohol (especially excessive consumption) or drugs
• Abrupt discontinuation of alcohol consumption
• Recent discontinuation of medications, such as opioids or MAOIs (a type of antidpressant)
• Use of other medications (prescription and over-the-counter), supplements or herbal products – and for what types of purposes these products are being used
• Existing medical problems, such as high blood pressure, mood disorders, eating problems, organ dysfunction,Parkinson’s disease or diabetes.
• If a woman is pregnant (or intends to become pregnant) or is breastfeeding
• Age of the patient (consideration may only be given to persons over the age of 18)

Contrave forms and dosage strengths

Contrave is available as:

• Extended-release tablets (12 hours): 90mg bupropion hydrochloride and 8mg naltrexone hydrochloride

Contrave dosage, administration recommendations and expected results

Doses of Contrave are normally recommended to be take orally once in the morning and again in the evening. Tablets must be swallowed whole with water and not chewed, broken, divided or crushed, so as to avoid altering the manufactured release rate of the medication. Contrave must never be injected or snorted as this can result in life-threatening seizures, coma or even death.

Contrave therapy is indicated for the treatment of obesity and is recommended to be implemented alongside a reduced-calorie diet and increased physical activity. Together, the intention is to help reduce a patient’s BMI, initiate safe weight loss and ensure that weight gain risk is kept as low as possible.

A typical dosing schedule (provided no other medical condition is required to be managed and no other medications are being taken) is likely to be as follows:

	Dose (morning)	Dose (evening)
First week (therapy initiation)	1 tablet	-
Second week	1 tablet	1 tablet
Third week	2 tablets	1 tablet
Fourth week (onwards)	2 tablets	2 tablets

Contrave should be taken exactly as recommended by a qualified medical doctor and those taking it should not alter their dosing schedule in any way. Any adjustments made must be managed by the treating physician and a person’s overall state of health monitored accordingly. Dosages will only be adjusted as needed and assessed as being safe to do so.

Dosages should not exceed 4 tablets a day (360mg bupropion and 32mg naltrexone) and must be initiated as above. Two tablets, taken twice daily is the optimal recommendation for Contrave therapy. More than one dose at the required time of day must never be exceeded.

During therapy, periodic evaluations and monitoring may be required. Monitoring is expected, especially during the first 3 months (12 weeks), as blood pressure elevations and heart rate changes can occur, even if existing sensitivities and problems were not clinically relevant prior to therapy initiation.

Should other medical conditions require medication management, dosing schedules will need to be carefully recommended and monitored. For instance, if CYP2B6 inhibitors are necessary or a patient displays liver function impairment, Contrave dosing treatment may not exceed 1 - 2 tablets daily. Should a patient show signs of mild to moderate renal function impairment, a doctor may only recommend doses of 1 tablet, twice daily.

Contrave weight-loss results

By the 12^th week of treatment, a patient is expected to have achieved at least 5% weight loss. In general, therapy for weight loss using Contrave is not favoured beyond a 12 to 16-week period. Should the 5% target not have been reached by this time, a treating physician is likely to discontinue Contrave therapy and consider an alternative approach. It is generally agreed that weight loss benefits may not be achievable using Contrave beyond this point. ⁽⁸⁾ The medication is also not recommended for chronic use.

What to keep in mind while taking Contrave

• It is advisable to ensure that all healthcare providers are notified of Contrave therapy – including all medical physicians, nurses, dentists and pharmacists.
• Users must follow the nutrition and exercise plan that is recommended along with the dosing schedule.
• The treating physician should be notified of any new or worsening symptoms as soon as possible while a person is on Contrave treatment, especially if serious complications like seizures, high blood pressure or low blood sugar levels develop.
• Should eye problems develop while using Contrave, an evaluation with a recommended ocular specialist is necessary. Patients should notify their treating physician immediately, especially if eye pain, eyesight changes or swelling develop, so that an appropriate consultation with a specialist can be arranged swiftly.
• Heavy alcohol consumption should be avoided while taking Contrave.
• The professional advice of the treating doctor should be sought before taking any other substances, including over-the-counter products (like those for the treatment of coughs or colds and diarrhoea) or supplements, vitamins and herbal remedies. Those taking Contrave may still be at risk of serious side-effects when mixing it with other drugs or supplements, even if the other substance is taken at a low dosage.
• Contrave must not be taken with the intention of treating mood disorders as it may worsen the symptoms of these or to treat a smoking habit.
• Women who become pregnant while using Contrave must notify their treating physician immediately.
• Contrave should never be shared.
• If a patient misses a dose of Contrave, it is recommended that the forgotten schedule be skipped and resumed again when the following dose is due. If an overdose is experienced or suspected, medical attention at an emergency facility is required immediately.
• Contrave must be stored at room temperature and in a dry environment (where it is not exposed to moisture). The medication must also be kept out of reach of children and pets.
• Unused or expired tablets must be safely discarded and not poured down a drain or flushed away in a toilet as this leads to contamination. Medical doctors and pharmacists can recommend safe disposal procedures. Drug take-back programmes are available in some countries in the world – a patient should check with their physician or pharmacist in this regard before attempting to dispose of medication that is no longer needed.

Reference: 

^{8. US National Library of Medicine - National Institutes of Health. 4 March 2016.Naltrexone/Bupropion ER (Contrave) - Newly Approved Treatment Option for Chronic Weight Management in Obese Adults https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771085/ [Accessed 23.08.2018]}