Managing Bupropion When Starting Contrave

Introduction to Contrave

The American Diabetes Association recommends Contrave, a fixed-dose combination containing naltrexone 8mg and bupropion 90mg per tablet, with the full maintenance dose being two tablets twice daily, resulting in a total daily bupropion dose of 360mg 1

The standard titration protocol for Contrave involves starting with one tablet every morning in Week 1, increasing to one tablet twice daily in Week 2, two tablets in the morning and one tablet in the evening in Week 3, and finally two tablets twice daily from Week 4 onward, with a total daily bupropion dose of 360mg 1
The maximum safe dose of bupropion is 450mg/day, and exceeding this dose substantially increases seizure risk, as noted by the Praxis Medical Insights 2

Patients starting Contrave should be monitored closely for depression recurrence, particularly during the first 1-2 weeks, as well as for changes in blood pressure and heart rate, and screened for neuropsychiatric symptoms including mood changes, anxiety, and suicidal ideation, especially in patients under 24 years old 1, 2
The American Heart Association and other organizations recommend avoiding Contrave in patients with seizure disorders, eating disorders, or those at risk of abrupt discontinuation of alcohol or benzodiazepines 1, 2

The Obesity Society recommends assessing weight loss at 12 weeks on the maintenance dose, and discontinuing Contrave if the patient has not lost at least 5% of baseline body weight by 12 weeks, as continued use is unlikely to provide meaningful benefit 3, 1
In patients with hepatic impairment (moderate to severe), the maximum dose is one tablet daily, and in patients with renal impairment (GFR <90), the dose should be reduced by half and monitored closely, as recommended by the Praxis Medical Insights 2
The American College of Cardiology recommends that Contrave is contraindicated in patients with uncontrolled hypertension 1