Frequently asked questions
Find answers to some of the frequently asked questions about CONTRAVE below.
How much does CONTRAVE cost? How can my patients save on CONTRAVE?
CONTRAVE is $99/month with FREE home delivery through the CurAccess Patient Support Program. Our best-in-class savings and support program can help your patients save on their CONTRAVE prescription.Learn more
How quickly can patients expect to lose weight?
In 3 clinical trials, there was significantly greater weight loss observed in patients using CONTRAVE compared to those on diet and exercise alone at the first time point assessed, which was 4 weeks after the initiation of therapy.1,2View study results
How can I help my patients get CONTRAVE home delivery?
Patients can get CONTRAVE for $99/month with FREE home delivery through the CurAccess Patient Support Program. We partner with KnippeRx Mail Order Pharmacy, so your patients can have CONTRAVE delivered directly to their door.Get started today
How long does CONTRAVE home delivery take once I have submitted a prescription?
Once you have submitted the prescription to KnippeRx Mail Order Pharmacy, and the patient has confirmed insurance and mailing details with the pharmacy, CONTRAVE will be shipped free using USPS first-class mail. Your patient will receive CONTRAVE in approximately 2-4 business days.
To rush an order, patients may opt to pay for expedited delivery through UPS next-day service.
What are the eligibility requirements of the CONTRAVE Savings Coupon Card?
The CONTRAVE Savings Coupon Card can help eligible patients with or without insurance coverage save on their prescription.View eligibility requirements
Can patients who stay on CONTRAVE expect to maintain their weight loss?
In the COR-1, COR-BMOD, and COR-Diabetes trials, peak weight loss, on average, was achieved after patients had been on CONTRAVE for 36 weeks. On average, patients maintained this weight loss through 56 weeks.1View study results
Can patients with Medicare or TRICARE use the CONTRAVE Savings Coupon Card?
Medicare Part D and TRICARE beneficiaries are eligible for the CONTRAVE Savings Coupon Card; however, terms and conditions apply.View eligibility requirements
What are the most common side effects of CONTRAVE?
The most common adverse reactions reported (≥5%) include: nausea (32.5%), constipation (19.2%), headache (17.6%), vomiting (10.7%), dizziness (9.9%), insomnia (9.2%), dry mouth (8.1%), and diarrhea (7.1%).1
Common GI-related adverse events were generally transient in nature and quickly resolved.2-4
How is CONTRAVE different from other weight-loss medications?
CONTRAVE, a combination of naltrexone HCl and bupropion HCl, targets the hypothalamus and mesolimbic reward system to give patients more control of their eating.1,5*
Unlike other weight-loss medications, CONTRAVE is not a controlled substance, scheduled drug, or stimulant.1,6
*The exact neurochemical effects of CONTRAVE leading to weight loss are not fully understood.1
What should patients do if they experience issues activating their CONTRAVE Savings Coupon Card?
Your patients can register for the CONTRAVE Savings Coupon Card at www.contrave.com/save. If they are having trouble signing up online, they can call 1-800-905-5576 for assistance.
What information is needed to submit a prior authorization (PA) for CONTRAVE?
Use this checklist to help collect the information most often needed to submit a PA for CONTRAVE.
How do my patients take CONTRAVE?
The dose of CONTRAVE is slowly increased over time to help patients adjust to their medication. Patients with hepatic or renal impairment, or those taking certain other medications, may need to take a different dose.1Review dosing information
How much weight can my patients expect to lose on CONTRAVE?
Across 3 clinical trials, patients lost approximately 2-4x more weight by adding CONTRAVE to their weight-loss program than with diet and exercise alone.1View study results
Can I use CONTRAVE in my patients with renal impairment?
Yes, you can use CONTRAVE in your patients with renal impairment. Dosing adjustments are needed for patients with moderate or severe renal impairment. CONTRAVE is not recommended for use in patients with end-stage renal disease.1View dosing adjustments
For patients who do not have hypertension, type 2 diabetes mellitus, or elevated cholesterol, why is the indication restricted to a BMI of 30 kg/m2?
The FDA provided the guidance on the BMI ranges. The BMI ranges in the indication for CONTRAVE are those used by other anti-obesity agents. HCPs should use their clinical judgement when prescribing any medication outside its indication.1,6
BMI=body mass index.
If a patient discontinues treatment, do they need to be weaned off CONTRAVE?
During the clinical trial program, there was no weaning period. Patients stopped the medication at the end of their participation in the study. There did not appear to be any increase in adverse events following the end of the study.
Important Safety Information for CONTRAVE
(naltrexone HCl and bupropion HCl) extended-release tablets
CONTRAVE is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:
- 30 kg/m2 or greater (obese) or
- 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (eg, hypertension, type 2 diabetes mellitus, or dyslipidemia)
Limitations of Use
The effect of CONTRAVE on cardiovascular morbidity and mortality has not been established. The safety and effectiveness of CONTRAVE in combination with other products intended for weight loss, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been established.
WARNING: SUICIDAL THOUGHTS AND BEHAVIORS
Suicidality and Antidepressant Drugs
CONTRAVE® is not approved for use in the treatment of major depressive disorder or other psychiatric disorders. CONTRAVE contains bupropion, the same active ingredient as some other antidepressant medications (including, but not limited to, WELLBUTRIN, WELLBUTRIN SR, WELLBUTRIN XL, and APLENZIN). Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials. These trials did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in subjects over age 24; there was a reduction in risk with antidepressant use in subjects aged 65 and older. In patients of all ages who are started on CONTRAVE, monitor closely for worsening, and for the emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber. CONTRAVE is not approved for use in pediatric patients.
CONTRAVE is contraindicated in: uncontrolled hypertension; seizure disorder or a history of seizures; use of other bupropion-containing products; bulimia or anorexia nervosa, which increase the risk for seizure; chronic opioid or opiate agonist (eg, methadone) or partial agonist (eg, buprenorphine) use, or acute opiate withdrawal; patients undergoing an abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs; use during/within 14 days following treatment with monoamine oxidase inhibitors (MAOIs), as there is an increased risk of hypertensive reactions when CONTRAVE is used concomitantly with MAOIs, including reversible MAOIs such as linezolid or intravenous methylene blue; known allergy to any component of CONTRAVE, as anaphylactoid/anaphylactic reactions and Stevens-Johnson syndrome have been reported; and pregnancy.
WARNINGS AND PRECAUTIONS
Suicidal Behavior and Ideation
All patients being treated with antidepressants for any indication should be monitored and observed for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes.
Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of suicidality, anxiety, agitation, irritability, unusual changes in behavior, and other symptoms, and to report such symptoms immediately to healthcare providers.
Neuropsychiatric Adverse Events and Suicide Risk in Smoking Cessation Treatment
CONTRAVE is not approved for smoking cessation. Serious neuropsychiatric adverse events have been reported in patients taking bupropion for smoking cessation. These postmarketing reports have included changes in mood (including depression and mania), psychosis, hallucinations, paranoia, delusions, homicidal ideation, aggression, hostility, agitation, anxiety, and panic, as well as suicidal ideation, suicide attempt, and completed suicide.
Some patients who stopped smoking may have been experiencing symptoms of nicotine withdrawal, including depressed mood. Depression, rarely including suicidal ideation, has been reported in smokers undergoing a smoking cessation attempt without medication. However, some of these adverse events occurred in patients taking bupropion who continued to smoke.
Neuropsychiatric adverse events occurred in patients without and with pre-existing psychiatric disease; some patients experienced worsening of their psychiatric illnesses. Observe patients for the occurrence of neuropsychiatric adverse events. Advise patients and caregivers that the patient should stop taking CONTRAVE and contact a healthcare provider immediately if agitation, depressed mood, or changes in behavior or thinking that are not typical for the patient are observed, or if the patient develops suicidal ideation or suicidal behavior. In many postmarketing cases, resolution of symptoms after discontinuation of bupropion was reported. However, the symptoms persisted in some cases, therefore, ongoing monitoring and supportive care should be provided until symptoms resolve.
Depression, suicide, attempted suicide, and suicidal ideation have been reported in the postmarketing experience with naltrexone used in the treatment of opioid dependence. No causal relationship has been demonstrated.
The risk of seizure is dose-related. Discontinue treatment and do not restart CONTRAVE in patients who experience a seizure. Use caution when prescribing CONTRAVE to patients with an elevated risk of seizure, including: history of head trauma or prior seizure, severe stroke, arteriovenous malformation, central nervous system tumor or infection, or metabolic disorders (eg, hypoglycemia, hyponatremia, severe hepatic impairment, and hypoxia); excessive use of alcohol or sedatives, addiction to cocaine or stimulants, or withdrawal from sedatives; patients with diabetes treated with insulin and/or oral diabetic medications (sulfonylureas and meglitinides) that may cause hypoglycemia; concomitant administration of medications that may lower the seizure threshold, including other bupropion products, antipsychotics, tricyclic antidepressants, theophylline, and systemic steroids.
Clinical experience with bupropion suggests that the risk of seizure may be minimized by adhering to the recommended dosing recommendations, including the avoidance of high-fat meals while taking CONTRAVE.
Patients Receiving Opioid Analgesics
CONTRAVE should not be administered to patients receiving chronic opioids. If chronic opiate therapy is required, CONTRAVE treatment should be stopped. In patients requiring intermittent opiate treatment, CONTRAVE therapy should be temporarily discontinued and lower doses of opioids may be needed. Patients should be alerted that they may be more sensitive to opioids, even at lower doses, after CONTRAVE treatment is discontinued.
An opioid-free interval of a minimum of 7 to 10 days is recommended for patients previously dependent on short-acting opioids, and those patients transitioning from buprenorphine or methadone may need as long as two weeks. Patients should be made aware of the risks associated with precipitated withdrawal and encouraged to give an accurate account of last opioid use.
Increase in Blood Pressure (BP) and Heart Rate (HR)
CONTRAVE can cause an increase in systolic BP, diastolic BP, and/or resting HR. These events were observed in both patients with and without evidence of preexisting hypertension. In clinical practice with other bupropion-containing products, hypertension, in some cases severe and requiring acute treatment, has been reported. Blood pressure and pulse should be monitored at regular intervals.
Anaphylactoid/anaphylactic reactions and symptoms suggestive of delayed hypersensitivity have been reported with bupropion, as well as rare spontaneous reports of erythema multiforme, Stevens-Johnson syndrome, and anaphylactic shock. Instruct patients to discontinue CONTRAVE and consult a healthcare provider if they develop an allergic or anaphylactoid/anaphylactic reaction.
Cases of hepatitis, clinically significant liver dysfunction, and transient asymptomatic hepatic transaminase elevations have been observed with naltrexone exposure. Warn patients of the risk of hepatic injury and advise them to discontinue CONTRAVE if they experience symptoms of acute hepatitis.
Activation of Mania
CONTRAVE treatment can precipitate a manic, mixed, or hypomanic episode. The risk appears to be increased in patients with bipolar disorder or who have risk factors for bipolar disorder. Prior to initiating CONTRAVE, screen patients for history of bipolar disorder and the presence of risk factors for bipolar disorder (eg, family history of bipolar disorder, suicide, or depression). CONTRAVE is not approved for use in treating bipolar depression.
The pupillary dilation that occurs following use of many antidepressant drugs, including bupropion, may trigger an angle-closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy.
Hypoglycemia with Use of Antidiabetic Medications
Weight loss may increase the risk of hypoglycemia in patients with type 2 diabetes mellitus treated with insulin and/or insulin secretagogues (eg, sulfonylureas). Measurement of blood glucose levels prior to starting CONTRAVE and during CONTRAVE treatment is recommended in patients with type 2 diabetes. Decreases in medication doses for antidiabetic medications that are non-glucose-dependent should be considered to mitigate the risk of hypoglycemia.
Most common adverse reactions (≥5%) include: nausea (32.5%), constipation (19.2%), headache (17.6%), vomiting (10.7%), dizziness (9.9%), insomnia (9.2%), dry mouth (8.1%), and diarrhea (7.1%).
Use caution when prescribing CONTRAVE concomitantly with dopaminergic drugs (levodopa and amantadine), drugs metabolized by CYP2D6, or drugs that lower the seizure threshold. Avoid concomitant use with MAOIs and CYP2B6 inducers. Reduce CONTRAVE dose when taken with CYP2B6 inhibitors. CONTRAVE can cause false positive urine test results for amphetamines.
- CONTRAVE (naltrexone HCI and bupropion HCI) [prescribing information]. San Diego, CA: Nalpropion Pharmaceuticals, Inc.; 2014.
- 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;376(9741):595-605.
- Wadden TA, Foreyt JP, Foster GD, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring). 2011;19(1):110-120.
- Hong K, Herrmann K, Dybala C, Halseth AE, Lam H, Foreyt JP. Naltrexone/bupropion extended release-induced weight loss is independent of nausea in subjects without diabetes. Clin Obes. 2016;6(5):305-312.
- Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes (Lond). 2015;39(8):1188-1196.
- QSYMIA [prescribing information]. Campbell, CA: VIVUS, Inc; 2017.