Contrave: Control Cravings, Reduce Hunger

Contrave is the third in the recent wave of new weight loss medications. The FDA approved Contrave for release on October 14, 2014. Similar to Qsymia, it is a combination of two older medications, naltrexone (sold under the brand names ReVia, Depade, and Vivitrol) and bupropion (sold under the brand names Wellbutrin, Zyban, Aplenzin, and Forfivo). Unlike other new medications developed for this purpose, neither of the active ingredients in Contrave are weight loss drugs.

Contrave reduces hunger and cravings, helping patients achieve 2-4x more weight loss than with diet alone. Cravings are the desire for specific foods whether or not you are hungry. They are one of the main reasons diets fail. Eliminating the cravings dramatically increases the likelihood of your diet being successful – and keeping the weight off.

Introducing Contrave-Plus

Dr. Lipman’s New Synergistic Weight Loss Treatment

Contrave is an excellent medication for compulsive eating and cravings. However, it is less effective as an appetite suppressant. Adding an appetite suppressant in very low doses, such as 8-15mg of phentermine, has yielded excellent results. Patients experience more weight loss with the combination than by taking either medication alone.

Over 100 patients treated with this new protocol lost weight due to substantial reductions in hunger, cravings, and appetite. The synergistic effects of this reduced dosage combination help to lower daily calorie intake without added side effects. In the Contrave-Plus protocol, 2+2 equals much more than 4 and patients could not be happier with their results.

How Does Contrave Work?

Contrave’s Bupropion Component
On the market since 1995, doctors prescribe bupropion to treat depression, anxiety, and compulsive behavior. It is marketed to reduce cigarette smoking because of its effect on compulsive behavior. It has some mild weight loss effects when taken alone, perhaps related to the reduction of compulsive behavior.

Contrave’s Naltrexone Component
Naltrexone has been on the market since 2004. It is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. It is marketed in generic form as its hydrochloride salt, naltrexone hydrochloride. There is minimal to no weight loss with this component.

How Contrave Works in the Brain

When these two medications are combined, weight loss increases by a factor of 4-5x. The combination affects the appetite center in the hypothalamus and the mesolimbic reward system in the brain to reduce cravings and hunger. The medication activates POMC neurons in the hypothalamus. These neurons release neurotransmitters that reduce the desire to eat.

The mesolimbic reward system is involved with feeling pleasure during rewarding experiences, such as eating. When you eat – or sometimes just think about certain foods – it can stimulate the release of the reward neurotransmitter dopamine. Over time, your brain seeks to repeat those rewarding experiences. This is where cravings (and addiction) get their start. Contrave helps to alter this cycle and reduce your cravings.

Contrave is different from other weight loss medications.

1. No development of tolerance
2. No stimulatory side effects
3. Works for 24 hours
4. Absence of dry mouth
5. Contrave can be take late in the day and at night. In fact, patients take the medication at bedtime.
6. The bupropion component is especially helpful for patients with depression and obsessive eating and cravings.

How Effective is Contrave?

Clinical studies of this drug have shown ten to twenty percent weight loss in completing participants. More than 45% of subjects in the 3-year long studies lost more than 15% of their body weight.

Since it is composed of older drugs with proven safe track records, safety is not an issue. In addition, unlike most weight loss drugs, Contrave is a non-controlled drug.

What are the Side Effects of Contrave?

Less than 6% of patients have reported mild side effects during clinical trials and post-approval general usage. All of the side effects are minimal and include most often nausea, constipation, headache, vomiting, dizziness, trouble sleeping, dry mouth, and diarrhea. Most of these are eliminated or reduced to manageable levels after 4-6 weeks or with dose adjustment. So far, my patients have reported no significant side effects. Similar to Belviq, there is very little insomnia or stimulation as is seen with most other weight loss medications.

Who Can Take Contrave?

Contrave can help adults with a body mass index (BMI) of 30 kg/m2 or greater (obese), or a BMI of 27 kg/m2 or greater (overweight) with at least one weight-related medical problem such as high blood pressure, high cholesterol, or type 2 diabetes, lose weight and keep it off.

Who Should NOT Take Contrave?

Do not take Contrave if you have uncontrolled high blood pressure; have or have had seizures; use other medicines that contain bupropion; have or have had an eating disorder; are dependent on opioid pain medicines or use medicines to help stop taking opioids such, or are in opiate withdrawal; drink a lot of alcohol and abruptly stop drinking; are allergic to any of the ingredients in Contrave; or are pregnant or planning to become pregnant.

Each individual needs to discuss the use of these medications with their personal physician to see which medications will be safe and effective.