Patient Experiences: How Do You Feel on Contrave?

October 7, 2025 •

4 min read

In clinical trials, approximately 32.5% of participants experience nausea when starting Contrave, one of the most common initial feelings [1.2.4, 1.6.6]. This article explores the question, 'How do you feel on Contrave?', detailing both the challenging side effects and the positive impacts on appetite and weight.

Quick Summary

Contrave affects individuals differently, with common initial side effects including nausea, headache, and constipation that often lessen over time. Users also report reduced cravings and appetite, leading to weight loss.

Key Points

Initial Feelings: Nausea, headache, and constipation are the most common side effects when starting Contrave, but they often diminish over time [1.2.1, 1.2.4].
Appetite Control: The primary positive effect is a reduction in appetite and 'food noise,' helping users control cravings [1.3.2].
Dosage Escalation: Treatment begins with a low dose that is gradually increased over four weeks to minimize side effects [1.4.3].
Weight Loss: When combined with lifestyle changes, users can achieve an average weight loss of 5-9% of their body weight [1.5.3].
Safety Warning: Contrave has a boxed warning for suicidal thoughts and behaviors and should not be taken by people with seizure disorders or uncontrolled hypertension [1.2.4, 1.4.6].
Dietary Considerations: Avoid taking Contrave with high-fat meals to reduce seizure risk, and avoid alcohol entirely [1.4.3, 1.6.4].
Efficacy Check: Doctors typically assess effectiveness at 12-16 weeks; continued use is not recommended if at least 5% of body weight has not been lost [1.4.2, 1.4.3].

Understanding Contrave: A Dual-Action Approach to Weight Loss

Contrave is a prescription medication approved for chronic weight management in adults with a body mass index (BMI) of 30 or greater, or a BMI of 27 or greater with at least one weight-related comorbidity like hypertension or type 2 diabetes [1.4.4]. It combines two drugs: naltrexone and bupropion [1.3.2]. Naltrexone is an opioid antagonist, and bupropion is a dopamine and norepinephrine reuptake inhibitor, which is also used as an antidepressant [1.3.2, 1.3.5].

This combination works on two key areas of the brain: the hypothalamus (the appetite regulatory center) and the mesolimbic dopamine reward system [1.3.2, 1.3.5]. Bupropion stimulates POMC neurons in the hypothalamus, which helps to reduce appetite, while naltrexone blocks an inhibitory feedback loop on these same neurons, sustaining the appetite-suppressing effect [1.3.6, 1.3.5]. Together, they help control hunger and reduce food cravings, which are often significant barriers to losing weight [1.2.1, 1.3.2].

The First Few Weeks: What to Expect

Starting Contrave involves a gradual dose escalation to help the body adjust and minimize side effects [1.6.1]. The typical starting dose is one tablet in the morning for the first week, increasing weekly to a maintenance dose of two tablets twice a day by the fourth week [1.4.3].

The initial adjustment period is when most people report noticeable side effects. The most frequently reported feelings include:

Nausea: This is the most common side effect, affecting around 32.5% of users in clinical trials [1.2.4]. It is often described as mild and tends to subside within a few weeks as the body adapts [1.2.4, 1.6.6]. Taking the pill with food (but not high-fat meals) can help mitigate this [1.2.4].
Headache: Reported by about 17.6% of trial participants, headaches are also common initially [1.2.4, 1.6.6]. Staying well-hydrated can help manage this symptom [1.6.2].
Constipation: Around 19.2% of users experience constipation [1.2.4]. Increasing dietary fiber and fluid intake is recommended to manage this [1.6.1].
Dizziness and Insomnia: Dizziness was reported by 9.9% of users, and trouble sleeping (insomnia) can also occur due to the stimulant effect of bupropion [1.2.4]. It's advised to avoid taking the evening dose too close to bedtime [1.2.3].
Irritability and Mood Changes: Some users report feeling more irritable or anxious, especially in the first couple of weeks [1.2.2, 1.2.1].

Positive Feelings and Long-Term Experiences

For those who tolerate the initial side effects, the primary positive feeling reported is a significant reduction in appetite and food cravings [1.3.2]. Many users find that the 'food noise' or constant thoughts about eating are diminished, making it easier to adhere to a reduced-calorie diet. This change in the brain's reward system can make high-fat and sugary foods seem less appealing [1.3.7].

Successful long-term users often describe a feeling of being in control of their eating habits for the first time. In conjunction with diet and exercise, patients in clinical trials achieved significant weight reduction, with some studies showing an average loss of around 5-9% of total body weight, and up to 11.7% for treatment responders at 56 weeks [1.5.3, 1.3.3]. The medication's effectiveness is typically evaluated after 12-16 weeks; if a patient hasn't lost at least 5% of their baseline body weight by then, discontinuation is often recommended [1.4.2, 1.4.3].

Managing the Experience: Tips for Success

Managing how you feel on Contrave often comes down to mitigating side effects and embracing lifestyle changes. Healthcare providers suggest several strategies:

Stay Hydrated: Drinking plenty of water can help with headaches, dizziness, and constipation [1.6.2].
Adjust Your Diet: To combat nausea, eat smaller, more frequent, bland meals and avoid high-fat meals when taking your dose, as fat can increase drug absorption and the risk of seizures [1.6.9, 1.4.3]. For constipation, gradually increase fiber intake [1.6.1].
Time Your Dose: Taking the morning dose with breakfast and the evening dose in the mid-afternoon can help reduce nausea and prevent insomnia [1.6.4].
Avoid Alcohol: Combining alcohol with Contrave can increase the risk of seizures and other adverse neuropsychiatric events [1.6.4].

Comparison with Other Weight Loss Medications

Contrave occupies a unique space among weight loss medications. Here’s how it compares to others:


Feature	Contrave (Naltrexone/Bupropion)	Phentermine	Wegovy (Semaglutide)
Mechanism	Works on the brain's appetite and reward centers [1.3.2].	A stimulant that suppresses appetite [1.5.2].	A GLP-1 agonist that slows digestion and reduces appetite [1.5.9].
Administration	Oral tablet, twice daily [1.5.6].	Oral tablet, once daily [1.5.2].	Weekly subcutaneous injection [1.5.6].
Treatment Duration	Long-term use [1.5.1].	Short-term use (up to 12 weeks) [1.5.7].	Long-term use [1.5.5].
Avg. Weight Loss	~5-9% [1.5.3].	Varies, short-term focus.	Up to 14.9% [1.5.3].
Controlled Substance?	No [1.3.2].	Yes (Schedule IV) [1.5.1].	No [1.5.5].

Important Safety Information

Contrave is not suitable for everyone. It carries a boxed warning—the FDA's most serious warning—for an increased risk of suicidal thoughts and behaviors, particularly in young adults, due to its bupropion component [1.2.4, 1.4.9]. It should not be used by individuals with uncontrolled high blood pressure, a seizure disorder, or those taking other medications containing bupropion or who are dependent on opioids [1.4.6]. The risk of seizures is a significant concern, especially if the medication is taken with high-fat meals or if the dose is exceeded [1.4.3].

Conclusion

So, how do you feel on Contrave? The experience is highly individual. The initial weeks can be challenging, with a notable prevalence of gastrointestinal and neurological side effects. However, for many, these symptoms are temporary and give way to the primary benefits of reduced hunger and cravings, which can empower significant weight loss when combined with diet and exercise. The journey requires patience and close communication with a healthcare provider to manage side effects and determine if the benefits outweigh the risks.

For more information on the medication's mechanism and appropriate use, one authoritative resource is the Obesity Action Coalition.

Frequently Asked Questions

The most common side effects in the first week are nausea, headache, constipation, dizziness, and sometimes trouble sleeping (insomnia). These effects are often mild and tend to get better as your body adjusts [1.2.1, 1.6.8].

Because Contrave contains bupropion (an antidepressant), it can affect mood. Some people report initial irritability or anxiety [1.2.2, 1.2.1]. It's crucial to monitor for any significant mood changes, as Contrave has a boxed warning for suicidal thoughts and behaviors [1.2.4].

The bupropion component can be stimulating, potentially causing feelings of energy, restlessness, or insomnia for some [1.2.3, 1.2.6]. Conversely, others may experience fatigue or sluggishness as a side effect [1.2.1].

It is strongly recommended to avoid alcohol while taking Contrave. The combination can increase the risk of seizures and other serious side effects [1.6.4].

Some people notice a reduction in appetite within the first few weeks [1.6.8]. However, a doctor will typically evaluate the drug's effectiveness for weight loss after 12 to 16 weeks of treatment at the full maintenance dose [1.4.3].

Taking Contrave with a high-fat meal can significantly increase the absorption of the medication in your body, which raises the risk of seizures [1.4.3, 1.6.9].

Contrave should not be taken by individuals with a seizure disorder, uncontrolled high blood pressure, those taking other medications containing bupropion, or those who are dependent on or taking opioid medications. It is also not recommended for pregnant women [1.4.6, 1.4.5].