Navigating the complexities of a new medication requires careful attention to potential interactions, and Contrave is no exception. This prescription drug, which combines the ingredients naltrexone and bupropion, is used for chronic weight management in adults with a higher body mass index (BMI). However, combining it with certain substances, foods, and other medications can lead to dangerous side effects, including seizures, overdose, and severe health complications.
Major Contraindications: What to Absolutely Avoid
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs) are a class of antidepressants that must never be combined with Contrave. Taking them together significantly increases the risk of a dangerous and life-threatening spike in blood pressure known as a hypertensive crisis. A 14-day washout period is required, meaning you must wait at least 14 days after stopping an MAOI to begin Contrave, and vice versa. Examples of MAOIs include:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
Opioid Medications
Opioids, which include prescription pain relievers and illicit drugs, are contraindicated with Contrave because of the naltrexone component. Naltrexone is an opioid antagonist, meaning it blocks the effects of opioids.
- Overdose Risk: If you take an opioid while on Contrave, the opioid's effect will be blocked. Attempting to overcome this by taking a larger dose can lead to a fatal overdose.
- Sudden Withdrawal: Starting Contrave while physically dependent on opioids can cause sudden and severe opioid withdrawal symptoms. A 7- to 10-day period of abstinence from all opioids is required before starting Contrave.
Other Bupropion-Containing Products
Contrave itself contains bupropion. Therefore, taking other medications that also contain bupropion, such as Wellbutrin (for depression) or Zyban (for smoking cessation), is prohibited. This would lead to an excessive amount of bupropion in your system, substantially increasing the risk of seizures and other side effects.
High-Fat Meals
Consuming a high-fat meal immediately before taking Contrave can increase the absorption of the drug, leading to a higher concentration in your body. This can significantly raise the risk of seizures. To minimize this risk, avoid foods such as greasy fried foods, rich sauces, large portions of fatty meats, and excessive butter or cheese when taking your dose.
Comparison of Contrave Interactions
| Substance/Condition | Risk Level | Reason for Interaction |
|---|---|---|
| MAOIs | High | Increased risk of a hypertensive crisis. |
| Opioids | High | Naltrexone blocks opioid effects, causing overdose risk and sudden withdrawal. |
| Alcohol | High | Increases seizure risk, can cause neuropsychiatric and liver issues. |
| High-Fat Meals | High | Increases drug absorption, raising seizure risk. |
| Other Bupropion Products | High | Leads to bupropion overdose and increased seizure risk. |
| Certain Antidepressants | Moderate | May interact with bupropion, requiring dose monitoring. |
| Seizure Disorders | High (Contraindicated) | Increases seizure risk. |
| Anorexia/Bulimia | High (Contraindicated) | Increases seizure risk. |
Serious Drug and Substance Interactions
Alcohol
Mixing Contrave and alcohol can be particularly dangerous. The bupropion component lowers the seizure threshold, and alcohol withdrawal has the same effect, creating a combined, elevated risk of seizures. Other potential issues include:
- Neuropsychiatric Effects: Mood changes, anxiety, and depression can worsen.
- Liver Strain: The naltrexone in Contrave is metabolized by the liver, as is alcohol, placing extra strain on the organ.
- Abrupt Cessation: Heavy drinkers who suddenly stop drinking when starting Contrave face a higher risk of seizures and should consult their doctor for a safe plan.
Medications That Lower the Seizure Threshold
Several other medications can lower the seizure threshold, and combining them with Contrave's bupropion component can increase the overall risk of seizures. This is why it's crucial to provide a complete medication list to your doctor. Such medications include:
- Certain antidepressants, including SSRIs and TCAs
- Antipsychotics
- Theophylline (for asthma)
- Systemic steroids
Special Considerations for Specific Conditions
Certain pre-existing medical conditions also make Contrave an unsafe choice. Patients with the following should not take this medication:
- Eating Disorders (Anorexia or Bulimia): Due to increased risk of seizures.
- Uncontrolled High Blood Pressure: Contrave can further elevate blood pressure, which is dangerous in uncontrolled hypertension.
- Seizure Disorder: A history of seizures is a strong contraindication for Contrave.
- Abrupt Withdrawal from Sedatives: Like alcohol, abruptly stopping benzodiazepines or barbiturates while on Contrave increases seizure risk.
Conclusion
For those considering Contrave, understanding the critical interactions and contraindications is a non-negotiable part of treatment. The drug's effectiveness hinges on proper usage, and disregarding warnings about substances like opioids, alcohol, and MAOIs can lead to severe, even life-threatening, health consequences. Always maintain an open and honest dialogue with your healthcare provider about all medications, supplements, and lifestyle habits, and never stop or start new treatments without their guidance. For more detailed information, you can also consult the official product website at contrave.com.
