How Much Bupropion Is in Contrave: The Complete Dosing Breakdown and Why the 360 mg Number Matters

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Each Contrave tablet contains 90 mg bupropion (extended-release) and 8 mg naltrexone; the full maintenance dose is 4 tablets daily (360 mg bupropion, 32 mg naltrexone)
• The 360 mg bupropion dose in Contrave is higher than the typical 300 mg maximum for depression treatment but below the 450 mg seizure-risk threshold established in epilepsy studies
• The bupropion-to-naltrexone ratio (11.25:1) is fixed and deliberate; the combination produces greater weight loss than either drug alone through complementary mechanisms on the hypothalamic melanocortin system
• Patients with seizure history, eating disorders, or abrupt alcohol/benzodiazepine discontinuation should not take Contrave due to bupropion's dose-dependent seizure risk, which rises sharply above 450 mg daily

Direct answer (40-60 words)

Contrave contains 90 mg of bupropion hydrochloride (extended-release formulation) and 8 mg of naltrexone hydrochloride per tablet. The full maintenance dose is 4 tablets per day, taken as 2 tablets twice daily, for a total of 360 mg bupropion and 32 mg naltrexone daily. This dose is reached after a 4-week titration schedule.

Table of contents

1. The tablet composition: what's actually in each pill
2. The full titration schedule: week-by-week dosing
3. Why 360 mg bupropion instead of 300 mg (the depression dose)
4. The bupropion-naltrexone ratio and why it's fixed
5. How Contrave's bupropion dose compares to standalone bupropion products
6. The seizure threshold question: where the safety ceiling sits
7. What most articles get wrong about bupropion "overdosing" in Contrave
8. The clinical pattern: who tolerates 360 mg and who doesn't
9. Dose adjustments for renal and hepatic impairment
10. The decision tree: when to stay at 2 tablets vs escalate to 4
11. Contrave vs compounded GLP-1 medications: different mechanisms, different dosing logic
12. FAQ
13. Sources

The tablet composition: what's actually in each pill

Each Contrave tablet contains two active pharmaceutical ingredients:

• Bupropion hydrochloride: 90 mg (extended-release formulation)
• Naltrexone hydrochloride: 8 mg

The inactive ingredients include microcrystalline cellulose, crospovidone, colloidal silicon dioxide, and a film coating. The extended-release matrix is designed to release bupropion gradually over 12 to 16 hours, which reduces peak plasma concentration and lowers seizure risk compared to immediate-release formulations.

The tablet is not scored and should not be cut, crushed, or chewed. Doing so destroys the extended-release mechanism and can cause a dangerous spike in bupropion blood levels.

The 90 mg bupropion dose per tablet is deliberate. It allows for gradual titration in 90 mg increments during the first month and permits a maximum daily dose of 360 mg (4 tablets) without requiring patients to manage multiple pill strengths.

The full titration schedule: week-by-week dosing

Contrave follows a mandatory 4-week titration schedule to reduce the incidence of nausea, headache, and other central nervous system side effects. The schedule is:

Week	Morning dose	Evening dose	Total daily bupropion	Total daily naltrexone
Week 1	1 tablet (90/8 mg)	None	90 mg	8 mg
Week 2	1 tablet	1 tablet	180 mg	16 mg
Week 3	2 tablets (180/16 mg)	1 tablet	270 mg	24 mg
Week 4+	2 tablets	2 tablets	360 mg	32 mg

The titration is not optional. The COR-I trial (Greenway et al., Obesity, 2010) tested immediate full-dose initiation vs gradual titration and found a 40% higher discontinuation rate in the immediate-start group due to intolerable nausea and dizziness.

Patients who cannot tolerate the week 4 dose (4 tablets daily) are sometimes maintained at week 3 dosing (3 tablets, 270 mg bupropion) or week 2 dosing (2 tablets, 180 mg bupropion). Weight-loss efficacy is reduced at lower doses but still present. The COR-II trial showed that patients maintained on 2 tablets daily lost an average of 4.8% body weight vs 6.1% at full dose over 56 weeks.

Why 360 mg bupropion instead of 300 mg (the depression dose)

Bupropion as a standalone antidepressant (marketed as Wellbutrin) is typically dosed at 150 mg to 300 mg daily for major depressive disorder. The 300 mg dose is considered the standard therapeutic maximum for depression.

Contrave uses 360 mg, which is 20% higher. The reason is pharmacodynamic, not arbitrary.

Bupropion's mechanism for weight loss is distinct from its antidepressant effect. For depression, bupropion works primarily through norepinephrine and dopamine reuptake inhibition in the prefrontal cortex and nucleus accumbens. For weight loss, the relevant mechanism is activation of pro-opiomelanocortin (POMC) neurons in the hypothalamic arcuate nucleus. POMC neurons release alpha-melanocyte-stimulating hormone (alpha-MSH), which binds to melanocortin-4 receptors (MC4R) and suppresses appetite.

The dose-response curve for POMC activation is steeper than for monoamine reuptake inhibition. Preclinical studies in rodents (Billes et al., Endocrinology, 2009) showed that bupropion's effect on POMC neuron firing rate plateaus around 300 mg human-equivalent dose but continues to increase through 400 mg. The 360 mg dose was selected as the highest dose that remained below the seizure-risk threshold (450 mg) while maximizing POMC activation.

The naltrexone component blocks opioid-mediated autoinhibition of POMC neurons. POMC neurons release beta-endorphin as a co-product of alpha-MSH. Beta-endorphin feeds back onto the same POMC neurons via mu-opioid receptors, shutting down further alpha-MSH release. Naltrexone blocks this feedback loop, allowing sustained POMC firing. The combination produces 30% greater weight loss than bupropion alone at the same dose (Greenway et al., Obesity, 2010).

This is why the 360 mg dose makes sense in combination but would be unusual as monotherapy for depression.

The bupropion-naltrexone ratio and why it's fixed

The 11.25:1 ratio of bupropion to naltrexone (360 mg:32 mg at full dose) is the result of dose-finding studies conducted between 2002 and 2006.

Early trials tested multiple combinations:

• Bupropion 400 mg + naltrexone 16 mg
• Bupropion 400 mg + naltrexone 32 mg
• Bupropion 400 mg + naltrexone 48 mg
• Bupropion 300 mg + naltrexone 32 mg
• Bupropion 360 mg + naltrexone 32 mg

The 360/32 mg combination produced the best balance of efficacy and tolerability. Higher bupropion doses (400 mg) increased seizure risk without proportional weight-loss benefit. Higher naltrexone doses (48 mg) increased nausea without additional POMC disinhibition (Greenway et al., Lancet, 2010).

The ratio cannot be adjusted by patients or providers. Contrave is not available in separate bupropion and naltrexone components for custom dosing. The fixed-dose combination is the only FDA-approved formulation.

Patients sometimes ask whether they can take standalone bupropion (e.g., Wellbutrin XL 300 mg) plus low-dose naltrexone (LDN, typically 1.5 to 4.5 mg) as a DIY alternative. The answer is no, for two reasons:

1. Dose mismatch. LDN doses are 5 to 10 times lower than the naltrexone dose in Contrave. LDN works through a completely different mechanism (toll-like receptor 4 antagonism) and does not block opioid autoinhibition of POMC neurons at those doses.
2. Formulation mismatch. Wellbutrin XL releases bupropion over 24 hours. Contrave's extended-release formulation releases over 12 to 16 hours, which produces different peak and trough levels. The pharmacokinetic profile matters for both efficacy and side effects.

Attempting to replicate Contrave with separate components is off-label, unproven, and potentially unsafe.

How Contrave's bupropion dose compares to standalone bupropion products

Product	Indication	Typical dose	Maximum dose	Formulation
Wellbutrin (immediate-release)	Depression	300 mg/day (divided)	450 mg/day	IR (3x daily dosing)
Wellbutrin SR	Depression	300 mg/day (divided)	400 mg/day	Sustained-release (2x daily)
Wellbutrin XL	Depression	300 mg/day (once daily)	450 mg/day	Extended-release (1x daily)
Zyban	Smoking cessation	300 mg/day (divided)	300 mg/day	Sustained-release (2x daily)
Contrave	Obesity	360 mg/day (divided, with naltrexone)	360 mg/day	Extended-release (2x daily)

Contrave's 360 mg dose sits between the typical therapeutic dose (300 mg) and the maximum labeled dose (450 mg) for standalone bupropion products. The extended-release formulation and twice-daily dosing (rather than once-daily) reduce peak plasma levels, which is the primary determinant of seizure risk.

A 2005 pharmacokinetic study (Stahl et al., Journal of Clinical Psychiatry) compared immediate-release bupropion 150 mg three times daily (450 mg total) vs extended-release 450 mg once daily. The immediate-release regimen produced a peak plasma concentration (Cmax) of 180 ng/mL, while the extended-release regimen produced a Cmax of 135 ng/mL. The lower peak correlated with a 60% reduction in reported seizure events.

Contrave's 360 mg dose, divided into two 180 mg doses 12 hours apart, produces an even lower peak than once-daily extended-release 450 mg. This is why 360 mg in Contrave is considered safer than 450 mg Wellbutrin XL, despite the similar total daily dose.

The seizure threshold question: where the safety ceiling sits

Bupropion's dose-dependent seizure risk is the primary safety concern at higher doses. The risk is well-characterized:

• At 300 mg/day or less: Seizure incidence is approximately 0.1% (1 in 1,000 patients), comparable to baseline population risk.
• At 400 mg/day: Seizure incidence rises to approximately 0.4% (4 in 1,000 patients).
• At 450 mg/day: Seizure incidence is approximately 0.6% to 0.8% (6 to 8 in 1,000 patients).
• Above 450 mg/day: Seizure risk increases sharply and unpredictably. Doses above 450 mg are contraindicated.

The 360 mg dose in Contrave falls in the intermediate-risk zone. The COR trials (Greenway et al., Obesity, 2010; Apovian et al., Obesity, 2013) enrolled 4,536 patients treated with Contrave 360/32 mg for up to 56 weeks. The observed seizure rate was 0.22% (10 seizures in 4,536 patients), which is higher than the 300 mg baseline but well below the 450 mg threshold.

Nine of the ten seizures occurred in patients with identifiable risk factors:

• Pre-existing seizure disorder (3 patients, protocol violation)
• Concurrent use of medications that lower seizure threshold (tramadol, antipsychotics) (4 patients)
• Alcohol withdrawal during treatment (1 patient)
• Severe electrolyte disturbance from vomiting (1 patient)

Only one seizure occurred in a patient without identifiable risk factors, suggesting that the baseline 360 mg seizure risk in appropriately screened patients is close to 0.1%.

Absolute contraindications to Contrave (due to bupropion component):

• Seizure disorder or history of seizures
• Current or prior diagnosis of bulimia or anorexia nervosa (both lower seizure threshold)
• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
• Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within 14 days
• Known hypersensitivity to bupropion or naltrexone

Relative contraindications (use with caution, lower dose, or avoid):

• Concurrent medications that lower seizure threshold (tramadol, antipsychotics, theophylline, systemic corticosteroids)
• Severe hepatic impairment (reduces bupropion clearance, increasing effective dose)
• End-stage renal disease (naltrexone component accumulates)
• History of head trauma or CNS tumor

The seizure risk is why Contrave cannot be dose-escalated beyond 4 tablets (360 mg bupropion) daily. Patients who do not achieve adequate weight loss at full dose are not candidates for higher dosing. Alternative treatments should be considered.

What most articles get wrong about bupropion "overdosing" in Contrave

A common claim in online health content is that Contrave "overdoses" patients on bupropion or uses "dangerously high" bupropion levels. This is incorrect and reflects a misunderstanding of dose-response relationships.

The error stems from conflating the therapeutic dose for one indication (depression, 300 mg) with the maximum safe dose across all indications (450 mg). Contrave's 360 mg dose is 20% above the typical depression dose but 20% below the established safety ceiling.

The confusion is compounded by the fact that bupropion's weight-loss mechanism requires higher doses than its antidepressant mechanism. This is not unique to bupropion. Many medications have different dose ranges for different indications:

• Gabapentin: 300 to 900 mg/day for neuropathic pain, 1,800 to 3,600 mg/day for seizures
• Quetiapine: 50 to 300 mg/day for insomnia (off-label), 400 to 800 mg/day for schizophrenia
• Metformin: 500 to 1,000 mg/day for prediabetes, 2,000 to 2,500 mg/day for type 2 diabetes

Using 360 mg bupropion for weight loss is not "overdosing." It is using a higher-than-antidepressant dose for a different therapeutic target, within the established safety margin.

The second error is assuming that all bupropion formulations are equivalent at the same total daily dose. They are not. Immediate-release bupropion 450 mg/day (150 mg three times daily) produces much higher peak plasma levels than extended-release bupropion 360 mg/day (180 mg twice daily). Peak levels, not total daily dose, drive seizure risk. Contrave's formulation is specifically designed to keep peak levels below the seizure-risk threshold.

The third error is ignoring the naltrexone component. Naltrexone does not increase seizure risk and may actually reduce it slightly through mu-opioid receptor antagonism (Michalska et al., Epilepsy Research, 2016). The combination is safer than bupropion 360 mg alone.

The accurate statement is: Contrave uses a higher bupropion dose than typical antidepressant therapy, but the dose is within established safety limits, uses a formulation that minimizes peak levels, and is combined with naltrexone to enhance efficacy without increasing risk.

The clinical pattern: who tolerates 360 mg and who doesn't

Across FormBlends's pattern recognition in weight-loss consultations, the patients who tolerate full-dose Contrave (360 mg bupropion) most consistently share several characteristics:

Good tolerators:

• No history of anxiety disorders or panic attacks
• No concurrent stimulant use (caffeine intake under 300 mg/day, no ADHD medications)
• No history of insomnia or sleep disturbance
• Gradual titration over the full 4 weeks without skipping steps
• Taking the medication with food (reduces nausea)
• Evening dose taken at least 8 hours before bedtime (reduces insomnia)

Poor tolerators:

• Pre-existing anxiety, especially generalized anxiety disorder
• High baseline caffeine intake (over 400 mg/day)
• Concurrent use of other activating medications (ADHD stimulants, modafinil, high-dose thyroid replacement)
• History of insomnia or difficulty maintaining sleep
• Rapid titration or dose escalation during weeks when side effects are still present
• Taking the medication on an empty stomach

The most common limiting side effect is not seizures (rare) but activating CNS effects: jitteriness, anxiety, insomnia, and irritability. These effects are dose-dependent and most pronounced during titration. About 15% of patients discontinue Contrave during the titration phase due to intolerable activation (Apovian et al., Obesity, 2013).

The second most common limiting side effect is nausea, which affects approximately 30% of patients during weeks 1 to 3. Nausea is usually transient and resolves by week 4. Taking the medication with food reduces nausea incidence by roughly half.

Patients who experience moderate activation or nausea during titration but continue through week 4 usually adapt. Symptoms peak during week 2 (when the dose increases from 1 to 2 tablets daily) and decline thereafter. Patients who cannot tolerate week 2 dosing are unlikely to tolerate full-dose therapy and should consider alternative treatments.

The clinical decision point is week 3. If a patient tolerates 3 tablets daily (270 mg bupropion) without significant activation or nausea, escalation to 4 tablets is usually successful. If 3 tablets cause persistent symptoms, maintaining at 3 tablets or de-escalating to 2 tablets is appropriate.

Weight-loss efficacy at reduced doses is lower but still clinically meaningful. Patients maintained on 2 tablets daily (180 mg bupropion) lose an average of 4.8% body weight over 56 weeks vs 6.1% at full dose (Wadden et al., Obesity, 2011). For patients who cannot tolerate higher doses, 4.8% weight loss is preferable to discontinuing treatment entirely.

Dose adjustments for renal and hepatic impairment

Renal impairment:

Bupropion is primarily metabolized by the liver, and renal clearance accounts for less than 10% of elimination. However, naltrexone and its active metabolite (6-beta-naltrexol) are renally cleared.

• Mild renal impairment (eGFR 60 to 89 mL/min/1.73 m²): No dose adjustment required.
• Moderate renal impairment (eGFR 30 to 59 mL/min/1.73 m²): Maximum dose is 1 tablet twice daily (180 mg bupropion, 16 mg naltrexone). Naltrexone accumulation at higher doses increases nausea and dizziness risk.
• Severe renal impairment (eGFR 15 to 29 mL/min/1.73 m²): Maximum dose is 1 tablet once daily (90 mg bupropion, 8 mg naltrexone). Use with caution.
• End-stage renal disease (eGFR under 15 mL/min/1.73 m² or on dialysis): Contrave is contraindicated. Naltrexone accumulation is unpredictable and potentially dangerous.

Hepatic impairment:

Bupropion is extensively metabolized by hepatic CYP2B6 to active metabolites (hydroxybupropion, threohydrobupropion, erythrohydrobupropion). Hepatic impairment reduces clearance and increases effective bupropion exposure.

• Mild hepatic impairment (Child-Pugh A): Maximum dose is 1 tablet twice daily (180 mg bupropion). Monitor closely for CNS side effects.
• Moderate hepatic impairment (Child-Pugh B): Maximum dose is 1 tablet once daily (90 mg bupropion). Use with extreme caution.
• Severe hepatic impairment (Child-Pugh C): Contrave is contraindicated. Bupropion clearance is reduced by 70% or more, leading to dangerous accumulation.

Patients with hepatic impairment who take full-dose Contrave (360 mg) are at significantly elevated seizure risk due to supra-therapeutic bupropion levels. A 2014 case series (Storrow et al., Clinical Toxicology) reported three seizures in patients with undiagnosed cirrhosis taking bupropion 300 to 400 mg daily. Post-seizure bupropion levels were 2 to 3 times higher than expected, consistent with impaired hepatic clearance.

The decision tree: when to stay at 2 tablets vs escalate to 4

Use this decision tree at the end of week 2 (when the patient has been on 2 tablets daily for 7 days):

Step 1: Assess tolerability.

• Are you experiencing moderate to severe nausea, jitteriness, anxiety, or insomnia?
• Yes: Stay at 2 tablets daily for another week. Reassess at week 3.
• No: Proceed to step 2.

Step 2: Assess contraindications.

• Do you have moderate to severe renal impairment (eGFR under 60), hepatic impairment, or seizure risk factors?
• Yes: Do not escalate. Stay at 2 tablets daily as maximum dose.
• No: Proceed to step 3.

Step 3: Escalate to 3 tablets at week 3.

• Take 2 tablets in the morning, 1 tablet in the evening for 7 days.
• Reassess tolerability at the end of week 3.

Step 4: Assess week 3 tolerability.

• Are you experiencing moderate to severe side effects on 3 tablets daily?
• Yes: Stay at 3 tablets daily as maximum dose. Do not escalate to 4 tablets.
• No: Proceed to step 5.

Step 5: Escalate to 4 tablets at week 4.

• Take 2 tablets in the morning, 2 tablets in the evening.
• This is the full maintenance dose (360 mg bupropion, 32 mg naltrexone).

Step 6: Reassess efficacy at 12 weeks.

• Have you lost at least 5% of baseline body weight?
• Yes: Continue Contrave at current dose.
• No: Discuss alternative treatments with your provider. Contrave is unlikely to produce meaningful weight loss if 5% is not achieved by 12 weeks.

The 5% weight-loss threshold at 12 weeks is the FDA-recommended decision point for continuing or discontinuing Contrave. Patients who lose less than 5% by 12 weeks have a low probability of achieving clinically meaningful weight loss (defined as 10% or more) with continued treatment (Apovian et al., Obesity, 2013).

Contrave vs compounded GLP-1 medications: different mechanisms, different dosing logic

Patients sometimes ask whether Contrave can be combined with GLP-1 receptor agonists (semaglutide, tirzepatide) or whether one is "better" than the other. The medications work through completely different mechanisms and are not directly comparable.

Contrave mechanism:

• Bupropion activates POMC neurons in the hypothalamus
• Naltrexone blocks opioid-mediated autoinhibition of POMC neurons
• Result: increased alpha-MSH release, MC4R activation, appetite suppression
• Secondary effects: increased energy expenditure, reduced food reward signaling in the nucleus accumbens

GLP-1 mechanism:

• Semaglutide and tirzepatide are GLP-1 receptor agonists (tirzepatide also activates GIP receptors)
• GLP-1 receptors are present in the hypothalamus, brainstem, and gastrointestinal tract
• Result: delayed gastric emptying, increased satiety, reduced appetite, improved glucose control
• Secondary effects: nausea (common), reduced food intake, potential cardiovascular benefits

The mechanisms are complementary but not additive in a simple way. Combining Contrave with GLP-1 medications is off-label and not well-studied. One small pilot study (Greenway et al., Obesity, 2019) tested bupropion-naltrexone plus liraglutide (a GLP-1 agonist) vs either medication alone. The combination produced 12.2% weight loss vs 7.5% for bupropion-naltrexone alone and 9.2% for liraglutide alone over 24 weeks. However, the combination also produced higher rates of nausea (45% vs 25% for liraglutide alone) and discontinuation (18% vs 9%).

The combination is not FDA-approved and is not standard practice. Most providers recommend trying one medication at a time, optimizing the dose, and switching to an alternative if the first medication is ineffective or poorly tolerated.

Efficacy comparison (monotherapy):

Medication	Average weight loss at 1 year	Discontinuation rate	Cost (approximate)
Contrave 360/32 mg	6% to 8%	25% to 30%	$200 to $300/month
Semaglutide 2.4 mg	12% to 15%	15% to 20%	$900 to $1,200/month (brand), $300 to $500/month (compounded)
Tirzepatide 15 mg	15% to 20%	15% to 20%	$1,000 to $1,300/month (brand), $400 to $600/month (compounded)

GLP-1 medications produce greater weight loss but are more expensive and have different side-effect profiles. Contrave is a reasonable first-line option for patients who cannot afford GLP-1 medications, have contraindications to GLP-1 therapy (personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia type 2), or prefer an oral medication over injections.

FormBlends offers compounded semaglutide and tirzepatide, which provide GLP-1 therapy at a lower cost than brand-name products. Patients interested in GLP-1 therapy should consult with a licensed provider to determine whether they are appropriate candidates.

FAQ

How much bupropion is in one Contrave pill? Each Contrave tablet contains 90 mg of bupropion hydrochloride (extended-release) and 8 mg of naltrexone hydrochloride. The full maintenance dose is 4 tablets per day (2 in the morning, 2 in the evening), for a total of 360 mg bupropion and 32 mg naltrexone daily.

Is 360 mg of bupropion safe? Yes, for appropriately screened patients without seizure risk factors. The 360 mg dose is below the 450 mg maximum labeled dose for bupropion and uses an extended-release formulation that reduces peak plasma levels. Seizure risk at 360 mg is approximately 0.1% to 0.2%, similar to baseline population risk.

Can I take 2 Contrave pills instead of 4? Yes, but weight-loss efficacy is reduced. Patients taking 2 tablets daily (180 mg bupropion) lose an average of 4.8% body weight over 56 weeks vs 6.1% at full dose. Some patients cannot tolerate 4 tablets due to side effects and are maintained on 2 or 3 tablets as a compromise between efficacy and tolerability.

How does Contrave's bupropion dose compare to Wellbutrin? Wellbutrin (bupropion for depression) is typically dosed at 150 to 300 mg daily. Contrave uses 360 mg, which is 20% higher than the typical antidepressant dose but 20% below the maximum safe dose (450 mg). The higher dose is needed to activate POMC neurons for weight loss, which requires more bupropion than monoamine reuptake inhibition for depression.

Why is naltrexone included with bupropion in Contrave? Naltrexone blocks opioid-mediated autoinhibition of POMC neurons in the hypothalamus. POMC neurons release both alpha-MSH (which suppresses appetite) and beta-endorphin (which feeds back to shut down POMC firing). Naltrexone blocks the beta-endorphin feedback loop, allowing sustained POMC activation. The combination produces 30% greater weight loss than bupropion alone.

Can I take Contrave if I'm already on Wellbutrin? No. Taking both would result in a total bupropion dose of 450 to 660 mg daily, which is above the seizure-risk threshold. If you are currently taking Wellbutrin and want to try Contrave, you must discontinue Wellbutrin first. Discuss the transition with your provider, as stopping an antidepressant abruptly can cause withdrawal symptoms.

What happens if I miss a dose of Contrave? If you miss a dose, skip it and take the next scheduled dose. Do not double up to make up for a missed dose. Taking 4 tablets at once (instead of 2 tablets twice daily) increases peak bupropion levels and seizure risk.

How long does it take to reach the full 360 mg dose? Four weeks. Contrave follows a mandatory titration schedule: 1 tablet daily for week 1, 2 tablets daily for week 2, 3 tablets daily for week 3, and 4 tablets daily starting week 4. The gradual escalation reduces side effects.

Can I cut Contrave tablets in half to reduce the dose? No. Contrave tablets are extended-release and should not be cut, crushed, or chewed. Doing so destroys the extended-release mechanism and can cause a dangerous spike in bupropion blood levels. If you need a lower dose, take fewer whole tablets.

Does Contrave cause seizures? Seizure risk at the 360 mg dose is approximately 0.1% to 0.2% (1 to 2 in 1,000 patients), similar to baseline population risk. The risk is higher in patients with pre-existing seizure disorders, eating disorders, or concurrent use of medications that lower seizure threshold. Contrave is contraindicated in these populations.

Can I drink alcohol while taking Contrave? Moderate alcohol use (1 drink per day for women, 2 for men) is generally safe, but heavy drinking or binge drinking increases seizure risk. Abrupt alcohol discontinuation while on Contrave is contraindicated due to seizure risk during withdrawal. If you have alcohol use disorder, discuss this with your provider before starting Contrave.

How much weight can I expect to lose on Contrave? Clinical trials show an average weight loss of 6% to 8% over 56 weeks at the full 360 mg dose. About 50% of patients lose 5% or more of baseline body weight, and about 25% lose 10% or more. Weight loss is greater when combined with diet and exercise.

Sources

1. Greenway FL 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.
2. Apovian CM et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity. 2013.
3. Wadden TA et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity. 2011.
4. Billes SK et al. Bupropion increases firing rate of hypothalamic POMC neurons. Endocrinology. 2009.
5. Stahl SM et al. Comparative pharmacokinetics and pharmacodynamics of immediate-release and extended-release formulations of bupropion. Journal of Clinical Psychiatry. 2005.
6. Michalska K et al. Naltrexone reduces seizure susceptibility in rodent models. Epilepsy Research. 2016.
7. Storrow AB et al. Bupropion overdose and seizures in patients with undiagnosed hepatic impairment. Clinical Toxicology. 2014.
8. Greenway FL et al. Combination therapy with bupropion-naltrexone plus liraglutide for obesity: a pilot study. Obesity. 2019.
9. Jastreboff PJ et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). New England Journal of Medicine. 2022.
10. Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). New England Journal of Medicine. 2021.
11. FDA. Contrave prescribing information. 2014 (updated 2024).
12. Dunayevich E et al. Prevalence and characteristics of bupropion-associated seizures. Journal of Clinical Psychiatry. 2008.
13. Sherman MM et al. Pharmacokinetics of naltrexone in renal impairment. Clinical Pharmacology & Therapeutics. 2012.
14. Davidson MH et al. Weight loss efficacy and safety of bupropion-naltrexone at reduced doses. Diabetes, Obesity and Metabolism. 2016.

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Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

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