How Contrave Helps with Weight Loss + Who should use it

Is Contrave really a miracle weight loss medication? 

Well, it is a newer weight loss medication but it's far from perfect. 

This particular medication helps people lose weight by influencing certain factors in the body ranging from hormonal control to appetite modulation. 

Because of this, certain people stand to benefit more from using this medication than others. 

Learn how Contrave can help with weight loss and determine if it is right for you: 

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Contrave for Weight Loss

Everyone and I mean everyone, is looking for an easy way to lose weight. 

So, naturally, you are probably wondering if Contrave fits the bill?

Well, before we jump into that answer - let's discuss weight loss more generally. 

First: 

You should know (or at least come to appreciate) that there will probably never be a super simple weight loss pill.

Instead, there will be medications that may augment (or make easier) your weight loss efforts - but it's unlikely that medication will ever cause significant weight loss by itself.

Why?

Because weight gain is much more complex than simply eating more than you exercise.

Weight loss with wellbutrin

​The process by which your body gains weight has to do with multiple hormone systems that become dysregulated that then tell your body to cling on to fat and reduce the amount that you lose. 

And this is important because this is how the NEW AGE weight loss medications work.

They don't work by simply reducing your appetite and hoping that you lose weight.

They work by modulating these hormones that make your body cling onto fat and make weight loss more difficult.

We are going to talk in detail about how Contrave works below, but for now, just realize that it works by altering these hormone levels in your body. 

Who should use Contrave? ​

Having said that - does this mean that Contrave will work for you?

Actually, it might not.

Why?

Because the reason that YOU are gaining weight may be for a different reason than your neighbor or cousin or brother or sister.

We know that there is not just ONE cause to weight gain, and by using that simple logic we know that there will never be a universal weight loss treatment.

Science has shown us that we gain

Because of this, we know that only certain people will benefit from using these special weight loss medications.

​So who will benefit from using Contrave?

Contrave tends to work best if you fall into any of the following categories: 

  • Patients with body set point malfunction (those who are "stuck" at a certain weight or who have reached a weight loss plateau)
  • Those who struggle with binge eating or emotional eating
  • Those with high levels of inflammation or those with autoimmune disease (such as Hashimoto's thyroiditis)
  • Those with hypothyroidism or thyroid issues
  • Patients with insulin resistance or issues with blood sugar
  • Patients struggling with chronic pain and weight gain or weight loss resistance
  • Patients with eating disorders 
  • Patients with PCOS or who are on the PCOS spectrum

​If you are suffering from any of these symptoms PLUS you are struggling to lose weight then Contrave may actually help you. 

How does Contrave Work?

Contrave is actually a combination of two medications:

Wellbutrin and Naltrexone.

Wellbutrin you probably know as an anti-depressant but chances are high that you've never heard of naltrexone before.

Naltrexone is an opiate blocker which means that it blocks the effects of pain medication. 

Traditionally, it's used to treat alcohol addition. 

But at small doses, Naltrexone causes some interesting changes in the body that can actually promote weight loss. 

Another interesting fact is that Wellbutrin has been shown to cause weight loss by itself as well. 

But it's really the combination of these medications that work synergistically with one another to promote significant weight loss. ​

To understand HOW they work I've compiled a list of scientifically proven reasons that they help: ​

#1. Helps modulate body set point

​This is not #1 because it is the most important, but it is #1 because modulating body set point can be very important for certain people. 

So what is the body set point?

Body set point refers to a metabolic state that your body sets based on a number of factors which results in you maintaining a certain and specific weight (1).

This set point is what keeps healthy people at a relatively normal weight despite eating very large meals, reducing caloric expenditure, etc.

It allows your body to achieve homeostatic balance based on a set of averages, rather than absolute numbers. 

Your hypothalamus (part of your brain) helps set your basal metabolic rate and your total weight through its influence on leptin and thyroid hormone (2).

Thyroid hormone is largely responsible for heat and energy production in your body, while leptin is a regulatory hormone secreted from fat cells which communicate with your brain and hypothalamus. 

Disarray in this body set point leads to conditions such as thyroid resistance and leptin resistance which make weight loss almost impossible. ​

For practical purposes, it means that your body will stay a certain weight regardless of other influences that you put on the system.

So if you've been working out, changing your diet, taking supplements and medications and you still aren't losing weight then you may have an issue with this body set point.

Body set point also comes into play when someone is in the process of losing weight.

Some people are able to lose 10-20 pounds but find themselves hitting a "plateau" after a certain amount of weight loss. 

This plateau may be your body resisting further weight loss due to your body set point.

So how does Contrave fit in?

Naltrexone, along with Wellbutrin, influence hypothalamic function which may be part of the reason why this medication helps certain people lose weight. 

In my own personal practice, I tend to look to these medications when someone has hit a plateau and is unable to lose further weight despite doing everything else perfectly. 

#2. Helps reduce Insulin Resistance & Improve Thyroid Function

​Beyond its effects on the brain, Contrave also helps influence other hormone systems in the body. 

In particular, it alters thyroid function (for the better) and helps reduce insulin resistance.

​You probably know thyroid function is important for regulating your total weight, but you may not understand just how important your thyroid is for optimal weight loss. 

Simply gaining weight has actually been shown to reduce thyroid hormone which may further weight gain and make weight loss more difficult. 

You've probably heard of people "blaming" their thyroid for weight gain (which is true in some individuals) but it's important to realize that having excess fat on your body WILL impair thyroid function somewhat. 

Naltrexone has been shown to improve thyroid hormone status by increasing T4 to T3 conversion and by increasing total T3 (3).

Thyroid regulation and control

This means that your body will ​be producing more of the ACTIVE thyroid hormone T3 which may improve metabolism. 

In addition, studies have also shown (4) that Naltrexone may reduce insulin resistance by sensitizing the body to blood sugar.

This is important because it is estimated that about 50% of people in the US have some degree of insulin resistance contributing to their weight and health overall.

​The effect of naltrexone to reduce blood sugar and insulin resistance seems to be more effective in women who also suffer from PCOS like symptoms (high testosterone or high androgens). 

#3. Reduces Binge Eating and Overeating

​Traditionally we think that in order to lose weight we must reduce how much we eat and exercise more, right?

Well, it turns out to not be as straightforward as we thought.

While overeating can definitely lead to weight gain, undereating does NOT lead to significant and long-lasting weight loss. 

So why is it helpful that Contrave reduces binge eating?

Binge eating tends to be more harmful than simply overeating because of the stimulus it sends to your body.

An abundance of high sugar foods and carbohydrates can spike insulin levels and promote hormone imbalances like insulin resistance.

Because of the effects that binge eating has on hormonal balance, and therefore weight loss, it becomes very important to treat if you are interested in weight loss. ​

For the purpose of this article, I am lumping together overeating, binge eating and emotional into eating into 1 category. 

These are all different, but how they impact your hormones is very similar. 

So how does Contrave fit in?

Studies have shown that taking Wellbutrin (5) has been shown to help promote a remission in binge eating in certain patients. 

Contrave and binge eating

While patients who underwent this study didn't notice any weight loss, they did, however, notice a reduction in binge eating episodes. 

It's important to note that this study was done with Wellbutrin ONLY.

The benefit of using Contrave (the combination of Wellbutrin PLUS naltrexone) is that Wellbutrin can reduce the number of binge eating episodes while naltrexone works to reduce the hormone imbalances caused by previous binging. 

I have found that using Contrave (or even just Wellbutrin by itself) can be very helpful for certain patients who suffer from eating disorders. 

#4. Suppresses Appetite

Generally, I am not a fan of medications that simply reduce the total amount of calories that someone consumes UNLESS they are also overeating (see above).

For this reason, I generally recommend that patients avoid appetite suppressants like Phentermine or other amphetamine-based medications designed for weight loss. 

Why?

Because once you stop taking the medication, and your appetite returns, you will invariably gain all of your weight back. 

When I talk about weight loss I am always looking for long terms solutions that not only result in weight loss but that result in long-lasting weight loss (not just temporary weight loss). 

The reason I let Contrave slip by is that in certain individuals this suppression in appetite can help reduce sugar cravings and reduce cravings for unhealthy and insulinogenic foods in general. 

If you decide to use Contrave please do not use it solely for the purpose of reducing your appetite. 

I recommend that you use Contrave if you are having trouble staying away from sugary foods, sugary beverages, refined carbohydrates, sweets and other foods that stimulate insulin and promote hormone dysregulation. 

It's also important that if you do decide to use Contrave that you make sure you are eating enough food to maintain metabolic balance in your body. 

That means you are consuming enough food to maintain muscle mass while avoiding the hormone changes that occur with calorie restriction. 

thyroid metabolism reset poster for side bar

#5. Reduces Inflammation

​Next on the list is inflammation. 

Contrave, particularly naltrexone, has been shown in certain studies (6) to act as an anti-inflammatory agent.

Why is this important?

Inflammation, in general, promotes certain changes in the body which both promote weight gain and make weight loss more difficult: 

  • Inflammation promotes poor thyroid function leading to high reverse T3 and low free thyroid concentration
  • Inflammation increases appetite
  • Inflammation lowers testosterone which may result in a decrease in muscle mass and therefore metabolism
  • Inflammation promotes the development of leptin resistance
  • Inflammation promotes the development of insulin resistance
  • Inflammation may lead to increased intestinal permeability and changes in bacterial microflora leading to changes in caloric absorption

No matter how you look at it, chronic low-grade inflammation is not something you want going on in your body if you are serious about losing weight. 

Contrave and inflammation

Luckily it's quite easy to check for chronic inflammation through simple blood tests. 

If you think you have inflammation I recommend checking these 3 basic lab tests:

  • CRP (C-reactive protein) - Nonspecific marker of inflammation
  • ESR (erythrocyte sedimentation rate) - Non-specific marker of inflammation
  • Ferritin - Non-specific marker of inflammation, but also a potential marker of iron stores in the body

​If these tests are positive (or flag as high) then you know inflammation is present in your body. 

The next step is to go about finding the source and treating it. ​

Using Contrave as part of a Weight Loss Plan

​So while Contrave definitely stands to benefit some people you need to be realistic about whether or not it will work for you. 

The first thing to do is ​check to see if you are one of the people who would stand to benefit from using it (see list above). 

If you fall into any of those categories does that mean Contrave will definitely work for you?

Not necessarily.

Remember:

There is no magic weight loss pill.

While Contrave acts through a number of mechanisms to help with weight loss it should NEVER be used by itself.

You should always layer several therapies on top of each other to get the best results.

For instance:

If you find that hormones are contributing (like low thyroid) to your weight loss problem, then it makes sense to use a combination of hormones, prescription medications (Like Contrave or Saxenda), supplements and ​lifestyle changes like exercise and a healthy diet. 

​If you walk into weight loss and think you are going to get serious results by just taking an extra pill each day - think again. 

The way to get serious results (I'm talking 50+ pounds of weight loss) like the patients I discuss in my case studies, is to take this layered approach. 

Using Naltrexone for Weight loss by itself

Another question you might be asking is this:

Can I take Naltrexone by itself for weight loss?

And the answer is yes, it can potentially help certain people, even if it isn't used with Wellbutrin.

Many people (and I understand why) would prefer not to interfere with neurotransmitter levels​ if they aren't at all necessary. 

So if you are a person who ISN'T suffering from depression, anxiety or binge eating, you don't necessarily have to use the combination of Wellbutrin plus Naltrexone to get optimal weight loss.

In these situations, you should be able to get many of the benefits by cutting out the Wellbutrin and going straight to the Naltrexone. 

In order to get this prescribed, you will have to ask for "low dose naltrexone" somewhere in the range of 4.5 to 13.5mg per day.

You can learn more about using low dose naltrexone for weight loss and other conditions like autoimmune disease in this post. ​

Combining individual Wellbutrin and Low Dose Naltrexone Prescriptions together​

One of the drawbacks of Contrave (and other newer weight loss medications) is that they are incredibly expensive.

Pharmaceutical companies know that they can charge high prices for newer weight loss medications and they know that some people will be willing to pay those prices.

Unfortunately, most insurance companies don't really cover weight loss medications (not the newer ones) which leaves some people in an unfortunate situation where they can't afford the newer medications. 

​One way to get around this is by simply combining Wellbutrin with low dose naltrexone in two separate prescriptions to get the same benefit. 

Remember:

Contrave is really just a medication which comes two other medications (which allows the pharmaceutical company to patent the medication and charge higher prices).

​You can get around this by getting two separate medications. 

If you choose to go this route you even have more control over the individual dosages which may be beneficial for certain people.

If you go this route try to get ​your medications in the following dose range: 

  • Naltrexone -> Around 4.5 to 12 mg per day
  • Wellbutrin -> 100 to 200mg per day (depending on tolerance and symptoms)

​Over to you 

​Contrave is a newer weight loss medication that works by influencing hormone levels in your body, by manipulating your appetite and by modulating your body set point through your hypothalamus. 

Contrave really is just a combination of two medications: Wellbutrin and Naltrexone.

But just because this is a new weight loss medication doesn't mean it will work for you.

Before you consider using it make sure you check the list of people who stand to benefit the most from this medication!

Now I want to hear from you:

Are you using Contrave?

Has it helped you with weight loss? Why or why not?

Leave your comment below! ​

References (Click to Expand)

This post was most recently updated on February 19th, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

62 thoughts on “How Contrave Helps with Weight Loss + Who should use it”

  1. I have hashimotos and have been incresing weight, no matter what I do. I really need some help regarding this. I’d like to go with combining the two drugs by myself. Please help with the dosage part.

    Thanks
    Vaishnavi

    • How long can you stay on Contrave? I used phentermine & Lost weight & felt great but since it is a controlled substance the doctor took me off it. I did gain weight & Contrave was prescribed. It is not as affective as phentermine but does help to control the craving. If this really works can I stay on it for a longer period of time.

  2. Dr. Childs,

    I have a question about Contrave. To start off I have been having medical issues since I had H1N1 in January 2014. Went from being a healthy individual to being a medical hot mess so to speak. I have fibromyalgia symptoms, joint pain, extreme fatigue among many other symptoms. I was referred to a rheumatologist who is treating me for fibro. I started feeling really bad back in February 2017, tired all the time, run low grade fever off and on, numbness/tingling in hands etc. So I went to my nurse practitioner whom I see for general issues. She decided to run a bunch of labs to see what is going on. My ANA came back positive so she suggested I follow up with my rheumatologist again. He re-ran my labs and said ANA was negative but there was a scleroderma level that was elevated. Sent me for a nerve conduction study and that was it. I was taking contrave at the time he re-ran that blood work but after his tests stopped taking it for a for a few months. Could it have caused my ANA to read differently because my nurse practitioner ran more labs again at the end of May when I was not taking it and ANA was positive. Went back to rheumatologist and he blew me off and said he didn’t trust results from lab and insisted it’s my fibro and wanted me to double up on meds for the pain. I dnt think it is so I went back to my practitioner and we discussed my thyroid. I feel like I have many thyroid symptoms but my TSH is like 2 and Free T4 is .9 so she started me in levothyroxin 25 mg a day. Any suggestions?

    • Hi Beth,

      It’s probably unlikely that contrave caused your elevated ANA, but it’s really impossible to say for sure one way or the other.

  3. Last Thursday I started taking a compound of Naltrexone and Wellbutrin. I was on Phentermine 37.5 for well over a year and a half but it just stopped working. I lost 125 lbs total on the Phentermine but gained 25 back in the past year due to my workload doubling and getting into a relationship. I weighed 295lbs last Thursday when I started taking he Compound and just weighed myself again tonight and weigh 300 lbs with a weight gain of 5 lbs. I have been unusually tired and absolutely Zero motivation but have been forcing myself to be active and have done at least 45 min of activity a day since I started the compound. I also haven’t been eating much at all and have to force myself to eat because I feel nauseous and extremely unhappy if I don’t eat. I don’t understand why I am gaining weight. I am on one pill once a day for now and afraid to up my dose to 2 pills. Please help!!!!

    • Hi Alissa,

      Not all weight loss medications work for everyone, in addition these medications are designed to be used with changes to your diet/exercise, etc. Using these medications without changing anything else rarely results in weight loss.

      • I actually have a pretty active life as well as working on my feet caring for 12 children a day and am on the Fast Metabolism Diet my doctor told me about. After a week it seems to be finally working. I’m not extremely tired anymore and have a little motivation. I gained 5 lbs the first week then suddenly dropped 6 lbs yesterday after weight myself in the morning and evening. I’m thinking my extreme hunger and fatigue was from stopping the Phentermine and starting the new medication. Maybe it just takes some people time for their body to adjust.

  4. I have depression, anxiety, fibromyalgia, and PCOS. My doctor doesn’t think I’m hypothyroid because my labs are in range (with a 17 rt3) but the medication helps with my joint pain. I’m 210 lbs and unable to lose weight. I have a history of disordered eating (periods of starvation, mostly). I’m on a lot of medications for these things but none seem to help enough, and nothing helps with weight loss.

    Some of my medications:
    Effexor 300 mg/day Depression
    Vitamin D-3 2,000 mg/day Depression
    Enskyce Birth Control PCOS
    Armour 60mcg/day Depression/Various
    Liothyronine 12.5 mcg/day Depression/Various
    Myo-Inositol powder 2g twice a day PCOS/Various
    Brazil nuts (estimated 204-272 mcg selenium)/day Thyroid

    I also take a multivitamin and some blood pressure meds.

    Would you recommend adding wellbutrin+naltrexone to my medications? It seems like it has positive effects on a lot of things I’m dealing with. If not, do you have any other recommendations?

    Thank you for your time,

    -Jessie

  5. Ive currently been on contrave since October 2016. Ive had good results in that I’ve lost 30lb. I was also going through a very stressful time. The past couple months the contrave does not seem as effective as it used to be. My stress levels have decrease to very minimal and I’ve found I’ve put some weight back on. I can not find any research on if I should continue with it and it will regain its effectiveness,or if I should discontinue.

  6. Today is January 3, 2018.

    A little history of me. I’ve struggled with weight my whole life. Looking back (and looking at my granddaughter who is actually heavier than I was at her age and seeing how healthy and great she looks) I know that I struggled even when I wasn’t overweight. I was larger than other girls my age, and more mature looking, and I related that to being too fat. I was 5’6″ and 150 pounds when I graduated from high school and stayed at that until I had a foot surgery a year later. I gained 6 pounds in a week. My mother took me to a weight loss meeting with her and I joined and lost 16 pounds that summer. I was at 139 and 4 pounds heavier than the doctor had set my goal. I however, wanted to be 125. Anyway, I had reached a plateau and continued to eat less and less, trying to lose more. I eventually was eating about 600 calories a day and still not losing. Of course, I couldn’t stick to that, so I would have moments of weakness and binge. I would then make myself throw up.

    I became scared of that behavior and quit the purging. So, since I was unable to stop the occasional binge, I started gaining. I gained 40 pounds in 4 months. I am 62 years old and have never been below 172 the rest of my life. If only it had stopped there!

    Fast forward through single motherhood and multiple diets and weight loss and gain. I went to Weight Watchers in 2005 at 264 pounds. I lost 60 pounds the first year, an additional 32 in the second year. I needed a hysterectomy, and went for that in September 2007. I asked to keep my ovaries since I had never had any problems other than large fibroid tumors that led to excessive bleeding and painful intercourse. My doctor advised me that there was too much risk they would have to go back in and I should have them removed. I went with her advice, since she was the educated one. I’ve never regretted anything more in my life.

    I had had a major surgery before and had no appetite for weeks afterwards. I awoke from this surgery hungry. Within a few weeks, they had to increase the estrogen they had given me. By the time my appetite and leg cramps were under control (I don’t know why those were my major symptom and I’ve never had hot flashes!) they were giving me 3 times what they started me on and I was back up to 264 pounds. They only gave me estrogen. My blood pressure was also elevated during my surgery so they started me on blood pressure medications which I am still on. I have tried several, but have been on Atenol and HTZ for several years now. My blood pressure was never really down to what it should be on that, but attempts at others usually resulted in side effects or extremely high blood pressure (Amlodipine rocketed it up to 226/113 on the very first, and last day).

    By April 2017, I was miserable. Swollen legs (cankles!) dry cough, dry EVERYTHING… eyes, skin, vagina, fighting hemorrhoids, symptoms of UTI but negative results… miserable. My doctors would ask how my hot flashes were doing, and when I said I didn’t have hot flashes, all other symptoms seemed to be disregarded. I had reached 305 pounds in 2015, and got down to 255 but was almost back up to the 305 by this point. I got word of a doctor an hour away who was helping many people who had problems like mine. I started seeing her in April 2017. She has been a Godsend.

    She started me on hormone shots… first testosterone with just a little bit of estrogen, then dropping the estrogen and only adding a little when my symptoms seem to need it. She also gave me Metformin for insulin resistance. I felt much better, but no weight loss. I had asked my PCP for something to help with weight loss, and also something for overactive bladder. Her reply was that all those medications increased blood pressure so I couldn’t take them. I asked my new doctor about Belviq, for which I had seen commercials and read that it generally did not raise blood pressure. She said, “Sure, we can try something. We’ll just watch your blood pressure and change things if there are problems. But I have had better luck with Contrave.” It was the first I had heard of it. She started me on 150 mg Buproprion twice a day, and sent my Naltrexone prescription to be compounded so I could take 4.5 mg. I went ahead and started B while waiting for the N.

    Within 3 days, I felt like something was better, but I asked myself if I was sure. I usually did very well on diets to start, but couldn’t maintain my dedication. So was this just my “determined” state? I noticed I didn’t go to the kitchen just “wanting something” like I usually did. But two things happened to convince me it was something different. I live about a half hour from my preferred grocery store. Any time I went, I would get something to snack on during the drive home. Usually this was chips or trail mix or some kind of candy or cookies. Usually they were pretty much gone by the time I was 5 minutes into my drive home. This day, I got strawberries, because, after all, I was being good. I was almost home before I glanced at the seat beside me and realized I never even opened the strawberries, and didn’t think of them once! Then I went to my granddaughter’s softball tournament. I always ate sunflower seeds during games. I entered them into my meal plan, allowing for them because I knew I would want them. I ate a few, about 6 or so, and laid them aside, intending to pick them back up and eat more. It was 2 games later before I realized I never picked them back up! We finished the season and I have not had any sunflower seeds at all since that day. I haven’t wanted them.

    What I have found is that I no longer have cravings that lead me to the kitchen. Because I was always trying to be “good” there would be stretches when I didn’t have anything to satisfy those cravings, and I would get creative. And often starting with carrots or celery sticks, but advancing to things with sugar… cinnamon toast or stuffing my mouth full of marshmallows. One time I had some almond bark in the freezer. I am amazed I didn’t cut a finger off chopping off pieces! And what I had noticed for years was that, as I was bingeing, I would be reminding myself that I wasn’t going to do this, and it was like a wall would slam down and shut off my thoughts of control and willpower. I don’t do that any more. I started on Buproprion on July 7. I have lost 53 pounds to date.

    Because the B was working, I didn’t add the Naltrexone until after I had lost 35 pounds. At that point, I noticed that, although I didn’t have cravings, I was no longer stopping myself when I was satisfied, and was eating more at meals. The N has helped with that, but my true “miracle” came from B. Oh, and it also helped immensely with my overactive bladder (a rare side effect, I understand). I am now taking 150 mg Buproprion ER twice a day, and 25 mg Naltrexone, just in the morning. And my blood pressure, although not perfect, is certainly no worse, and sometimes really great. That never happened before. But, in fairness, I also educated myself more on the diet for it and have been watching sodium much closer and adding beet powder to my smoothies.

    I know I have been very long winded and this is too much to post in your comments, but there is even more to the story. I will stop now.

    Lana

    • Hi Lana,

      Thanks for sharing your story! It can be very helpful for other patients to know that other people are experiencing similar or even the same type of issues.

      • Dr. Childs,

        A follow up. It is now Nov. 13, 2018. I have lost 96#, even though my set-point seems to have set in. Shortly after my last post, I began having sciatic nerve pain and read in a support group that some people got that from Naltrexone. So I reverted back to just Bupropion. I have just started N again, cutting my 50 mg pills into 8 pieces and taking one piece a day, hoping for help at resetting my set point. I still need to lose close to 50#, but things are SO much better at 207 than they were at 305!

    • Hi Lana,
      I just came across this forum, I started taking Contrave 3 days ago. Your post has been extremely helpful to me. I just turned 60 years old and have experienced many of the same symptoms and behaviors that you share about. I am finding myself having a different attitude towards food, like you explained. However, I do have some other issues and wondered how you found the doctor who is helping you? You mentioned that “you got word of a doctor who was helping many people who had problems like yours”. My doctor is ok, he sent me to see a behavioral health specialist when I explained my issues with food and weight (I have the same as what you explained), the behavior specialist is the one who suggested to him that I try Contrave. When I asked if I could keep seeing her, I was told that she isn’t a primary doctor and would not be able to see her regularly. If you can explain how you found the doctor you’re seeing, it would be most helpful. thanks!

  7. Hello, I started using Contrave in October of 2017. As of the end of December, I have lost 25 pounds. My doctor started me with the full dose day one and I have not had any severe symptoms. The most enduring symptoms seem to be constipation (I now take miralax daily) and dry mouth (I just drink more—all day). I did not have nausea or severe head aches.

    For me it has been a godsend. It does work to reduce my appetite, but more importantly, it reduces my cravings and desire to binge eat. I even lost 1 pound through the Christmas Holidays. Most days I eat a reduced calorie diet, but I have still eaten many non-diet foods and just eat less—far less. It has been years since I actually felt my stomach give me the “I am full” signal. And at a healthy stopping point!

    I do suffer from anxiety and take a daily does of Cymbalta for that. I also have hypothyroidism and take a very small daily dose of synthroid. Other than that, I have mostly weight-related issues.

    As the article says, it may not work for everyone, but it does work for some—and I am glad that I am one of them.

    • Hi Amy,

      I am glad it is working for you, but I would definitely be careful with the food intake. If you use Contrave primarily as an appetite suppressant then when you stop the medication all of your weight may return. You can prevent this by also taking other weight loss steps such as dietary changes, exercise changes and so on.

  8. I took 450 mg Wellbutrin XL for years – the brand, because the mechanism for the release of the generic never worked for me. Then the price gauging for the brand happened a year ago, and I could no longer get the brand. So once again I tried the generic buproprion immediate release and slow release. Could only manage to tolerate 200 mg buproprion SR without getting unmanageable insomnia/anxiety. Didn’t control depression well and also gained 40 lbs over that year! Now I’m excited to be going back to my old dosage on the brand (manufacturer discount program), and adding Naltrexone to help with the weight. I fall within the “type” that it should help. I was prescribed 50 mg Naltrexone… I’m wondering if that’s too much and I should ask for a lower dose? Is LDN necessary for the weight loss benefits, or do people see results with higher doses?

    • Hi BJ,

      Like other medications it appears to be dose dependent but based on the individual. Some people do fine on 50mg while others tend to benefit more from smaller doses. I always start small and titrate up slowly.

  9. Hi! Just started seeing a hormone specialist. So she put me on the Contrave, while also putting me on Naturthroid and injecting a testosterone pellet. I currently take Adderall (20MG) and Effexor (150mg). I am 46 and really struggling in weightloss and libido. I was told to get off the Effexor cold turkey. Since starting, Thursday, I have been a COMPLETE mess. To much to soon? Bad combo?

    • Hey JWick,

      It’s impossible to say for sure without exact symptoms but it could absolutely be from doing too much too quickly or simply because of withdrawal symptoms from the Effexor or a combination of both.

  10. I have been on contrave for about 6 months. I am a prime candidate for all the things that this drug will help. I feel more in control of my eating. My thyroid feels like it is working more normally. I have lost 45 pounds without any drastic dietary restrictions. I have no negative side effects (except dry mouth) and feel like I have a new lease on life. My kids tell me I am fiesty again!!!

    • Hi Brenda,

      Thanks for sharing and glad it is working for you! The key to using these medications is to fit them to the individual and it seems that you have done exactly that.

  11. I have had success with Contrave. My thyroid was “destroyed” by radioactive iodine in January 2010. I had a toxic nodule and I chose the RI over surgery. (Not sure that was the best choice but hindsight is 20/20) I later found out that my parathyroid’s were affected as well. I did not have any significant weight gain for the first 3 years. Diet was the same, activity level was the same, just a higher stress level. The weight seemed to occur in 7 to 8 pounds at a time, usually over a month. It would plateau and several months later another 7 or 8 pounds. This cycle continued for about 18 months until I had gained 30 pounds. All the while I was increasing exercise and decreasing calories. At times I would gain 4 or 5 pounds in water weight and then lose it but the weight stayed the same. My doctor prescribed Contrave in April of 2015. I almost stopped taking it after the first few days due to side effects but they quickly went away. Over 7 months, I lost 22 pounds and didn’t change anything. (My caloric intake was between 1,200 and 1,400 per day). I stopped taking Contrave in October of 2015, thinking I could continue losing weight without the Rx by diet and exercise alone.(It is a fairly expensive Rx) Within 6 months, I had gained 33 pounds. That brings things up to April 2017. I started taking Contrave again. I lost 25 pounds in 10 months. Concerned that I was approaching the 1 year mark of suggested safe useage, I thought I would work to taper my doseage just as it was increased. Going from 4 pills a day to 3 and then 2 until I eventually was not taking them. As soon as I decreased doseage to 2 pills a day, I gained 5 pounds in a week. So instead of continuing to decrease pills , I increased back to 4 pills a day as directed. I lost 3 pounds in 10 days. I have 20 pounds to lose before I get below the overweight level on the weight chart.

    Some medical history:
    My thyroid levels are rarely normal. My doctor increases and decreases medication based on test results. I mentioned my damaged parathyroid glands. An adrenal panel ran in March of 2016, showed very low cortisol levels. I am currently in perimenopause but have not had a hormonal panel ran for any of those potentially skewed results.

    My stress level has been extremely high in the past several years but is getting better. I have more tools to work with and have learned EFT techniques as well as trying meditation.

    Approaching the 12 month mark, I did not discuss long term useage of Contrave with my doctor and he retired at the end of the year. I am hoping my endocrinologist sees the benefits of Contrave beyond the advertised “diet drug”. With all of my hormonal issues and how it has worked, it must be working on some conversion of my TSH or T3/T4 function. I was told that I could possibly be burning 400 or 500 calories less than normal, due to thyroid issues which could relate to leptin.

    Before Contrave: 1,200 to 1,400 calorie diet. Walk 3 miles a day plus resistance/weight training. Gain weight.

    After Contrave: 1,200 to 1,400 calorie diet. Walk 3 miles a day plus resistance/weight training. Lose weight.

    There has to be something to it!

  12. I’ve been on Contrave for 5 days, I started getting sick, nausea and having a lot bowl movement .felt so nausea I couldn’t go for a walk, would wake up, with a stomach ache…

  13. I’ve been on Contrave since January. I have lost almost 40 lbs without changing much of my lifestyle except for eating. It does suppress my appetite. Some days I seriously can go without eating. The downside to this is my husband has to remind me that he and my little girl have to eat. The only side effects I have experienced are constipation and (now this is a WEIRD one) I have tremors mainly in my right calf muscle. Not constantly, only while at rest but you can literally watch my calf muscled twitch all over in places. I was actually quite worried about this because we look stuff like that up, you see ALS and MS but I went to my Dr. and he did all the motion tests for ALS and everything was normal. He said he’d bet anything it’s just from the meds so if I can endure being super annoyed every night when I have my feet propped up to keep doing what I’ve been doing. I take 4 pills- 2 in the morning and 2 at night. My question is, when do I stop? Will we do a decreasing dose or when I hit my goal will my doctor take me off of it. We never talked about the “after” and he gave me 6 months of refills through July. If anyone knows or has reached their goal I would love to know the next steps you took after. Thanks and I hope everyone has as much success as I have. (Without the weird calf thing…) 🙂

  14. I was diagnosed with Hashimoto’s a little over a month ago and at the suggestion of my PA immediately cut gluten from my diet. This alleviated the chronic joint and muscle pain and fatigue I’d been experiencing for the past year. I just completed my first week of Contrave. I lost approx 7 lbs by changing my diet alone and have lost another 4 since starting Contrave. So far, I am very satisfied and feel better than I have in over a year. On a side note, my insurance would not cover Contrave before my diagnosis of Hashimoto’s.

  15. Hi Dr. Child’s,

    I am 41yr old female. No kids, single. I’ve tried to cook and eat healthy and alternate days of workouts between resistance training (with my own body weight) and cardio (walking 2-3 miles on the track at my gym). I’ve a stressful job (sales and yes, I understand it’s my responsibility to change that) yet I’m doing well at it.

    I’ve gained 30+ pounds since January 2017 and am now over 190lbs. I’ve struggled with cooking and size proportions, I’ve purchased a juicer to gain extra nutrients to help fight off cravings, clean out any toxins, etc.

    Would I be a good candidate to talk with my doctor about getting a prescription of Contrave? I hate the idea of taking a prescription weight loss pill but I know that weight and age play a factor. Any suggesstions would be helpful. Thank you!

    Sincerely,

    Colleen Farrell

  16. Dear Dr. Child’s,
    I am a 66 yo female that started taking Contrave in January 2018. I started at 293 with a current weight of 251. The very first pill stopped my horrible craving for sugar! I have eaten no deserts, candy or anything with added sugar since that first pill. I have had no side effects besides constipation. I take one pill at mid morning one day and the next day I take one mid morning and 1 pill late afternoon. More Wellbutrin gives me terrible insomnia and my cravings and binge eating are controlled with this dose. I also started on a small dose of thyroid mid January due to my lab work. I was depressed and didn’t realize it. My mood and outlook are much improved. My joint and hip pain has also significantly improved to the point that I can walk my dogs and work in my garden. This is truly a miracle for me. I finally feel like I am in control of my life.
    Thank you for your interest,
    Cordell

  17. Greeting, I have been using Contrave (C) for 3 months, and have lost 45 lbs. C is almost a miracle drug; I have suffered from chronic obesity all of my life. My BMI was at 35%. Taking C I find that I have no desire to overeat, and can easily control my caloric intake. Also, I am following Weight Watchers. I have never had a particularly strong desire for sweets, and can easily avoid them altogether. Even before C, I did not drink soft drinks or sugary beverages. My intent is to use C until I reach my goal weight, then wean myself off C, and hopefully succeed with Weight Watchers. C has some interesting side effects, for the first 10 days, I had a foggy-fuzzy mental feeling but I could function and that went away. However, C seems to have caused a mild tinnitus that I can live with. I hope the latter is not permanent. The literature on C says that both of my particular side effects are known and normal. Ideally I would prefer to use C until I reach goal weight, and then discontinue use. I would consider using C for maintenance if necessary.

    • Hi Eddie,

      It might be worth exploring other medications such as Saxenda if you are experiencing the side effects you listed. The goal would be to temporarily take a medication to help with weight loss while not experiencing any negative side effects or at least limiting/mitigating the potential negative side effects of the medication.

    • Hi Chantal,

      Dosing frequency depends on whether you use the combination medication or if you use each medication individually.

      • Hi!

        I use Contrave now, but I would like to try with Wellbutrin and Naltrexone individually. My physician is not familiar with this.

    • Hi Lisa,

      Not really, it’s certainly possible to use it temporarily to help with weight loss then stop it and that would be the goal.

  18. Do you suggest Contrave be taken intermittently (no more than 2-3 days per week like you indicate Phentermine should be taken) or does this med need to be taken daily? If daily, how can weight a plateau be overcome? Can Contrave be taken indefinitely or should it be stopped when you plateau or reach your weight loss goal?

  19. Hello Dr. Childs:

    I have been on Contrave since October 2017. I have lost 57 pounds over that time. Contrave has helped with cravings…..I just don’t seem to have them much. I started with 2 pills in the morning and 2 in the evening (my doctor did not know about tapering) My only real side affect is constipation.

    I just recently started taking your T-3 Booster about 2 weeks ago. Now….I seem to be slipping…not as much in control. I am worried about backsliding. I still need to lose another 35-40 pounds. Do you have any suggestions?

    Amy

    • Hi Amy,

      If you’ve reached a plateau then you may need to consider combination supplements and/or different weight loss medications to help. To control cravings you may find success with supplements such as L-glutamine or glucomannan.

  20. This is an excellent article. It seems this drug effects everyone differently. I’m only on day four and have seen a tremendous difference in my emotional eating. I’m much calmer and my mind is not spinning around and out of control. I don’t have depression but I’m a very energetic person. At night I binge eat because of the stresses in my life. This pill has strangely helped me be calmer and when I eat I don’t feel the need to binge. It’s really like night and day. Also I’m in the hospitality industry and people aren’t grating my nerves as bad it really is amazing. I’m on cloud nine but not loopy. Good luck to everyone out there.

  21. Hi,
    I have severe endometriosis and hypothyroidism (sort of go hand in hand). I had been eating very well for years- GF to avoid inflammation and lean proteins and a lot of vegetables. My endo has been increasingly getting worse and over the last four years weight has just creeped on despite a very healthy diet and a solid fitness program. Because I can not manage synthetic hormones at all I have relied on natural remedies and vitamin supplements to help manage it.

    In general I look ok but kept telling my DR. the weight gain was killing me b/c nothing I was doing was helping. I switched to a plant based diet to try and reduce inflammation and to try and reduce markers for Lupus which are inconclusive. I was pretty desperate and just wanted to eliminate hormones. After 4 months of a plant based GF diet I had zero weight loss and maybe some weight gain. I thought I was going crazy, I knew I was eating well and exercising but knew the weight was creeping up, I thought I had gained about 25lbs but to my horror I was up 40lbs. My Dr. prescribed Contrave even though I am at the lower end of BMI reco and it seemed extreme in a way but it has been the best course of treatment ever.

    I have been on Contrave for about 7 weeks & the weight is just melting off. My diet is almost the same BUT I do have less sugar cravings. (YAY). Before I would have cravings and would treat myself to a small amount of sugar to abate it, but now they are much much less. I did have nausea and dry mouth (but these are not as noticeable as when I first started). I probably have lost 15 pounds in under 2 months and I am thrilled. My dose is only 2 pills a day as I haven’t needed to move it up as the results are still coming.

    I am still am eating well and exercising and my mental state is greatly improved because I just feel better about myself. Fingers crossed I can adjust my set point and when I reach my goal weight I can successfully stop taking meds and have by body function restored.

    I get it is not for everyone but for those who are struggling and their body and hormones are highly dysfunctional this seems to be a magic bullet (in conjunction with a healthy diet and exercise). Thank you for this article and others as another article similar to this lead my to push my Dr. for a deeper look at my weight gain .

    This article checks literally 90% of the boxes for me and is a great explanation as to why Contrave is working for me.

  22. Just starting week 2 of Contrave. This week I will take one in the morning and one at night. Haven’t noticed any difference but I know it takes time. I am a gastric bypass patient. I lost 170 lbs 10 years ago with the surgery. I have regained 70 lbs. My stomach size still limits amounts I can eat, but my problem is sweets and carbs…potatoes, bread etc. As a bypass patient, I am not supposed to take extended release medications, but I am giving it a try. Do you think I could safely cut the tablets in half to improve absorption?
    And one more question…I am also taking Lexapro. Are there any issues with interaction and what should I look for if so. Your article was extremely helpful! I look forward to reading more! Thank you!

  23. I was using Contrave along with doing the “17-day diet” and I lost 5% of my body weight. Then started gradually gaining weight back while still on Contrave. Just started Contrave again. I binge eat at night and need help controlling it. I eat very healthy and moderately all day long. Would it be better for me to take just one Comtrave in the morning and take 2 at dinner and one more around 9 pm?

    • Hi Sharon,

      You can play around with the dosing (with your doctor) to see what works best for you. You’ll find you may do really well on that dosing schedule.

  24. I have been taking Contrave for 4 weeks with no results, I’m wondering if taking Armour for my Thyroid may be interfering?

  25. This is my first month on Contrave and I have already lost 7pds. I have the emotional binge eating issue but no more! However, it seems recently that I have extreme nausea after taking it in the morning and it hangs around all day which is making me miserable! So now I’m wondering if I should just try the bupropion alone? I need relief from the nausea because I just can’t function feeling like this all day. Any advice? Thanks!

  26. I had gastric sleeve in June 2012. Did wonderful until end of 2017. It seemed no matter how I ate I would gain a pound steadily every time I stepped on a scale. Food addition, binge eating thoughts had crept back in. I am an RN and feel overall I have been very faithful to my sleeve diet and exercise program. Not perfect but do well 90% of the time. Frustrated, I turned to my primary physician who started me on Contrave. It has been a God send. I have lost the 25 lbs I had gained and have had no trouble keeping it off. My body just started dropping the weight. I also have felt more in control of my eating thoughts. I am 5’4 and at 135 feel comfortable again. I know it doesn’t work for everyone but it sure has for me.

  27. Hi Dr. Childs,

    Thank you so much for such an informative article.

    I am on day 8 of Contrave (just started 2 pills a day) and can’t say I’ve felt very different. I’m wondering if you could speak to how quickly people typically start to feel any different?

    Some more about me: I started binge eating about 12 years ago when I was severely restricting my calories to lose weight. In the last ~2 years, I gained about 20 Lbs without much change to diet or exercise. I started to investigate and found out I have PCOS, low-grade inflammation and hypothyroidism. Strangely these diagnoses have gotten in my head and made my binge eating worse since nothing I do seems to produce results I’ve just become hopeless in a way and given up.

    Reading everyone’s stories was very inspiring, and this article makes me think id be a perfect candidate for Contrave. But if it doesn’t end up working for me, is there another medication you would recommend? Or maybe I can play with the dosing and increase the Wellbutrin to help w the BED? I know Vyvanse is the only approved drug for BED but it gave me crazy insomnia. At this point, I’m desperate and will try anything.

    Thanks so much for any recommendations you can make.

    Laura

  28. Dear Dr Childs,
    I took Saxenda for three months and had very good results losing 18 pounds (10% of my body weight). It worked very well in the first month and then my weight loss slowed and I plateaued after three months. I kept taking it for another two months with zero weight loss.
    My doctor switched me to Contrave and I gained 7 pounds in just three weeks before I reached the maximum dose of four tablets!
    I have very high leptin levels = 96; Reverse T3 =31; TSH =3.6; Free T4 = 13; Free T3 = 4.1
    I was prescribed Thyroxine for a short time but I felt absolutely dreadful on it. Should I be taking T3 only?
    Any advice would be very welcome as it is near impossible to find a practitioner with your understanding of hormonal weight gain here in Australia!
    Thank you
    Linda

    • Hi Linda,

      I can’t really give you personal advice but I can tell you that these medications must be used appropriately (in the right doses for the right amount of time) if you want lasting results. Some of this information is expanded upon in my weight loss guide.

  29. Hi Dr Childs,

    You say above that Naltrexone should be taken at 4-12mg/day, but obviously the therapeutic dose in Contrave is 32mg/day. Can you explain This discrepancy? I read a 3 prong RCT where patients were given placebo, wellbutrin 300mg + naltrexone 16mg, or wellbutrin 300mg + naltrexone 32mg and the 32mg naltrexone group lost the most weight.

    Also, Im getting insomnia from the Contrave. Its a side effect of both N+W. In your experience, which one typically is the culprit?

    Thanks!

    Laura

    • Hi Laura,

      Those numbers are based on my own experience using them individually. I find that the lower dosages are just as effective (if not more effective) and carry with them very few if any side effects.

  30. My doctor has recommended Contrave to me because while I had lost 50 lbs. with diet & exercise, I’m gaining it back even while maintaining my new lifestyle habits. I’m concerned about the side effects. Is this a medication I’ll be on for the duration, or is there a maximum time to take this as a treatment? How have patients done with keeping the weight off after they no longer take the medication?

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