Contrave

The most common side effect is nausea, which occurs in roughly 30% of patients during the initial dose-escalation period. Other common side effects include constipation, headache, insomnia, dry mouth, and dizziness. These are typically mild and improve significantly after the first 2–4 weeks as the dose gradually increases to the full maintenance level. Contrave uses a 4-week titration schedule specifically to minimize these early side effects.

PEAK counsels patients to limit or avoid alcohol while taking Contrave. There are two reasons for this: naltrexone blocks opioid receptors, which can blunt the pleasurable effects of alcohol and change how you experience it. More importantly, bupropion lowers the seizure threshold, and alcohol consumption increases seizure risk. Combining alcohol with bupropion raises this risk further. Your clinician will discuss your alcohol use during your consultation and provide specific guidance.

Contrave and phentermine work through entirely different mechanisms. Contrave targets food cravings and the reward response (via naltrexone) while also suppressing appetite and boosting energy (via bupropion). Phentermine is a CNS stimulant that primarily suppresses appetite through norepinephrine release. Contrave is non-stimulant and approved for long-term use, while phentermine is a controlled substance approved for short-term use. Phentermine may work faster, but Contrave may be a better fit for emotional eaters or patients who cannot tolerate stimulants. Read more about medication comparisons.

Contrave and Wegovy have different mechanisms and different levels of efficacy. GLP-1 medications like Wegovy produce significantly more weight loss (approximately 15% of body weight) compared to Contrave (5–6%). However, Wegovy is an injectable medication and is considerably more expensive. Contrave is an oral tablet, is often better covered by insurance, and offers a $99/month Home Delivery program. For some patients, Contrave is prescribed as a step therapy requirement before their insurer will approve Wegovy. Your PEAK clinician will help determine which medication is the right starting point for you. Read the full Contrave vs. Wegovy comparison.

Many commercial insurance plans cover Contrave with prior authorization. The manufacturer also offers a Home Delivery Program at $99/month or less with free shipping. PEAK accepts Anthem, Cigna, Aetna, UnitedHealthcare, Sentara, and TRICARE commercial plans, and does not accept Medicare or Medicaid plans. Visit pricing is $199 for the initial appointment, $135 for follow-up visits, and $75 for dietitian visits. View insurance and pricing details.

Contrave uses a 4-week dose escalation to reach the full maintenance dose. During this period, you start with one tablet per day and gradually increase to four tablets per day (two in the morning, two in the evening). Most patients notice reduced cravings within the first 2–4 weeks. Meaningful, measurable weight loss typically begins by weeks 8–12. If you haven't lost at least 5% of your body weight by week 16, your clinician will reassess and discuss alternative approaches.