The most common Contrave side effects reported in its FDA label are nausea, constipation, headache, vomiting, dizziness, insomnia and dry mouth. Contrave also carries a boxed warning. telos rx does not sell Contrave, and offers a separate compounded oral GLP-1 option.
Contrave is FDA-approved and for some people it works. It also carries a boxed warning and a long contraindication list, so its safety section deserves reading properly. What follows comes from the current label and the pivotal trial, not medical advice.
What Contrave Is, in One Paragraph
Contrave is an extended-release tablet combining naltrexone hydrochloride and bupropion hydrochloride, 8 mg and 90 mg per tablet. It is indicated alongside a reduced-calorie diet and increased physical activity for adults with obesity, or overweight with at least one weight-related comorbid condition. Its side effects are essentially those of both ingredients together, set out in how naltrexone and bupropion work. One correction: Contrave is not a GLP-1 and does not act on GLP-1 receptors.
Side Effects of Contrave Reported in the Clinical Trials
The label pools five placebo-controlled trials in 4,754 patients, treated up to 56 weeks. Below are the most frequent reactions reported by at least 2 percent of patients, and more often than placebo.
| Adverse reaction | Contrave (n=2,545) | Placebo (n=1,515) |
|---|---|---|
| Nausea | 32.5% | 6.7% |
| Constipation | 19.2% | 7.2% |
| Headache | 17.6% | 10.4% |
| Vomiting | 10.7% | 2.9% |
| Dizziness | 9.9% | 3.4% |
| Insomnia | 9.2% | 5.9% |
| Dry mouth | 8.1% | 2.3% |
| Diarrhea | 7.1% | 5.2% |
Contrave nausea is the most reported effect and the most common reason people stopped. In those trials, 24% on Contrave discontinued for an adverse event against 12% on placebo, nausea accounting for 6.3%. The COR-I trial in the Lancet reported nausea in 29.8% against 5.3%. These are findings in a studied population, not a forecast for any individual.
The Boxed Warning for Suicidal Thoughts and Behaviors
Contrave carries a boxed warning, the FDA's most serious warning format, for suicidal thoughts and behaviors. The reason is bupropion, the same active ingredient as antidepressants including Wellbutrin. Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents and young adults in short-term trials.
The label is precise about that finding's boundaries: no increased risk was shown over age 24, and risk fell in people aged 65 and older. In Contrave's own obesity trials, suicidal ideation was reported by 1 of 3,239 patients against 3 of 1,515 on placebo.
The warning stands, and what it asks for is monitoring: patients of all ages watched closely for worsening mood and emerging suicidal thoughts, with families and caregivers in contact with the prescriber. Contrave is not approved for use in pediatric patients, nor for treating depression.
If you are having thoughts of suicide or are in crisis, call or text 988 to reach the US Suicide and Crisis Lifeline, free and available at any hour. If your mood changes on any medicine, tell your prescriber. The National Institute of Mental Health lists warning signs plainly.
Contrave and Blood Pressure and Heart Rate
Contrave can raise blood pressure and resting heart rate, though the measured effect was modest. Mean blood pressure ran roughly 1 mmHg above baseline at weeks 4 and 8, then about 1 mmHg below baseline by weeks 24 to 56, but because placebo dropped further the difference reached significance at every assessment. Heart rate ran about 2.1 bpm above placebo early on.
The label is candid that the significance of this is unclear, especially in cardiac disease, since patients with recent myocardial infarction or stroke, life-threatening arrhythmias or heart failure were excluded. Pressure and pulse should be checked before starting and monitored after, and uncontrolled hypertension is a contraindication, not a caution.
Seizure Risk and Why the Contraindications Exist
Bupropion can cause seizures and the risk is dose-related. Incidence in Contrave trials was approximately 0.1% against 0% on placebo, and the label states it should be discontinued and not restarted after a seizure.
Most of the contraindication list traces back to this one property. A seizure disorder raises baseline risk. Bulimia and anorexia nervosa raise it through electrolyte disturbance. Abruptly stopping alcohol, benzodiazepines, barbiturates or antiepileptic drugs lowers the seizure threshold. The label separately urges caution around prior head trauma and other threshold-lowering medicines.
telos rx does not sell or prescribe Contrave. What we do offer is a different oral option: a compounded oral GLP-1 taken daily under the tongue, not FDA-approved, working through a separate mechanism with its own safety profile.
See the oral GLP-1 optionWho Should Not Take Contrave
The label contraindicates Contrave in any of the following. This is orientation only; a prescriber assesses it properly.
- Uncontrolled hypertension.
- A seizure disorder or a history of seizures.
- Bulimia or anorexia nervosa, current or previously diagnosed.
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates or antiepileptic drugs.
- Chronic opioid use, including methadone and buprenorphine, or acute opiate withdrawal.
- Other bupropion-containing products, including Wellbutrin and Zyban.
- MAOI use, currently or within the previous 14 days.
- Known allergy to bupropion, naltrexone or any component.
Pregnancy is often misreported here: it is not a listed contraindication in the current label. The label says weight loss offers no benefit in pregnancy and may cause fetal harm, and that Contrave should be discontinued when a pregnancy is recognised.
Wellbutrin Side Effects and the Overlap
Searches for Wellbutrin side effects and for Contrave safety circle the same pharmacology. Because bupropion is shared, the insomnia, dry mouth, headache, tremor and seizure considerations carry across, and taking both together is contraindicated. The naltrexone half adds hepatotoxicity signals and the opioid interaction, unpacked in Contrave vs Wellbutrin.
Titration, Reported as Label Fact
The label describes an escalation over four weeks to a maintenance dose of two tablets twice daily, partly to limit seizure risk. That is label information, not guidance; only your prescribing clinician decides what you take. Detail sits in the four-week titration, efficacy in what the trials found.
If Contrave Is Not an Option, What Else Exists
Plenty of people read a page like this, recognise themselves in the contraindications, and ask what is left. Other approved options exist, compared in Contrave vs Qsymia vs phentermine and priced in Contrave cost with and without insurance.
GLP-1 medicines are a different class, acting on GLP-1 receptors rather than the appetite and reward pathways Contrave targets, as explained in how GLP-1 medicines work, and they carry their own adverse effects, set out in GLP-1 side effects research. No head-to-head trial comparing the two is cited here; the trials behind each ran in different populations under different protocols.
telos rx offers compounded oral semaglutide and oral tirzepatide, a daily dose held under the tongue for about 60 to 90 seconds then swallowed, with ondansetron included. Sublingual absorption is lower than an injection and the provider sets the dose accordingly, a trade-off covered in oral vs injectable GLP-1.
The honest regulatory point: Contrave is FDA-approved and the compounded oral GLP-1 from telos rx is not. Compounded medicines are prepared by licensed US compounding pharmacies under federal compounding regulations against a prescription for an individual patient, without the FDA's own review of safety and effectiveness. That is a genuine advantage for Contrave.
Both are prescription-only. telos rx is online-first and asynchronous: you complete a written intake and a licensed provider reviews it in writing, subject to medical approval by a licensed provider, and approval is not guaranteed. Eligibility generally starts at a BMI of 30 or higher, or 27 or higher with a weight-related condition. As of publication, plans start from $9 a day on the prepaid 3-month plan, with the visit, expedited shipping and ondansetron included.
Frequently Asked Questions
What are the most common side effects of Contrave?
Nausea leads, reported by 32.5% of patients in pooled label trials against 6.7% on placebo. Constipation, headache, vomiting, dizziness, insomnia, dry mouth and diarrhea follow. Nausea was also the top reason people stopped. Discuss any effect with your prescribing clinician.
Why does Contrave have a boxed warning?
Because it contains bupropion, the same active ingredient as some antidepressants. Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents and young adults in short-term trials. The warning directs close monitoring for worsening mood at all ages. Contrave is not approved for pediatric use.
Does Contrave raise blood pressure?
It can raise both blood pressure and resting heart rate, though average changes in trials were small, around 1 mmHg and about 2 bpm above placebo early on. Pressure and pulse should be checked before starting and monitored after. Uncontrolled hypertension is contraindicated.
Who should not take Contrave?
The label contraindicates it in uncontrolled hypertension, seizure disorder or history, bulimia or anorexia nervosa, abrupt withdrawal from alcohol, benzodiazepines, barbiturates or antiepileptic drugs, chronic opioid use, other bupropion products, MAOI use within 14 days, and known allergy to any component. A prescriber assesses this individually.
Can Contrave cause seizures?
Yes. Bupropion can cause seizures and the risk is dose-related. Incidence in Contrave trials was approximately 0.1% against 0% on placebo. The label states Contrave should be discontinued and not restarted after a seizure. Much of the contraindication list exists to keep this risk low overall.
Is Contrave a GLP-1 medication?
No. Contrave combines naltrexone and bupropion and does not act on GLP-1 receptors. It is thought to work on appetite regulation and reward pathways instead. Its side effects and contraindications differ genuinely from those of GLP-1 medicines, so the two should not be assumed alike.
Safety information here comes from the Contrave prescribing information on DailyMed, revised November 2025. Labels change; check the current version.
TelosRX is LegitScript-certified. Compounded medications are not FDA-approved and are prepared under federal compounding regulations. Approval is subject to evaluation by a licensed provider; approval is not guaranteed. Individual results vary. TelosRX operates as an online-first, asynchronous telehealth service.
If Contrave is not right for you and you want a different mechanism, the telos rx oral GLP-1 page explains what compounded oral semaglutide and tirzepatide involve, including that they are not FDA-approved. When you are ready, start an online visit for the oral GLP-1. This is not a route to Contrave, and a licensed provider reviews every request.