Contrave is taken as a tablet twice daily, building up gradually over four weeks to the full dose. Each tablet contains two active ingredients that work together on appetite and craving centers in the brain. Getting the dosing schedule, timing, and food pairing right matters for both effectiveness and minimizing side effects.
The 4-Week Dose Build-Up
You don’t start at the full dose. Contrave uses a weekly escalation schedule that lets your body adjust gradually:
- Week 1: 1 tablet in the morning, nothing in the evening
- Week 2: 1 tablet in the morning, 1 tablet in the evening
- Week 3: 2 tablets in the morning, 1 tablet in the evening
- Week 4 onward: 2 tablets in the morning, 2 tablets in the evening
The full maintenance dose is 4 tablets per day, split into two doses. This is the maximum recommended amount. Resist the urge to speed up the schedule, even if side effects feel mild in the first week or two. The gradual ramp-up is specifically designed to reduce nausea, which is the most common reason people stop taking the medication early.
When and How to Take Each Dose
Swallow the tablets whole. Do not crush, chew, or cut them, as this breaks the extended-release coating and can dump the full dose into your system at once.
One important rule: avoid taking Contrave with a high-fat meal. When taken alongside fatty food, the absorption of one of its active ingredients nearly doubles (a 1.9-fold increase in peak blood levels). This spike raises the risk of side effects, particularly seizures. A moderate or low-fat meal is fine, and many people find that taking it with some food helps with nausea. Just skip the bacon-and-eggs breakfast on dosing mornings.
Try to keep your morning and evening doses roughly consistent in timing. If you miss a dose and it’s almost time for the next one, skip the missed dose and continue your regular schedule. Never double up to compensate.
How Contrave Works in Your Brain
The two ingredients in each tablet target different parts of the brain’s appetite system. One (bupropion) activates specific neurons in the hunger-regulation center of the brain, the same neurons responsible for suppressing appetite when you’ve eaten enough. These neurons normally shut themselves off after firing for a while, which is where the second ingredient (naltrexone) comes in. It blocks that self-shutdown mechanism, keeping the appetite-suppressing signal going longer than it otherwise would.
The result is reduced hunger and, for many people, fewer food cravings, particularly for high-calorie comfort foods. The combination also acts on the brain’s reward pathways, which is why some of the craving reduction feels more emotional than physical. You may notice that food simply becomes less interesting rather than feeling a dramatic loss of hunger.
The 12-Week Checkpoint
Contrave has a built-in evaluation point. After 12 weeks on the full maintenance dose, you should have lost at least 5% of your starting body weight. If you haven’t hit that threshold, the FDA labeling recommends stopping the medication. The reasoning is straightforward: clinical data shows that people who haven’t responded by 12 weeks are unlikely to see meaningful results with continued use.
This means you should be tracking your weight from the start. The 12-week clock begins once you reach the full 4-tablet-per-day dose in week 4, not from your very first tablet. So in practice, you’re looking at roughly 16 weeks from the day you begin treatment to the point where you and your prescriber evaluate whether it’s working.
Who Should Not Take Contrave
Several conditions make Contrave unsafe. The FDA lists these as firm contraindications:
- Seizure disorders: Any history of seizures rules out Contrave, because bupropion lowers the seizure threshold.
- Eating disorders: Specifically bulimia and anorexia nervosa, which also increase seizure risk with this medication.
- Opioid use: If you take opioid pain medications, use opioid-based addiction treatments, or are in acute opioid withdrawal, naltrexone will either block the opioid from working or trigger sudden withdrawal symptoms.
- Uncontrolled high blood pressure.
- Recent abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs, all of which heighten seizure risk during withdrawal.
- Use of MAO inhibitor medications.
- Other bupropion-containing products: This includes certain antidepressants and smoking cessation aids that already contain the same active ingredient.
Alcohol and Contrave
Drinking while on Contrave is risky for two reasons. First, bupropion lowers your seizure threshold, and alcohol does the same, so the combination compounds that risk. Second, if you’ve been a regular drinker and suddenly stop while taking Contrave, alcohol withdrawal itself can trigger seizures. The safest approach is to minimize or eliminate alcohol entirely while on this medication. If you currently drink heavily, that’s a conversation to have with your prescriber before starting.
Managing Early Side Effects
Nausea is by far the most reported side effect, and it tends to be worst during the first few weeks as you’re ramping up the dose. Taking the tablets with a light meal (not high in fat) helps significantly. For most people, nausea fades as the body adjusts. Constipation, headache, dizziness, and dry mouth are also common in the early weeks.
If side effects are severe during the dose escalation, some prescribers will slow the ramp-up, spending two weeks at a given dose level instead of one. This isn’t part of the standard protocol, but it’s a practical approach that can make the difference between tolerating the medication and abandoning it. The key is reaching the full dose eventually, since the clinical results are based on the maintenance dose of 4 tablets per day.