Contrave Dosing Overview
Contrave is only sold in one strength: Contrave ER 8 mg / 90 mg — 8 mg naltrexone HCl and 90 mg bupropion HCl per extended-release tablet. Dose adjustments are made entirely by changing the number of tablets per day.
The target maintenance dose is 4 tablets per day (2 AM + 2 PM) = 32 mg naltrexone / 360 mg bupropion. Patients do not start at this dose. Contrave uses a 4-week titration schedule to minimize side effects.
Contrave Doses Explained
- Starting dose (Week 1): 1 tablet AM = 8 mg naltrexone / 90 mg bupropion
- Week 2: 1 AM + 1 PM = 16 mg / 180 mg daily
- Week 3: 2 AM + 1 PM = 24 mg / 270 mg daily
- Week 4 and ongoing: 2 AM + 2 PM = 32 mg / 360 mg daily (target)
Contrave 4-Week Titration Chart
Here is the FDA-recommended dosing schedule in visual form:
This titration exists because the full dose would cause intolerable side effects in most patients if started immediately. Bupropion is stimulating; naltrexone slows the gut. Ramping up slowly gives the brain and gut 4 weeks to adapt.
How to Take Contrave
- Swallow whole — do not crush, chew, cut, or dissolve. The extended-release coating controls the absorption rate. Breaking the tablet causes rapid bupropion release and significantly raises seizure risk.
- Take with food — always. Empty-stomach dosing increases nausea without improving efficacy.
- Avoid high-fat meals — especially at the morning dose. High-fat food dramatically raises peak blood levels of both drugs (30–80%), increasing side effects. Moderate- or low-fat meals are ideal.
- Stay consistent — same times every day. This keeps blood levels steady and minimizes breakthrough side effects.
- Hydrate — at least 2 L water daily. Helps with constipation and reduces headaches.
Best Time to Take Contrave (AM and PM)
The FDA labeling specifies "AM" and "PM" dosing but does not prescribe exact clock times. The practical guidance:
Morning dose
Take with breakfast, typically between 7–9 AM. Do not take on an empty stomach. Because bupropion is activating, morning dosing harnesses the stimulation productively.
Evening dose — the tricky one
The evening dose is where most patients get the timing wrong. Because bupropion is a mild stimulant, taking Contrave too close to bedtime causes insomnia. Too early, and you risk skipping dinner (empty stomach → nausea).
Best time to take the evening dose of Contrave: with dinner, ideally 5–7 PM, and no later than 6 hours before your usual bedtime.
If you are a late eater or shift worker, the general rule is: evening dose with a meal, and at least 6 hours before sleep. If this produces insomnia, shift the evening dose earlier.
First Week on Contrave: What to Expect
Week 1 involves just one pill per day. Yet this is often when side effects are most noticeable because your body is experiencing bupropion for the first time.
- Day 1–3: Possible mild nausea, headache, dry mouth, slight jitteriness
- Day 4–7: Your body begins to adapt. Most patients find side effects decrease
- Weight effects: Minimal in week 1 — no meaningful appetite suppression yet at 90 mg bupropion
If week 1 is intolerable, do not proceed to week 2. Contact your prescriber. Some patients stay at the week 1 dose longer (2 weeks) before titrating up.
Missed Dose of Contrave
- If you miss a dose, skip it and resume your normal schedule. Do not take two doses at the same time.
- If you miss several doses or stop for 1–2 weeks, you may need to re-titrate. Consult your prescriber.
- Doubling up on a missed dose significantly increases seizure risk. Never try to "catch up."
Dose Adjustments and Special Situations
Renal impairment (kidney disease)
Moderate-to-severe renal impairment: maximum dose is 2 tablets per day (1 AM + 1 PM). End-stage renal disease: Contrave is not recommended.
Hepatic impairment (liver disease)
Mild hepatic impairment: no adjustment. Moderate-to-severe: maximum 1 tablet AM only. Severe impairment: not recommended.
CYP2B6 inhibitors
Strong CYP2B6 inhibitors (ticlopidine, clopidogrel) can increase bupropion levels. Maximum dose: 2 tablets per day.
12-week rule
If you have not lost at least 5% of baseline body weight after 12 weeks at target dose, discontinue Contrave. This is an FDA-specified criterion — continuing beyond this point without meaningful loss is unlikely to succeed.
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| Dosing Feature | Contrave | Semaglutide (Wegovy) | Tirzepatide (Zepbound) |
|---|---|---|---|
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| Frequency | 4 pills/day | 1 injection/week | 1 injection/week |
| Titration duration | 4 weeks | 16 weeks | 20 weeks |
| Food restrictions | Must take with food; avoid high-fat | Any time, any meal | Any time, any meal |
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| Alcohol | Avoid | Moderation OK | Moderation OK |
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Frequently Asked Questions
What is the correct dosage of Contrave?
The target maintenance dose of Contrave is 32 mg naltrexone / 360 mg bupropion daily, taken as 2 tablets in the morning and 2 tablets in the evening (8/90 mg each). Patients reach this dose via a 4-week titration schedule starting at 1 tablet per day.
What is the best time to take the evening dose of Contrave?
Take the evening dose of Contrave with the evening meal, at least 6–8 hours after the morning dose. Avoid taking it too close to bedtime, as bupropion can cause insomnia. A common schedule is 8 AM and 5 PM with meals.
When is the best time to take Contrave?
Take Contrave with food — ideally a low- to moderate-fat meal. Avoid high-fat meals, which cause a 30–80% increase in peak levels and can increase side effects. The morning dose is best with breakfast; the evening dose with dinner.
How do you take Contrave for best results?
Swallow tablets whole. Do not crush, cut, or chew. Take with meals to reduce nausea. Stay hydrated and maintain adequate fiber to mitigate constipation. Complete the full 4-week titration even if early side effects are uncomfortable — most ease by week 4.
Should I take Contrave on an empty stomach?
No. Taking Contrave on an empty stomach increases nausea and does not improve efficacy. Always take with food — ideally not a high-fat meal (which increases peak blood levels and side effects).
What happens during the first week on Contrave?
In week 1, you take only 1 tablet (8 mg naltrexone / 90 mg bupropion) each morning. This starting dose is designed to introduce bupropion gradually. Expect possible nausea, headache, or mild insomnia. These usually subside by the end of week 2.