Contrave and Codeine Drug Interactions: Risks & Warnings

Combining medications can lead to unexpected and potentially dangerous interactions, particularly when they affect the central nervous system, cardiovascular function, or metabolic processes. This is especially true for Contrave and codeine drug interactions, which pose significant health risks due to their opposing mechanisms of action.

Contrave, a prescription medication used for chronic weight management for compatible individuals, contains naltrexone and bupropion, both of which can impact neurotransmitter activity and opioid receptors. Codeine, an opioid analgesic, is commonly prescribed for pain relief and cough suppression, but it also has sedative effects and carries the potential for physical dependence and respiratory depression.

When taken together, these medications can interact in ways that may lead to serious adverse reactions, including an increased risk of seizures, precipitated opioid withdrawal symptoms, and elevated blood pressure. Understanding these interactions is crucial for patients and healthcare providers to prevent potentially life-threatening complications. So, is Contrave the right fit for your weight loss journey?

This article will explore the effects of Contrave and codeine drug interactions, detailing the risks, symptoms, and necessary precautions to ensure safe medication use.

Key Takeaways

• Increased Risk of Seizures: Combining Contrave with codeine may elevate the risk of seizures due to bupropion’s effect on the seizure threshold.
• Potential for Opioid Withdrawal: Naltrexone in Contrave can precipitate withdrawal symptoms in individuals dependent on opioids like codeine.
• Elevated Blood Pressure: The combination may lead to increased blood pressure, necessitating careful monitoring.

What Is Contrave?

Contrave is a prescription medication combining two active ingredients: naltrexone and bupropion. It is primarily used for chronic weight management in certain adults with a body mass index (BMI) of 30 kg/m² or greater (obese) or 27 kg/m² or greater (overweight) with at least one weight-related condition, such as high blood pressure or type 2 diabetes.

Contrave is intended to be used alongside a reduced-calorie diet and increased physical activity.

• Naltrexone: An opioid antagonist that blocks the effects of opioids in the brain.
• Bupropion: A norepinephrine-dopamine reuptake inhibitor commonly used to treat depression and assist with smoking cessation.

Together, these components influence the central nervous system to reduce appetite and control cravings, aiding in weight loss efforts.

What Is Codeine?

Codeine is an opioid analgesic used to treat mild to moderately severe pain and to reduce coughing. It works by converting to morphine in the body, binding to opioid receptors in the brain to decrease the perception of pain and suppress cough reflexes.

As an opioid, codeine carries risks of physical dependence, respiratory depression, and potential for misuse. It is metabolized in the liver by the enzyme CYP2D6 into its active form, morphine.

Key Risks of Contrave and Codeine Interactions

Risk	Description
Seizures	Bupropion in Contrave lowers the seizure threshold, increasing seizure risk when combined with codeine.
Opioid Withdrawal	Naltrexone in Contrave blocks opioid receptors, triggering withdrawal symptoms in opioid-dependent individuals.
Elevated Blood Pressure	Both Contrave and codeine can raise blood pressure, posing a risk for individuals with hypertension.
Respiratory Depression	Codeine can slow breathing, and combining it with Contrave increases the risk of respiratory failure.
Allergic Reactions	Combining these drugs may increase the risk of allergic reactions, including rash, swelling, and breathing difficulties.

Dangers of Combining Contrave and Codeine

Using Contrave and codeine together can lead to several adverse reactions due to their pharmacological interactions:

Risk of Seizures

Bupropion, a component of Contrave, is known to lower the seizure threshold, increasing the likelihood of seizures. Combining bupropion with other drugs that also lower the seizure threshold or with substances that affect the central nervous system can further increase the risk of seizures.

Therefore, concurrent use of Contrave and codeine may elevate this risk.

Opioid Withdrawal Symptoms

Naltrexone in Contrave is an opioid antagonist that blocks opioid receptors. In individuals who regularly use opioids like codeine, naltrexone can precipitate opioid withdrawal symptoms.

These symptoms may occur rapidly and can be severe, including agitation, nausea, vomiting, sweating, and abdominal cramps.

Increased Blood Pressure

Contrave has been associated with increases in blood pressure and heart rate. Combining it with codeine, which can also affect cardiovascular function, may lead to further elevations in blood pressure. Additionally, Contrave and Metoprolol drug interactions can pose similar cardiovascular risks, particularly for individuals managing hypertension with beta-blockers.

This is particularly concerning for individuals with pre-existing high blood pressure or other cardiovascular conditions.

Symptoms of Interaction

When Contrave and codeine are taken together, several symptoms may manifest due to their pharmacological interactions. These symptoms can range from mild discomfort to severe, life-threatening conditions. Understanding these potential effects is crucial for patients taking bupropion and opioids, as some interactions may require immediate medical intervention.

Each symptom is outlined below in detail:

Seizures

The combination of bupropion in Contrave and codeine may significantly lower the seizure threshold, increasing the seizure risk.

Bupropion naltrexone is known to have pro-convulsant properties, which can increase the risk of seizures, especially in individuals with seizure disorders or other risk factors, such as a history of brain tumors or eating disorders.

Symptoms of seizures may include:

• Convulsions or involuntary muscle contractions
• Loss of consciousness
• Sudden confusion or disorientation
• Uncontrolled jerking movements
• Aura (sensory disturbances before a seizure)

People taking other drugs that lower the seizure threshold, such as tricyclic antidepressants, may face an increased risk when using Contrave and codeine together.

Opioid Withdrawal Symptoms

Because naltrexone is an opioid antagonist, it blocks the effects of opioids like codeine. For individuals who have opioid dependence, Contrave can trigger opioid withdrawal symptoms, which may occur suddenly and may be severe.

Patients treated with opioids for chronic pain or opioid withdrawal management should avoid taking Contrave, as the combination can result in rapid and life-threatening withdrawal effects.

Symptoms of opioid withdrawal may include:

• Extreme anxiety or restlessness
• Muscle aches and joint pain
• Profuse sweating and chills
• Nausea, vomiting, or diarrhea
• Abdominal cramps
• Tremors or shaking
• Rapid heart rate and high blood pressure

In severe cases, withdrawal symptoms can lead to cardiovascular complications, including severely high blood pressure or heart arrhythmias.

Elevated Blood Pressure

Both bupropion and naltrexone in Contrave have been linked to increased blood pressure, which can be further exacerbated by codeine’s effects on the cardiovascular system.

Patients with high blood pressure or those taking medications to regulate blood pressure should be especially cautious.

Signs of elevated blood pressure may include:

• Persistent headaches
• Dizziness or feeling lightheaded
• Blurred vision
• Shortness of breath
• Nosebleeds
• Chest pain in severe cases

A dosage adjustment or close monitoring of blood pressure may be required when taking naltrexone bupropion alongside other medications that impact cardiovascular function.

Respiratory Depression

Codeine is a central nervous system depressant that can slow down breathing. When combined with Contrave, especially in individuals with pre-existing respiratory conditions, there is an increased risk of severe respiratory depression, which may occur suddenly.

This risk is even higher for individuals taking other medications that suppress respiration, such as benzodiazepines.

Symptoms of respiratory depression may include:

• Slow or shallow breathing
• Difficulty breathing or gasping for air
• Extreme drowsiness or unresponsiveness
• Blue tint to lips or fingernails (cyanosis)
• Confusion or mental fog

If respiratory depression progresses, it can lead to coma or even death, requiring immediate emergency medical attention.

Allergic Reactions

Taking Contrave and codeine together may increase the risk of an allergic reaction, especially in individuals with hypersensitivity to either medication.

A serious allergic reaction could lead to anaphylaxis, a life-threatening emergency that requires immediate medical intervention.

Symptoms of an allergic reaction may include:

• Skin rash, redness, or itching
• Swelling of the face, lips, or throat
• Severe dizziness or fainting
• Difficulty breathing or wheezing

Patients with a history of serious allergic reaction to bupropion, naltrexone, or opioids should not take Contrave and codeine together due to the heightened risk of anaphylaxis.

Other Potential Symptoms

In addition to the major interactions listed above, some patients treated with Contrave and codeine may experience adverse reactions, including:

• Low blood sugar (hypoglycemia): Patients with diabetes using naltrexone bupropion should monitor blood sugar levels closely.
• Unusual tiredness or fatigue: This may occur due to central nervous system effects.
• Skin rash or hives: A sign of an allergic reaction or adverse reactions to the drug combination.
• Mental health changes: Suicidal thoughts or mood instability may occur, especially in those with bipolar disorder or other mental health conditions.

Given these risks, it is crucial to monitor patients using Contrave and codeine closely and report any serious symptoms to a healthcare provider immediately.

Precautions and Recommendations

When taking prescription medications, especially those with significant drug interactions, following proper precautions is essential to prevent adverse effects.

Since Contrave and codeine can interact in ways that increase health risks, individuals should take the following measures to ensure safe and effective treatment.

Consult Healthcare Providers

Before starting or stopping any medication, including over-the-counter drugs, it is crucial to consult a healthcare provider to assess potential interactions.

• Why this is important: Some drug interactions may increase the risk of severe complications, including seizures, opioid withdrawal symptoms, and respiratory depression.
• Who should be extra cautious? Individuals with pre-existing health conditions, those taking multiple medications, or those with a history of opioid dependence or seizure disorders.
• What to discuss with a provider:
  • Current medications, including prescription drugs, over-the-counter treatments, and supplements.
  • Any history of mental health conditions, high blood pressure, or seizure risk.
  • Past allergic reactions to medications, including bupropion naltrexone or opioids.

Avoid Concurrent Use

Due to the significant risks, concurrent use of Contrave and codeine is generally not recommended.

• Why this is important: The combination can lead to severe effects such as opioid withdrawal symptoms, elevated blood pressure, and respiratory depression.
• Who is at the highest risk?
  • Patients with opioid dependence: Naltrexone bupropion in Contrave blocks opioid receptors, leading to precipitated withdrawal if opioids are in the system.
  • Patients with a seizure disorder: Bupropion lowers the seizure threshold, making seizures more likely.
  • Those with high blood pressure: Contrave can increase blood pressure, and codeine may further alter cardiovascular function.
• Alternatives to consider:
  • If pain management is necessary, discuss alternative medications with a healthcare provider.
  • If weight loss medications are needed, explore different weight loss options that do not interact with opioids.

Monitor Health Conditions

Individuals with pre-existing conditions such as seizure disorders, high blood pressure, or bipolar disorder should be closely monitored when taking naltrexone bupropion.

• Seizure Disorders: Since bupropion lowers the seizure threshold, individuals with a history of brain tumors, eating disorders, or other neurological conditions should use extreme caution. Seizure risk may also increase the risk of severe complications.
• High Blood Pressure: Naltrexone bupropion can raise blood pressure, particularly in individuals with hypertension. Severely high blood pressure may develop, requiring dose adjustment or discontinuation.
• Bipolar Disorder & Mental Health Conditions: Since bupropion affects the serotonergic neurotransmitter system, patients with major depressive disorder or mental health conditions should be monitored for suicidal thoughts, mood changes, or increased mental health symptoms.

Be Aware of Other Medications

It is essential to inform healthcare providers about all medications being taken, including over-the-counter drugs, herbal supplements, and prescription medications.

• Why this is important:
  • Other drugs may increase the risk of interactions, such as tricyclic antidepressants, systemic corticosteroids, or monoamine oxidase inhibitors.
  • Opioid withdrawal symptoms may occur if an opioid antagonist like naltrexone is introduced into the system while taking opioid painkillers.
  • Serotonin syndrome occurs when drugs affecting serotonin levels, such as certain antidepressants, are combined.
• Medications to discuss with your doctor:
  • Antidepressants (tricyclic antidepressants, SSRIs, MAOIs). When taking Prozac and Contrave together, drug interactions can occur.
  • Blood pressure medications
  • Other weight loss medications
  • Pain relievers, including opioids and NSAIDs
  • Over-the-counter drugs and herbal supplements

See our complete guide on Contrave drug interactions for more information.

Follow Prescribed Dosages

Adhering to prescribed dosages and schedules is essential for reducing the risk of adverse reactions.

• Do not increase or decrease the dosage of Contrave or codeine without consulting a healthcare provider. Dosage adjustment may be required for individuals with severe hepatic impairment or other health conditions.
• Avoid high-fat meals when taking extended-release tablets of Contrave, as they can increase the systemic exposure of the drug, raising the likelihood of side effects.
• Do not suddenly stop drinking alcohol only under medical supervision, as alcohol withdrawal may increase the risk of seizures when taking both bupropion and opioids.
• Doctors should monitor patients for symptoms of serotonin syndrome, unusual tiredness, or serious allergic reaction while taking these medications.

Frequently Asked Questions (FAQ)

Understanding potential drug interactions is essential to maintaining safe and effective treatment when taking Contrave, codeine, or other prescription medications.

Below are answers to common questions regarding the use of Contrave, codeine, and pain medications, ensuring you have the information needed to avoid serious health risks.

1. Can you take bupropion and codeine together?

Taking bupropion and codeine together is generally not recommended due to potential drug interactions. Bupropion, one of the active ingredients in Contrave, can lower the seizure threshold, increasing the risk of seizures when combined with codeine.

Additionally, bupropion affects liver enzymes that metabolize codeine, potentially altering its effectiveness or leading to unexpected side effects. If you need pain relief while taking Contrave, consult a healthcare provider for safer alternatives.

2. Can you take opioids with Contrave?

Opioids should not be taken with Contrave due to the presence of naltrexone, which is an opioid antagonist. Naltrexone blocks opioid receptors, preventing opioids like codeine, hydrocodone, or oxycodone from working properly. If an individual dependent on opioids takes Contrave, they may experience severe opioid withdrawal symptoms, including nausea, vomiting, sweating, muscle pain, and extreme discomfort.

If you require pain management, speak with a healthcare provider about alternative pain relief options that are compatible with Contrave.

3. What medications should I avoid with Contrave?

Several medications should be avoided while taking Contrave due to potential interactions that may cause serious side effects. Opioids should be avoided since naltrexone can block their effects and trigger withdrawal symptoms. Other medications that may interact with Contrave include antidepressants, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and medicines that affect serotonin levels, as they may increase the risk of serotonin syndrome.

Additionally, high-fat meals should be avoided when taking extended-release Contrave tablets, as they can increase drug absorption and the risk of side effects, such as Contrave constipation. Always discuss your full medication list with a healthcare provider before starting Contrave.

4. What pain medicine can I take with Contrave?

Since opioids cannot be taken with Contrave, patients should consider non-opioid pain relief options. Acetaminophen (Tylenol) is generally considered safe and can be used for mild to moderate pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve) may also be suitable. Still, they should be used with caution, especially in individuals with high blood pressure or cardiovascular conditions.

Before using any pain medication, consult with a healthcare provider to ensure it is safe and appropriate for your specific health conditions.

5. Can you take painkillers with Contrave?

Certain painkillers can be taken with Contrave, but opioid-based painkillers should be avoided. Opioids, such as codeine, oxycodone, or hydrocodone, interact with naltrexone, potentially leading to opioid withdrawal symptoms or reduced pain relief effectiveness.

However, over-the-counter painkillers such as acetaminophen, ibuprofen, and naproxen are generally considered safer options. Always check with your doctor before taking any painkillers while using Contrave to avoid adverse reactions or unintended drug interactions.

Final Considerations

Since Contrave and codeine drug interactions can lead to life-threatening complications, patients treated with these medications should follow strict medical supervision.

Understanding the potential risks, including increased risk of seizures, opioid withdrawal, and elevated blood pressure, is key to ensuring safe treatment initiation and successful weight loss without compromising overall health.

In summary, the combination of Contrave and codeine presents significant health risks, including seizures, opioid withdrawal, elevated blood pressure, and respiratory depression. It is crucial to consult healthcare providers before combining these medications to ensure safe and effective treatment.