Contrave and Lexapro Drug Interactions: Risks & Side Effects

Contrave (bupropion naltrexone) is a weight loss drug, while Lexapro (escitalopram) is commonly prescribed to treat depression and anxiety. When used together, these drugs may interact in ways that increase the risk of severe side effects.

Understanding Contrave and Lexapro drug interactions is essential for patients considering taking Contrave while already on Lexapro or vice versa.

Key Takeaways

• Potential Risks: Taking Contrave and Lexapro together can increase the risk of seizures, serotonin syndrome, and high blood pressure.
• Side Effects: Users may experience chest pain, dry mouth, liver damage, and withdrawal symptoms.
• Medical Supervision: Consulting a healthcare provider before starting Contrave is crucial, especially for those with bipolar disorder, heart disease, or other health conditions.

Understanding Contrave

Contrave (bupropion naltrexone) is a prescription weight loss drug designed to help certain individuals struggling with obesity or weight-related health conditions. It works by affecting brain pathways that regulate appetite and cravings.

The medication consists of two active ingredients: bupropion hydrochloride, which is also used in antidepressants such as Wellbutrin SR, and naltrexone, which is typically prescribed for opioid withdrawal and substance use disorder.

Taking Contrave can increase the risk of side effects, including high blood pressure, liver damage, and risk of seizures. Additionally, Contrave drug interactions are common, and patients should be aware of Contrave and Qsymia together drug interactions when considering weight loss treatments. Patients should disclose all current medications with their healthcare provider before taking Contrave,  follow dosage recommendations closely, and avoid high-fat meals, which can affect drug absorption.

Understanding Lexapro

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety disorders. It works by increasing serotonin levels in the brain, which helps regulate mood. While effective in treating depression, Lexapro carries risks, including serotonin syndrome, when combined with other drugs that affect serotonin levels, such as Contrave.

Lexapro can also cause side effects such as dry mouth, dizziness, and suicidal thoughts in young adults. Patients should consult their healthcare provider before combining Lexapro with other medications, particularly those that affect the central nervous system.

Contrave and Lexapro Drug Interactions: Risks & Side Effects

Interaction	Description	Warning Signs
Increased Risk of Seizures	Contrave (bupropion) lowers seizure threshold, which is worsened when combined with Lexapro. Higher risk for those with a history of seizures, head trauma, or alcohol use.	Twitching, convulsions, loss of consciousness.
Blood Pressure and Cardiovascular Risks	Both drugs can elevate blood pressure, increasing the risk of heart attack, stroke, and chest pain. Regular monitoring is required for those with cardiovascular conditions.	Severe headache, dizziness, chest pain, irregular heartbeat.
Risk of Serotonin Syndrome	Excessive serotonin activity from Lexapro and indirect serotonin influence of Contrave can lead to serotonin syndrome, causing confusion, rapid heartbeat, fever, and muscle rigidity.	Agitation, excessive sweating, muscle stiffness, hallucinations.
Effects on Liver Function	Both drugs stress liver function. Higher risk for individuals with liver disease or those consuming alcohol. Symptoms include jaundice, fatigue, and dark urine.	Yellowing of skin/eyes, abdominal pain, severe fatigue.
Gastrointestinal Issues	Increased risk of nausea, vomiting, diarrhea, constipation, and appetite changes due to neurotransmitter effects on digestion.	Severe nausea, persistent vomiting, unpredictable bowel movements.
Sleep Disturbances	Contrave’s stimulant effect and Lexapro’s serotonin regulation can cause insomnia, vivid dreams, and daytime fatigue.	Insomnia, nightmares, excessive daytime sleepiness.
Mood and Behavioral Changes	Increased anxiety, irritability, paranoia, and hallucinations due to combined neurotransmitter effects.	Rapid mood swings, panic attacks, delusions.
Suicidal Thoughts and Depression Worsening	Both medications carry a black box warning for increased suicidal thoughts, especially in young adults and those with mood disorders.	Withdrawal from social interactions, hopelessness, self-harm thoughts.
Dizziness and Coordination Issues	Both drugs affect the central nervous system, leading to dizziness, loss of coordination, blurred vision, and eye pain.	Lightheadedness when standing, frequent falls, blurry vision.
Increased Risk of High or Low Blood Sugar	Contrave alters blood sugar levels, increasing the risk of hyperglycemia or hypoglycemia, particularly in diabetics.	Shakiness, confusion, excessive thirst, blurred vision.
Increased Risk of Accidental Overdose	Confusion, loss of consciousness, seizures, and dangerously high blood pressure may occur if dosages are mismanaged.	Blackouts, tremors, dangerously high blood pressure, stroke risk.

Understanding Contrave and Lexapro Drug Interactions

Combining Contrave with Lexapro presents multiple risks due to their effects on the central nervous system (CNS) and serotonin levels. Lexapro is a selective serotonin reuptake inhibitor (SSRI), which increases serotonin levels in the brain to help regulate mood. Contrave, which contains bupropion and naltrexone, also affects brain chemistry but in different ways—bupropion influences dopamine and norepinephrine levels, while naltrexone is an opioid antagonist. When deciding if Contrave is right for you, a thorough understanding of all the medications it interacts with is essential to your safety, which is particularly true with Lexapro.

When these two drugs interact, they can lead to serious neurological and cardiovascular complications. The most dangerous risks include serotonin syndrome, increased seizure potential, and heightened blood pressure levels. Individuals taking both medications should be closely monitored by a healthcare provider for any signs of adverse effects.

Contrave and Lexapro drug interactions can include:

1. Increased Risk of Seizures

Certain factors can further increase the likelihood of seizures when taking these medications together, including a history of seizure disorder, alcohol use, or combining Contrave with other medications that lower the seizure threshold, such as Gabapentin. Bupropion, a primary ingredient in Contrave, is known to lower the seizure threshold, making individuals more vulnerable to seizure activity. This effect is exacerbated when combined with Lexapro, which can also affect neurological stability.

Certain factors can further increase the likelihood of seizures when taking these medications together, including:

• A history of seizure disorder or epilepsy
• Head trauma or past concussions
• Brain tumors or neurological diseases
• Excessive alcohol consumption or suddenly stopping alcohol
• Use of other medications that lower the seizure threshold

Individuals at higher risk of seizures should avoid taking Contrave, especially in combination with Lexapro. If a patient experiences twitching, convulsions, or loss of consciousness, they should seek immediate medical attention.

2. Blood Pressure and Cardiovascular Risks

Both bupropion (in Contrave) and Lexapro can increase blood pressure, leading to serious cardiovascular issues. Contrave has been associated with severely high blood pressure, which can escalate the risk of:

• Heart attack
• Chest pain (angina)
• Irregular heartbeat (arrhythmia)
• Stroke

Patients with a history of high blood pressure, heart disease, or other cardiovascular conditions should exercise extreme caution when using Contrave and Lexapro together. Regular blood pressure monitoring is essential for individuals who take both medications.

If a patient experiences severe headaches, dizziness, chest pain, or shortness of breath, they should seek immediate medical attention.

3. Risk of Serotonin Syndrome

Lexapro directly affects serotonin levels by increasing its presence in the brain, while bupropion indirectly impacts serotonin regulation. When combined, these medications may result in serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin activity.

Symptoms of Serotonin Syndrome:

• Agitation or restlessness
• Excessive sweating
• Rapid or irregular heartbeat
• Muscle stiffness or tremors
• Fever or shivering
• Confusion or hallucinations

Serotonin syndrome can progress rapidly, leading to seizures, high fever, and loss of consciousness. If any of these symptoms occur, the individual should stop taking the medication immediately and seek emergency medical care.

4. Effects on Liver Function

Bupropion naltrexone (Contrave) has been associated with liver damage and dysfunction. Since the liver metabolizes both Contrave and Lexapro, taking them together places extra stress on liver function. This risk is heightened in individuals who:

• Have a history of liver disease or liver problems
• Drink alcohol regularly
• Are taking other medications that affect the liver

Signs of Liver Damage:

• Dark urine
• Pale stools
• Yellowing of the skin or eyes (jaundice)
• Severe fatigue
• Abdominal pain

Patients experiencing any of these warning signs should stop taking the medication and seek immediate medical attention. Individuals using Contrave and Lexapro together may need regular liver function tests.

Additional Contrave and Lexapro Interaction Symptoms

1. Gastrointestinal Issues

The combination of Contrave and Lexapro can significantly impact the digestive system, as both medications influence neurotransmitter activity, which in turn affects gut function.

• Nausea and vomiting: This is one of the most common side effects when taking either drug alone, and the risk is further heightened when combined. The nausea may be mild or persistent and can sometimes lead to vomiting, particularly in the early stages of treatment.
• Diarrhea or constipation: Lexapro can cause diarrhea by increasing serotonin levels in the gut, which stimulates motility. Contrave, on the other hand, can contribute to constipation due to its effect on appetite and digestion. This combination may lead to unpredictable bowel habits.
• Loss of appetite: Contrave is designed to suppress appetite for weight loss, while Lexapro can also alter eating patterns. Some individuals may experience a significant decrease in appetite, potentially leading to unintended weight loss.
• Abdominal cramps and bloating: Changes in serotonin levels can trigger gut spasms and bloating, leading to discomfort and gas buildup. Individuals with pre-existing gastrointestinal conditions, such as IBS or acid reflux, may experience exacerbated symptoms.

To manage these digestive side effects, patients should maintain hydration, fiber intake, and balanced meals. If severe nausea or persistent vomiting occurs, a dose adjustment under the supervision of a healthcare provider may be necessary.

2. Sleep Disturbances

Both Contrave and Lexapro influence neurotransmitter activity, which can significantly disrupt sleep patterns.

• Insomnia or trouble falling asleep: Bupropion, one of the main ingredients in Contrave, stimulates the brain, leading to increased energy and difficulty sleeping. When combined with Lexapro, which also affects serotonin balance, sleep disturbances may become more pronounced.
• Vivid dreams or nightmares – Many individuals taking Lexapro report intense and vivid dreams due to increased serotonin activity in the brain. Combining it with Contrave may heighten dream intensity, leading to restless nights or even nightmares.
• Daytime drowsiness or fatigue – While some people experience insomnia, others may feel excessive fatigue during the day, leading to a lack of focus, poor concentration, and reduced energy levels.

To improve sleep quality, patients should:

• Take Contrave earlier in the day to reduce stimulant effects at night.
• Avoid caffeine and high-fat meals in the evening, as they may worsen sleep disturbances.
• Establish a consistent sleep routine with relaxation techniques.

If sleep disturbances become persistent or severe, a healthcare provider may adjust the medication dosage or schedule.

3. Mood and Behavioral Changes

Because both Contrave and Lexapro influence brain chemistry, they can lead to unpredictable emotional and psychological effects.

• Increased anxiety or panic attacks – While Lexapro is intended to reduce anxiety, its interaction with Contrave can trigger excessive restlessness or panic attacks, particularly in individuals sensitive to medication changes.
• Irritability and mood swings – The combination of bupropion (a stimulant) and serotonin regulation can lead to rapid shifts in mood, causing irritability, frustration, or even agitation.
• Hallucinations or paranoia – Although rare, some patients may experience visual or auditory hallucinations due to excessive neurotransmitter stimulation.
• False beliefs (delusions) – A more extreme reaction may include paranoia, irrational thoughts, or delusional thinking, particularly in individuals with a history of bipolar disorder or psychosis.

If these symptoms develop or worsen, immediate consultation with a healthcare provider is necessary. Patients with a history of severe mental health disorders may need alternative treatments.

4. Suicidal Thoughts and Depression Worsening

Both Contrave and Lexapro come with a black box warning for an increased risk of suicidal thoughts, particularly in:

• Young adults under 25 years old
• Individuals with a history of depression or self-harm
• Those experiencing significant mood swings due to medication interactions

Warning Signs to Watch For:

• Sudden withdrawal from social interactions – Becoming uncharacteristically distant, avoiding loved ones, or canceling plans.
• Increased hopelessness or despair – Feeling overwhelmed, excessively sad, or unable to cope with daily tasks.
• Self-harm tendencies – Engaging in dangerous behaviors or expressing thoughts of self-harm.
• Obsessive thoughts about death – Having fixations on mortality, suicide, or feeling “better off dead.”

If any of these symptoms occur, the medication should not be stopped suddenly. Instead, immediate professional intervention is necessary, including contacting a crisis helpline or emergency care provider.

5. Dizziness and Coordination Issues

Since both Contrave and Lexapro affect the central nervous system, they may cause neurological side effects, including:

• Dizziness and lightheadedness: A drop in blood pressure or changes in serotonin levels can cause frequent dizziness, especially when standing up quickly.
• Loss of balance or coordination: Some individuals may feel unsteady on their feet, increasing the risk of falls and accidents.
• Blurred vision: Vision problems, including difficulty focusing or tunnel vision, may occur due to changes in neurotransmitter activity.
• Eye pain or pressure: Increased intraocular pressure may lead to eye pain, headaches, or a risk of developing acute glaucoma.

Until symptoms stabilize, people who experience dizziness should avoid driving, operating machinery, or engaging in physically demanding tasks.

6. Increased Risk of High Blood Sugar or Low Blood Sugar

Contrave can alter blood sugar levels, and when combined with Lexapro, these fluctuations may be unpredictable.

• Episodes of low blood sugar (hypoglycemia) – Shakiness, sweating, confusion, and irritability may occur, particularly in patients with diabetes or those on a low-calorie diet.
• Higher blood sugar levels (hyperglycemia) – Increased thirst, frequent urination, fatigue, and blurred vision can signal blood sugar instability.

Diabetics or individuals at risk of metabolic disorders should closely monitor their blood sugar levels, especially when starting Contrave.

7. Increased Risk of Accidental Overdose

Both Contrave and Lexapro affect brain function, meaning missing doses, doubling up, or miscalculating intake can have serious consequences.

Overdose Symptoms Include:

• Severe confusion or delirium
• Loss of consciousness or blackouts
• Dangerously high blood pressure, leading to stroke risk
• Seizures, tremors, or uncontrollable shaking

If accidental overdose is suspected, call 911 or poison control immediately. Never take an extra dose to make up for a missed one without consulting a healthcare provider.

When to Seek Immediate Medical Attention

Seek urgent medical care if you experience:

• Severe chest pain or irregular heartbeat
• Uncontrollable shaking or seizures
• Fainting or sudden loss of consciousness
• Severe allergic reaction (skin rash, difficulty breathing, swelling of the face/lips/tongue)
• Signs of serotonin syndrome (agitation, hallucinations, muscle twitching, high fever)

Frequently Asked Questions (FAQ)

When considering medications like Contrave and Lexapro, it is crucial to understand potential drug interactions and their effects on your health.

Below are some common questions regarding their use together and with other medications.

Can you take antidepressants with Contrave?

Yes, but with caution. Contrave contains bupropion, which is an atypical antidepressant that affects dopamine and norepinephrine levels. Combining it with other antidepressants, especially SSRIs like Lexapro, can increase the risk of serotonin syndrome, seizures, and high blood pressure.

It is essential to work closely with a healthcare provider when taking antidepressants with Contrave to monitor for potential side effects and ensure a safe treatment plan.

Can I take buPROPion and Lexapro together?

Yes, but this combination requires careful medical supervision. Bupropion (one of the active ingredients in Contrave) and Lexapro both affect brain neurotransmitters but in different ways. While Lexapro increases serotonin levels, bupropion primarily influences dopamine and norepinephrine.

The combination can sometimes be prescribed for individuals who do not respond well to a single antidepressant, but it also comes with a higher risk of seizures, mood instability, and increased anxiety.

Consulting a doctor before combining these medications is crucial to avoid serious side effects.

Can you take weight loss pills with Lexapro?

Some weight loss pills may be safe to take with Lexapro, but many stimulant-based or prescription weight loss drugs can negatively interact with SSRIs. Medications like Contrave, which contain bupropion, carry a higher risk of serotonin syndrome and increased blood pressure when combined with Lexapro.

Over-the-counter weight loss supplements, particularly those containing caffeine, green tea extract, or other stimulants, can also heighten anxiety, heart rate, and insomnia when mixed with Lexapro.

Always consult a healthcare provider before adding a weight loss medication to Lexapro therapy.

What medications should I avoid with Contrave?

Several medications should be avoided while taking Contrave due to potentially dangerous interactions. Monoamine oxidase inhibitors (MAOIs) can lead to life-threatening reactions if taken within 14 days of starting Contrave.

Opioid medications should also be avoided, as naltrexone (a key ingredient in Contrave) blocks opioid effects and can lead to withdrawal symptoms. Seizure medications, some antidepressants, and stimulant-based drugs may increase the risk of seizures or high blood pressure when taken with Contrave.

It is important to disclose all medications to a doctor or pharmacist before starting Contrave to prevent harmful interactions.

Can you take weight loss pills on Lexapro?

Taking weight loss pills while on Lexapro can be risky, depending on the type of pill. Prescription weight loss drugs like Contrave, phentermine, or other stimulant-based medications can increase blood pressure, cause heart palpitations, and worsen anxiety.

Over-the-counter weight loss supplements that contain stimulants, herbal extracts, or metabolism boosters may also lead to insomnia, jitteriness, or serotonin imbalances when combined with Lexapro.

If weight management is a concern, the best approach is to make lifestyle modifications and consult a healthcare provider for safe alternatives.

Conclusion

Understanding the potential risks and interactions between Contrave (bupropion naltrexone) and Lexapro (escitalopram) is crucial for ensuring safe and effective treatment. While both medications serve important functions—Contrave for weight management in compatible individuals and Lexapro for depression and anxiety—their combined use can lead to serious side effects, including seizures, serotonin syndrome, high blood pressure, and liver damage.

Before starting Contrave while taking Lexapro, or vice versa, patients should consult a healthcare provider to evaluate their personal risk factors and determine the best course of action. Regular monitoring for symptoms, including changes in mood, blood pressure levels, and neurological effects, is essential for minimizing complications.

If severe side effects occur, such as chest pain, suicidal thoughts, hallucinations, or signs of serotonin syndrome, immediate medical attention is required. Ensuring open communication with a healthcare provider can help patients safely navigate treatment adjustments and achieve their health goals while reducing the risk of adverse reactions.

For those experiencing concerns related to weight management, depression, or medication interactions, seeking professional medical advice remains the best approach.