Contrave and Nicotine Drug Interactions: Safety and Warnings

Contrave is a prescription weight loss medication that combines bupropion and naltrexone to help certain individuals manage their body weight. While this combination can be effective, taking Contrave alongside nicotine, including nicotine patches or smoking cessation aids, raises concerns about potential Contrave and Nicotine drug interactions. Understanding these risks is crucial for those using Contrave while also trying to stop smoking or manage nicotine use.

According to Dr. Matthew Olesiak, MD, Chief Medical Director of SANE MD, “Nicotine and bupropion, one of the active ingredients in Contrave, can have additive effects on the central nervous system, increasing the risk of side effects like high blood pressure, dizziness, and nausea. Patients should consult a healthcare provider before using these together.”

Key Takeaways

• Combining Contrave with nicotine can lead to an increase in blood pressure and other cardiovascular effects, requiring medical supervision.
• Taking Contrave while using nicotine patches or quitting smoking may elevate the risk of serious side effects such as seizures and mood changes.
• Individuals with health conditions like bipolar disorder, seizure disorder, or liver problems should speak with their healthcare provider before using these substances together.

Understanding Contrave and Nicotine Drug Interactions

Contrave is a prescription weight loss medication that combines bupropion and naltrexone to help manage body weight in compatible obese adults or overweight individuals with additional risk factors, such as high blood pressure or diabetes. It is intended to be used alongside a reduced-calorie diet and physical activity to enhance weight loss efforts. Combining bupropion and naltrexone may enhance the tolerability of side effects compared to each drug alone.

Because bupropion SR is also used to treat depression and assist with quitting smoking, individuals using nicotine patches or other nicotine-containing products should be aware of potential drug interactions. Combining Contrave and nicotine can lead to an increased risk of cardiovascular side effects and CNS toxicity, making it crucial to understand how these substances interact.

How Contrave Works

Contrave bupropion naltrexone targets areas in the brain that control hunger, cravings, and reward-seeking behavior.

The two active ingredients in Contrave serve different roles:

• Bupropion SR (sustained-release bupropion) is primarily an antidepressant that also helps individuals stop smoking by reducing nicotine cravings. It works by affecting dopamine and norepinephrine, neurotransmitters involved in mood, energy regulation, and appetite. Because of its stimulant-like effects, bupropion can interact with other medications that influence dopamine and norepinephrine, such as Vyvanse. Learn more about taking Contrave and Vyvanse together here.
• Naltrexone is commonly used to treat opioid withdrawal and alcohol dependence. In Contrave, it helps suppress cravings and enhances bupropion’s effects on appetite control.

By acting on these brain pathways, Contrave helps certain individuals lose weight by reducing food cravings and controlling binge-eating behaviors. However, bupropion’s stimulatory effects on the nervous system can lead to unwanted interactions with nicotine, which also influences neurotransmitter activity.

However, Contrave drug interactions can occur with numerous medications and substances, including nicotine. Because both bupropion and nicotine affect the dopaminergic and noradrenergic systems, using Contrave and nicotine together can lead to increased cardiovascular strain, high blood pressure, and mood-related side effects.

Risks of Combining Contrave and Nicotine

Individuals using nicotine patches, smoking cessation aids, or other nicotine-containing products while taking Contrave may experience the following risks:

1. Increased Blood Pressure and Cardiovascular Strain

Both bupropion and nicotine can cause an increase in blood pressure and heart rate. This effect is particularly concerning for individuals with heart disease or high blood pressure, as it may raise the risk of cardiovascular complications.

2. Higher Risk of Seizures

Bupropion is known to lower the seizure threshold, meaning it makes seizures more likely, especially at higher doses. Nicotine can further contribute to this risk, particularly in individuals with a seizure disorder or those prone to neurological side effects.

3. Additive Effects on Mood and Energy Levels

Since bupropion affects dopamine and norepinephrine, it can lead to nausea, dizziness, anxiety, and restlessness—effects that may be intensified when combined with nicotine. This combination may cause mood swings, agitation, or heightened anxiety, particularly in individuals with bipolar disorder or a history of suicidal thoughts.

4. Potential Liver Damage

Both naltrexone (a key ingredient in Contrave) and nicotine are processed through the liver. In individuals with liver problems, using both substances together may increase the risk of liver damage or worsen existing liver conditions. Symptoms such as itching, loss of appetite, and yellowing of the skin should be reported to a healthcare provider immediately.

Dr. Olesiak warns, “Patients using nicotine patches or other over-the-counter smoking cessation aids should tell their doctor before starting Contrave to assess their increased risk for side effects. Combining these substances without medical supervision can lead to serious complications, especially for those with pre-existing health conditions.”

Who Should Be Cautious?

While Contrave and nicotine can be used together under medical supervision, certain individuals may face higher risks due to their health history or underlying conditions. It is important to note that Contrave, which combines bupropion and naltrexone, is not approved for smoking cessation.

Taking Contrave with nicotine patches, smoking cessation aids, or tobacco products may worsen pre-existing conditions or lead to severe side effects.

1. Individuals with a History of Bipolar Disorder or Suicidal Thoughts

Bupropion, one of the active ingredients in Contrave bupropion naltrexone, is classified as an antidepressant. While it can help treat depression, it has also been linked to mood swings, agitation, and an increased risk of suicidal thoughts, particularly in people with bipolar disorder or a history of mental health conditions.

• Nicotine use can also impact mood, sometimes worsening anxiety, restlessness, or depressive symptoms.
• The combination of Contrave and nicotine may increase the likelihood of mood instability, depression, or suicidal thoughts, especially in young adults who are more susceptible to mood-related side effects.
• Anyone with a history of bipolar disorder or suicidal thoughts should speak with their healthcare provider before starting Contrave, particularly if they are using nicotine patches or attempting to stop smoking.

2. Individuals with High Blood Pressure or Cardiovascular Conditions

Both bupropion and nicotine can increase blood pressure and heart rate. This can be especially dangerous for people with high blood pressure, heart disease, or other cardiovascular conditions.

• Studies have shown that Contrave can increase blood pressure, particularly in the early weeks of use.
• Nicotine also raises blood pressure by stimulating the nervous system and constricting blood vessels.
• When combined, these effects may significantly increase the risk of hypertension, irregular heartbeats, and other cardiovascular issues.

Anyone with high blood pressure or a history of heart disease should consult their doctor or pharmacist before taking Contrave while using nicotine. Regular blood pressure monitoring is recommended to prevent complications.

3. Patients with Liver Damage or a History of Opioid Withdrawal

Since Contrave contains naltrexone, it can affect liver function and may pose a higher risk for individuals with liver problems or a history of opioid withdrawal.

• Naltrexone is metabolized in the liver, meaning that individuals with liver damage or hepatitis should exercise caution.
• Nicotine use may further stress the liver, as smoking has been linked to reduced liver function over time.
• Those recovering from opioid withdrawal may also experience heightened sensitivity to naltrexone, increasing the risk of physical dependence issues.

Patients with a history of liver disease, alcohol use disorder, or opioid use disorder should have their liver function monitored when taking Contrave, especially if they are also using nicotine patches or other smoking cessation aids.

4. Young Adults Prone to Mood-Related Side Effects

Younger individuals, particularly those under 25 years old, may experience more pronounced mood changes while taking Contrave.

• The combination of Contrave and nicotine may trigger increased anxiety, irritability, or depressive symptoms.
• Young adults who are attempting to stop smoking while using Contrave should be particularly cautious, as withdrawal from nicotine can also contribute to mood instability.
• Healthcare providers may recommend behavioral counseling alongside medication to help mitigate potential mood-related side effects.

Safe Use and Precautions

To minimize risks when taking Contrave alongside nicotine, it’s essential to follow proper safety guidelines. This includes consulting a healthcare provider, sticking to a regular dosing schedule, and being aware of potential drug interactions.

1. Consult a Healthcare Provider Before Combining These Substances

Before using nicotine patches, smoking cessation aids, or other nicotine-containing products while taking Contrave, it’s important to tell your doctor about:

• Any history of high blood pressure, heart disease, or seizure disorder
• Any liver problems or history of opioid withdrawal
• Past experiences with suicidal thoughts, depression, or bipolar disorder

Dr. Olesiak emphasizes, “Individuals using nicotine products while on Contrave should seek medical guidance to ensure they are not at increased risk for cardiovascular issues or mood-related side effects.”

2. Avoid High-Fat Meals, Which Can Affect the Absorption of Contrave Tablets

Taking Contrave with high-fat meals can increase drug absorption, raising the likelihood of nausea, dizziness, and other side effects.

To reduce risks:

• Take Contrave tablets on an empty stomach or with a low-fat meal.
• Avoid consuming large amounts of high-fat foods, as they can intensify Contrave’s effects and may contribute to gastrointestinal discomfort.

3. Follow a Regular Dosing Schedule and Avoid Missed Doses

To maintain consistent treatment effectiveness, adhere to a regular dosing schedule:

• Do not double your next dose if you miss one—take the next scheduled dose as directed.
• Avoid taking Contrave at bedtime, as it may cause insomnia or restlessness.
• Sticking to a consistent dosing schedule can help manage side effects and improve treatment outcomes.

4. If Symptoms Such as Dry Mouth, Nausea, or Dizziness Occur, Contact a Doctor or Pharmacist

Taking Contrave may lead to common side effects, such as:

• Dry mouth
• Nausea or vomiting
• Dizziness or lightheadedness
• Increased heart rate

If these symptoms persist or worsen, speak with a healthcare provider for guidance on adjusting medications or modifying treatment plans.

5. If You Suspect an Overdose, Seek Help from a Poison Control Center Immediately

Overdosing on Contrave, particularly when combined with nicotine, can result in life-threatening complications.

Seek emergency medical attention or contact a poison control center if symptoms such as severe nausea, confusion, hallucinations, or seizures occur.

Frequently Asked Questions (FAQ) About Contrave and Nicotine Interactions

Understanding how Contrave, nicotine, and other medications interact is essential for safety and effectiveness.

Below are answers to common questions about taking Contrave, potential drug interactions, and precautions. Always consult a healthcare provider before starting or combining medications.

1. Can you take Contrave with Celexa?

Contrave and Celexa (citalopram), a commonly prescribed selective serotonin reuptake inhibitor (SSRI) for depression and anxiety, may interact due to their effects on neurotransmitters. Both drugs influence dopamine, serotonin, and norepinephrine levels, increasing the potential for side effects such as high blood pressure, mood swings, anxiety, and dizziness.

Additionally, taking these medications together may slightly increase the risk of seizures, especially in individuals with a seizure disorder or those prone to neurological side effects. If a doctor prescribes both, regular monitoring is recommended to manage any additive effects on mood and blood pressure.

2. What medications should not be taken with Contrave?

Several medications should be used cautiously or avoided while taking Contrave, as they may lead to serious side effects or reduce effectiveness. Drugs that lower the seizure threshold, such as certain antidepressants or stimulants, require special attention. Additionally, individuals should be cautious about combining Contrave with anti-inflammatory medications, as Contrave and NSAIDs drug interactions can pose additional health risks.

Opioid pain medications should also be avoided because naltrexone blocks opioid receptors, rendering these drugs ineffective and potentially causing withdrawal symptoms. Monoamine oxidase inhibitors (MAOIs), like phenelzine or selegiline, can cause dangerously high blood pressure if taken with Contrave.

Additionally, medications affecting dopamine and norepinephrine levels, such as other antidepressants or stimulants, may intensify side effects like nausea, dizziness, or agitation. Always discuss medication changes with a healthcare provider to ensure safe treatment.

3. What medicine cannot mix with nicotine?

Nicotine can interact with several prescription and over-the-counter medications, potentially altering their effects. Stimulants like amphetamines or pseudoephedrine can lead to an increase in blood pressure and heart rate, raising cardiovascular risks.

Certain antidepressants, including tricyclic antidepressants and SSRIs, may have altered effectiveness due to nicotine’s effect on liver enzyme metabolism, potentially requiring dose adjustments. Blood thinners like warfarin can also be affected, as nicotine may change how they are metabolized, increasing the risk of bleeding or clotting issues.

Individuals using nicotine replacement therapy should consult a doctor or pharmacist to ensure their medications do not have harmful interactions.

4. Does nicotine interact with Wellbutrin?

Yes, nicotine interacts with Wellbutrin (bupropion) in ways that can increase the likelihood of side effects. Since bupropion is also one of the active ingredients in Contrave, this interaction is relevant for those using both medications. Nicotine and bupropion both stimulate dopaminergic pathways, which may lead to restlessness, irritability, or increased anxiety.

Additionally, bupropion lowers the seizure threshold, and when combined with nicotine, particularly in high doses or with nicotine patches, the risk of seizures increases. Patients using Wellbutrin for smoking cessation or Contrave for weight loss should inform their healthcare provider about their nicotine use to ensure proper dosage adjustments and minimize risks.

5. What should I avoid while taking Contrave?

Several factors should be avoided while taking Contrave to reduce the risk of side effects and maximize its effectiveness. High-fat meals can increase the absorption of Contrave tablets, leading to stronger side effects like nausea and dizziness. Alcohol consumption should also be limited or avoided, as bupropion and naltrexone can heighten alcohol sensitivity, increasing the risk of drowsiness, mood changes, or liver damage. Opioid medications, including prescription painkillers or illicit opioids, should not be taken, as naltrexone blocks opioid receptors, potentially leading to sudden opioid withdrawal symptoms.

Additionally, individuals should be cautious with over-the-counter stimulants like caffeine or decongestants, which can further elevate blood pressure and heart rate. Always follow a doctor’s guidance on medication use and lifestyle adjustments.

6. Does naltrexone interact with nicotine?

Naltrexone, one of the active ingredients in Contrave, does not have a direct pharmacological interaction with nicotine, but their combined effects on dopamine pathways can influence mood and energy levels. Since naltrexone helps reduce cravings, it has been studied for potential use in smoking cessation, though it is not typically prescribed for this purpose.

However, individuals using nicotine patches or other smoking cessation aids alongside naltrexone may experience changes in appetite, mood, or energy, which should be monitored by a healthcare provider. Those with a history of liver problems or high blood pressure should be especially cautious, as both substances can place additional stress on the cardiovascular and metabolic systems.

Conclusion

Understanding Contrave and nicotine drug interactions is essential for safe weight loss and smoking cessation efforts. If you smoke or are trying to quit smoking, considering these drug interactions is crucial in deciding if Contrave is right for you. Always consult a healthcare provider before combining these treatments, especially if you have underlying health conditions or take other medications.

By following proper precautions, individuals can safely manage body weight while minimizing risks associated with nicotine use.