Contrave and NSAIDS Drug Interactions: Risks & Safety Guide

Contrave (naltrexone-bupropion) is a prescription weight loss medication used to help certain adults lose weight. While it can be an effective option, it carries a risk of side effects and potential drug interactions, including those with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and naproxen.

NSAIDs are commonly used to relieve pain and inflammation, but their combination with Contrave can increase the risk of complications, including gastrointestinal bleeding, high blood pressure, and even seizures. If you’re considering Contrave treatment, tell your doctor about any NSAIDs or other medications you take to minimize risks.

Dr. Matthew Olesiak, Chief Medical Director of SANE MD, explains, “Understanding how Contrave interacts with NSAIDs is crucial for safe weight loss management. Patients should always consult their doctor or pharmacist to assess potential risks before starting any new medication.”

Key Takeaways

• Contrave and NSAIDs drug interactions can increase the risk of gastrointestinal bleeding, high blood pressure, and other complications.
• Talk with your doctor before using NSAIDs with Contrave to reduce potential risks.
• Side effects from Contrave may be worsened by NSAIDs, especially in individuals with certain risk factors related to heart health or gastrointestinal issues.

Understanding Contrave and NSAIDs Drug Interactions

Contrave contains two active ingredients: naltrexone hydrochloride and bupropion hydrochloride. These compounds work together to help compatible adults lose weight by regulating appetite and metabolism.

However, these same ingredients can also interact negatively with other medications, including NSAIDs (nonsteroidal anti-inflammatory drugs), increasing the risk of side effects.

Contrave and NSAID Interactions: Key Risks & Safer Alternatives

Issue	What Happens?	What to Do?
Ibuprofen (Advil, Motrin)	Can cause stomach bleeding, high blood pressure, and seizures	Ask your doctor before using
Naproxen (Aleve, Naprosyn)	May increase seizure and heart risks	Talk to your doctor first
Aspirin	Raises risk of ulcers and bleeding	Use with caution
Celecoxib (Celebrex)	Less risk of ulcers but still interacts with Contrave	Check with your doctor
Stomach Bleeding	NSAIDs and Contrave together raise ulcer risk	Watch for symptoms, see a doctor
Seizure Risk	Contrave lowers seizure threshold, NSAIDs make it worse	Avoid high NSAID doses
High Blood Pressure	Both drugs can increase blood pressure	Monitor BP regularly
Liver/Kidney Strain	NSAIDs and Contrave both stress these organs	Limit NSAID use, ask a doctor
Ulcer History	Higher risk when using NSAIDs with Contrave	Consider safer options
Heart Disease	NSAIDs and Contrave may worsen heart problems	Discuss with your doctor
Frequent NSAID Use	Increases interaction risks	Reduce NSAID intake
Safer Pain Relief Option	Acetaminophen (Tylenol)	Generally safe to use
Non-Drug Pain Relief	Physical therapy, stretching, exercise	May help reduce pain
Other Options	Prescription alternatives if NSAIDs aren’t safe	Doctor may suggest another option

Common NSAIDs That May Interact with Contrave

Some widely used NSAIDs that could cause interactions with Contrave include:

• Ibuprofen (Advil, Motrin): Commonly used for pain relief, fever reduction, and inflammation.
• Naproxen (Aleve, Naprosyn): Used for arthritis, muscle pain, and headaches, with a longer duration of action than ibuprofen.
• Aspirin: Often taken to reduce heart attack risk but can also cause stomach irritation and increase bleeding risk.
• Celecoxib (Celebrex): A prescription NSAID that targets inflammation while reducing the likelihood of stomach ulcers compared to other NSAIDs.

How NSAIDs and Contrave Interact

NSAIDs and Contrave both affect different biological pathways, but their combined use can lead to unintended adverse effects.

The primary concerns when taking Contrave with NSAIDs include:

1. Gastrointestinal Bleeding and Ulcers

NSAIDs are well known for their ability to irritate the lining of the stomach and intestines. Long-term or high-dose NSAID use can lead to:

• Stomach ulcers
• Gastrointestinal (GI) bleeding
• Increased acid production, worsening GERD (gastroesophageal reflux disease)

Contrave can compound these issues, raising your risk of developing severe stomach irritation, especially in individuals who already have gastric ulcers or a history of stomach problems.

If you’re starting Contrave treatment, tell your doctor if you take NSAIDs regularly to assess your risk.

2. Increased Risk of Seizures

One of the most serious potential side effects from Contrave is an increased risk of seizures. The bupropion component of Contrave affects neurotransmitter activity in the brain, lowering the seizure threshold, meaning seizures can occur more easily.

Additionally, Contrave has a boxed warning about the risk of suicidal thoughts and behaviors, which should be carefully considered before starting treatment.

NSAIDs, particularly ibuprofen and naproxen, have been linked to an increased risk of seizures in individuals with certain risk factors related to neurological conditions.

The combination of Contrave and NSAIDs may further raise the risk in those who:

• Have a history of epilepsy or seizures
• Have bipolar disorder or take mood-stabilizing medications
• Have suddenly stopped excessive drinking or are recovering from alcohol withdrawal

If you have a seizure disorder or are at high risk of seizures, your doctor likely won’t prescribe Contrave or will monitor you closely if NSAIDs are necessary for pain management.

3. Elevated Blood Pressure and Cardiovascular Risks

Contrave can increase blood pressure, which is a known concern for individuals with heart disease or hypertension. NSAIDs, particularly ibuprofen and naproxen, can also contribute to high blood pressure by causing the body to retain fluid and reducing the effectiveness of blood pressure medications.

This means that taking Contrave with NSAIDs could:

• Raise the risk of heart attack and stroke in individuals with pre-existing heart conditions.
• Increase your risk of high blood pressure-related complications such as kidney damage or heart failure.
• Cause fluid retention and swelling, making conditions like congestive heart failure worse.

If you have high blood pressure, it is crucial to talk with your doctor before combining Contrave with NSAIDs. Your doctor may prescribe a treatment other than Contrave or recommend alternative pain relievers, such as acetaminophen (Tylenol), which does not raise blood pressure.

4. Liver and Kidney Strain

NSAIDs and Contrave both place stress on the liver and kidneys, which can be dangerous for individuals with pre-existing liver disease or kidney dysfunction.

Naltrexone, one of the active ingredients in Contrave, is processed by the liver, and excessive NSAID use may worsen liver function.

Symptoms of liver or kidney problems include:

• Dark urine
• Yellowing of the skin (jaundice)
• Swelling in the legs and feet
• Fatigue and nausea

If you have a history of liver disease, kidney disease, or consume alcohol regularly, drinking alcohol or taking NSAIDs alongside Contrave could raise the risk of serious complications.

Always talk with your doctor before combining these medications.

Who Is at the Highest Risk?

Some individuals are at a higher risk for complications when using Contrave and NSAIDs together.

You may be at higher risk if you:

• Take Contrave and have a history of gastrointestinal bleeding or ulcers
• Have a history of seizures, alcohol withdrawal, or bipolar disorder
• Take other medications that increase seizure risk, such as SSRIs
• Have high blood pressure or cardiovascular disease
• Take high doses of NSAIDs frequently for chronic pain conditions

If any of these risk factors apply to you, your doctor likely won’t prescribe Contrave or may advise against using NSAIDs while taking Contrave.

Alternatives to NSAIDs for Pain Relief

If you are taking Contrave and need pain relief, consider discussing alternative treatments with your doctor or pharmacist.

Some safer alternatives may include:

• Acetaminophen (Tylenol): A good option for mild to moderate pain relief without increasing the risk of ulcers, high blood pressure, or kidney issues.
• Physical therapy: If you have chronic pain, non-drug approaches, such as exercise, stretching, or chiropractic care, may help reduce discomfort.
• Prescription alternatives: In some cases, your doctor may prescribe a treatment that provides pain relief without interfering with Contrave.

Increased Risk of Side Effects from Contrave

Taking NSAIDs with Contrave may increase the risk of side effects, such as:

• Gastrointestinal issues: NSAIDs can cause stomach irritation and ulcers, and Contrave can exacerbate these effects.
• High blood pressure: Both Contrave and NSAIDs can raise your blood pressure, increasing cardiovascular risks.
• Increased risk of seizures: Contrave already carries a risk of seizures, which NSAIDs may heighten.
• Liver and kidney concerns: NSAIDs can strain kidney function, which may worsen the effects of Contrave in individuals with pre-existing conditions.

Doctor Likely Won’t Prescribe Contrave If You Have Certain Risk Factors

Your doctor likely won’t prescribe Contrave if you:

• Have a history of gastrointestinal bleeding or ulcers
• Are at high risk for heart disease or high blood pressure
• Have a seizure disorder or take other medications that increase seizure risk
• Are dependent on alcohol or taking certain drugs that contain bupropion
• Have a history of certain eating disorders, such as bulimia or anorexia
• Are adults or children aged 24 years and younger, as the risk of suicidal thoughts and behaviors is higher in this age group

Dr. Olesiak advises, “Patients should always disclose their full health history to their doctor before starting Contrave treatment. Hidden risk factors may increase complications when combined with NSAIDs or other medications.” People with bulimia or anorexia should not take Contrave due to the increased risk of seizures.

NSAIDs aren’t the only drugs that may interact with Contrave. Certain medications can increase the risk of side effects, including seizures, suicidal thoughts and behaviors, and dangerously high blood pressure.

If you are taking Contrave, tell your doctor before combining it with any of the following:

1. Monoamine Oxidase Inhibitors (MAOIs)

Examples:

• Phenelzine (Nardil)
• Tranylcypromine (Parnate)
• Isocarboxazid (Marplan)
• Selegiline (Emsam, Zelapar)

Why is this interaction dangerous?

Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant that affect neurotransmitters in the brain.

Though Contrave is sometimes used for depression, taking it with MAOIs can cause a serious warning reaction known as serotonin syndrome, which can be life-threatening. Symptoms of serotonin syndrome include:

• Agitation and confusion
• Rapid heart rate and high blood pressure
• Tremors and muscle rigidity
• Severe headaches
• High fever and sweating

The Food and Drug Administration (FDA) warns that Contrave should not be taken within 14 days of stopping an MAOI to avoid a dangerous spike in serotonin levels.

If you are on an MAOI and considering Contrave treatment, tell your doctor first.

2. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Examples:

• SSRIs: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro)
• SNRIs: Duloxetine (Cymbalta), Venlafaxine (Effexor XR)

Why is this interaction dangerous?

SSRIs and SNRIs are commonly prescribed for depression and anxiety, but they can interact with bupropion hydrochloride, one of the active ingredients in Contrave.

This combination may:

• Increase the risk of seizures
• Cause serotonin syndrome when taken with Contrave
• Worsen side effects from SSRIs, such as anxiety, restlessness, and digestive problems

If you take an SSRI or SNRI, talk with your doctor before starting Contrave, as you may need a lower dose or an alternative treatment.

3. Opioid Pain Medications

Examples:

• Morphine (Mitigo, MS Contin)
• Oxycodone (Xtampza ER, Oxaydo, OxyContin)
• Hydrocodone (Vicodin, Norco, Zohydro ER)
• Fentanyl (Duragesic, Actiq, Sublimaze)
• Codeine and Tramadol

Why is this interaction dangerous?

Contrave contains naltrexone, an opioid antagonist, meaning it blocks the effects of opioids in the brain.

If you are taking prescription opioid medications and start Contrave, you may experience sudden opioid withdrawal, which can be severe and include:

• Extreme nausea and vomiting
• Severe anxiety and agitation
• Sweating and chills
• Rapid heartbeat and high blood pressure

If you regularly take opioids for pain relief, your doctor likely won’t prescribe Contrave, or they may gradually reduce your opioid dose before starting you on Contrave to prevent withdrawal symptoms.

4. Beta-Blockers

Examples:

• Propranolol (Inderal, Innopran XL, others)
• Metoprolol (Lopressor, Toprol XL)
• Atenolol (Tenormin)
• Carvedilol (Coreg)

Why is this interaction dangerous?

Beta-blockers are used to lower blood pressure and manage heart conditions, but Contrave may counteract their effects, raising your risk of high blood pressure.

If you take beta-blockers, your doctor or pharmacist should carefully monitor your blood pressure while on Contrave.

Additionally, beta-blockers can interact with Contrave’s bupropion hydrochloride component, potentially causing dizziness, irregular heartbeat, or extreme fatigue.

If you take a beta-blocker, talk with your doctor before starting Contrave.

5. Other Drugs Containing Bupropion

Examples:

• Aplenzin
• Forfivo XL
• Wellbutrin SR and Wellbutrin XL

Why is this interaction dangerous?

Bupropion is a stimulant-like antidepressant that increases the risk of seizures, particularly in high doses. Since Contrave already contains bupropion hydrochloride, taking other drugs that contain bupropion significantly raises the risk of seizures, suicidal thoughts and behaviors, and increased heart rate.

If you are currently taking bupropion for depression or smoking cessation, your doctor likely won’t prescribe Contrave, or they may recommend an alternative weight loss treatment other than Contrave.

Additional Medications That May Interact with Contrave

Alongside NSAIDs, opioids, MAOIs, and beta-blockers, several other treatments can interfere with Contrave’s effectiveness or cause serious side effects.

These include:

• Diabetes medications: Contrave can cause low blood sugar, so those taking insulin or oral diabetes drugs may need dosage adjustments.
• Blood thinners (anticoagulants): Contrave may increase the risk of bleeding complications when taken with warfarin, Xarelto, or Eliquis.
• Steroids (corticosteroids): Prednisone and dexamethasone can interact with Contrave, causing high blood pressure and increased blood sugar levels.
• Alcohol and certain medications: Drinking alcohol or taking certain medications, including seizure medications or sedatives, can increase your risk of seizures when combined with Contrave.
• Certain weight loss drugs: Medications that help with weight control, such as Phentermine and Qsymia can interact with Contrave, increasing your risk of side effects like gastrointestinal issues, seizures, etc.

How to Minimize Risks

If you take NSAIDs and are considering Contrave treatment, tell your doctor to discuss safer alternatives.

Your doctor may prescribe a treatment other than Contrave if your health history suggests a high risk of complications. Doctors are also unlikely to prescribe Contrave during pregnancy because weight loss during pregnancy is not typically recommended.

Steps you can take to reduce risk:

• Talk with your doctor about potential interactions before starting or stopping any medication.
• Monitor blood pressure regularly, as NSAIDs and Contrave may increase the risk of hypertension.
• Limit alcohol intake, as drinking alcohol or taking certain medications with Contrave can increase side effects.
• Avoid sudden NSAID use, especially in high doses, to prevent gastrointestinal issues and other serious reactions.

What to Do If You Experience Side Effects

If you experience severe side effects from Contrave, such as seizures, increased blood pressure, or an allergic reaction, seek immediate medical help. Contact your local emergency number or visit the nearest hospital if symptoms become life-threatening.

Your doctor may prescribe a treatment alternative or adjust your medication to reduce risks. Treatment other than Contrave may be necessary for individuals with underlying health conditions or who take multiple medications.

When to Contact a Doctor or Pharmacist

Consult your doctor or pharmacist if you:

• Experience new or worsening side effects from Contrave
• Develop low blood sugar (common in those with diabetes)
• Have a history of suddenly stopping excessive drinking
• Suspect an allergic reaction to Contrave or NSAIDs
• Have had an allergic reaction to Contrave or its ingredients in the past, as it should not be prescribed to you again

• Experience new or worsening side effects from Contrave
• Develop low blood sugar (common in those with diabetes)
• Have a history of suddenly stopping excessive drinking
• Suspect an allergic reaction to Contrave or NSAIDs

Frequently Asked Questions (FAQ) About Contrave and NSAIDs

When taking Contrave naltrexone bupropion for weight loss, it’s essential to be aware of potential drug interactions, especially with NSAIDs like ibuprofen, naproxen, and aspirin. These medications can increase the risk of side effects, such as gastrointestinal bleeding, high blood pressure, and seizures.

Below are answers to commonly asked questions regarding pain medication use while on Contrave.

1. Can you take ibuprofen when on Contrave?

It is generally not recommended to take ibuprofen (Advil, Motrin) while on Contrave without consulting your doctor or pharmacist. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of stomach ulcers, gastrointestinal bleeding, and high blood pressure, which may be worsened by Contrave.

Additionally, bupropion, one of the active ingredients in Contrave, may lower the seizure threshold, and ibuprofen can further increase this risk in some individuals. If you need pain relief, your doctor may prescribe a treatment alternative, such as acetaminophen (Tylenol), which does not carry the same risks.

2. What medications should I avoid with Contrave?

Several medications may interact with Contrave, increasing the risk of side effects such as high blood pressure, seizures, and suicidal thoughts and behaviors.

You should avoid or use caution when taking:

• NSAIDs (e.g., ibuprofen, naproxen, aspirin) – May cause gastrointestinal bleeding and increased blood pressure.
• Opioids (e.g., oxycodone, morphine, hydrocodone) – Contrave contains naltrexone, which blocks opioid effects and may trigger withdrawal symptoms.
• Antidepressants (e.g., SSRIs, MAOIs, SNRIs) – Combining Contrave with selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs) may increase the risk of serotonin syndrome and seizures.
• Other drugs containing bupropion (e.g., Wellbutrin, Aplenzin, Forfivo XL) – Increases the risk of seizures and elevated blood pressure.

Before taking Contrave, discuss all medications you use, including over-the-counter drugs, supplements, and herbal remedies, with your doctor.

3. Can I take Aleve while on Contrave?

Aleve (naproxen) is an NSAID that may increase your risk of stomach ulcers, gastrointestinal bleeding, and high blood pressure when taken with Contrave. The bupropion in Contrave also lowers the seizure threshold, and naproxen has been associated with an increased risk of seizures in some individuals.

If you require pain relief while taking Contrave, your doctor or pharmacist may recommend acetaminophen (Tylenol) instead, as it does not carry the same gastrointestinal and cardiovascular risks. Always talk with your doctor before using NSAIDs like Aleve while on Contrave.

4. Can you take ibuprofen while on bupropion?

Taking ibuprofen while on bupropion (one of the active ingredients in Contrave) can be risky, as both drugs can increase the risk of seizures. Bupropion already lowers the seizure threshold, and ibuprofen may further increase this risk, particularly if taken at high doses or in individuals with certain risk factors related to seizure disorders, alcohol withdrawal, or eating disorders.

Additionally, ibuprofen can contribute to high blood pressure and stomach irritation, which are also concerns when taking bupropion.

If you need a pain reliever, talk with your doctor to determine a safer alternative.

5. Can you take pain medication with Contrave?

Yes, but not all pain medications are safe to use with Contrave. NSAIDs like ibuprofen, naproxen, and aspirin may increase the risk of gastrointestinal bleeding, ulcers, and high blood pressure, while opioid pain medications can cause severe withdrawal symptoms due to Contrave’s naltrexone component.

The safest over-the-counter pain medication for most individuals on Contrave is acetaminophen (Tylenol), as it does not interact with Contrave in the same way as NSAIDs or opioids.

However, talk with your doctor or pharmacist before using any pain relief medications to ensure they are safe based on your health history.

6. Can I take ibuprofen while on naltrexone?

If you are taking naltrexone (one of the active drugs in Contrave), you should use ibuprofen with caution. NSAIDs like ibuprofen can raise your risk of stomach ulcers and gastrointestinal bleeding, which may be worsened when combined with naltrexone hydrochloride.

Additionally, ibuprofen may contribute to high blood pressure and kidney problems, particularly in individuals with pre-existing cardiovascular or renal conditions.

If you need a pain reliever, talk with your doctor to determine whether acetaminophen or other treatments are safer options.

Conclusion

Contrave and NSAIDs drug interactions can pose significant health risks, particularly for those with certain risk factors related to heart disease, seizures, or gastrointestinal issues.

If you’re considering Contrave treatment, tell your doctor about all your medications, including NSAIDs, to minimize complications.

You can safely navigate weight loss treatments like Contrave by discussing potential risks with your doctor or pharmacist, monitoring your blood pressure, and being aware of warning signs.