Taking Contrave and Paxil Together Drug Interactions: a Good Idea?

Combining medications for weight loss and mental health can be beneficial in some cases, but it can also lead to serious complications if not managed carefully. One common concern is taking Contrave and Paxil together drug interactions.

Contrave is a prescription weight loss drug that contains bupropion hydrochloride and naltrexone, while Paxil (paroxetine) is an antidepressant used to treat depression, anxiety, and other mental health conditions.

While both medications can be helpful on their own, when taking Contrave and Paxil together, drug interactions between them may increase the risk of certain side effects, some of which may be severe. Understanding how these medications interact and how to use them safely is key to protecting both your mental and physical health.

Key Takeaways

• Taking Contrave and Paxil together may increase the risk of seizures, serotonin syndrome, and worsening of mental health conditions.
• Common side effects may be amplified, including high blood pressure, nausea, suicidal thoughts, and mood changes.
• Always consult your doctor or pharmacist before starting Contrave treatment, adjusting doses, or stopping either medication.

How Contrave Works: Active Ingredients and Effects

Contrave treatment combines two active ingredients: bupropion hydrochloride, an antidepressant and smoking cessation aid, and naltrexone, typically used to treat alcohol and opioid dependence. Together, these ingredients target areas of the brain involved in appetite and reward response, helping support long-term weight loss and weight management for compatible individuals.

Because bupropion hydrochloride is also used to treat depression, combining it with another antidepressant like Paxil increases the likelihood of certain drug interactions. These risks are detailed in the patient package insert and are critical to review before starting Contrave.

Paxil Overview: Mental Health Support and Risks

Paxil is a selective serotonin reuptake inhibitor (SSRI) often prescribed for depression, anxiety, panic attacks, and other mental health conditions. Like many other antidepressants, it alters neurotransmitter levels in the brain.

Using Paxil alongside bupropion, one of the active ingredients in Contrave, may affect serotonin and dopamine systems in ways that increase the risk of side effects. A 2004 case study published in Clinical Neuropharmacology documented a rare but serious instance of serotonin syndrome in a patient taking bupropion and an SSRI, highlighting the potentially life-threatening risks when these medications are combined (Munhoz, 2004).

Drug Interactions Between Contrave and Paxil

The combination of Contrave and Paxil together raises concern for several potential drug interactions, especially given the way each medication affects brain chemistry and cardiovascular function.

While both drugs may be prescribed individually to support weight loss or manage mental health conditions, using them in tandem can increase the risk of serious side effects. How does Contrave interact with Paxil?

Here are the most important risks to consider:

1. Increased Seizure Risk

One of the most well-documented risks of bupropion hydrochloride—a key active ingredient in Contrave—is its ability to lower the seizure threshold. Paxil, while less commonly associated with seizures, can further complicate this risk, particularly in patients with a history of seizure disorder, head trauma, or those who suddenly stop drinking alcohol.

Combining these medications can amplify the chances of seizure activity, especially if dosing is not carefully managed.

2. Elevated Blood Pressure

Both Contrave and Paxil have been associated with rises in blood pressure and heart rate. When used together, they may increase blood pressure to levels that are dangerous, particularly for individuals with preexisting high blood pressure or heart disease.

If you are already taking medications to treat high blood pressure, this interaction may reduce their effectiveness or worsen cardiovascular strain.

3. Worsening of Mental Health Symptoms

Since both drugs act on brain chemicals like serotonin, dopamine, and norepinephrine, combining them may destabilize mood in some individuals. This is especially true for people with bipolar disorder, who may experience manic episodes, or those with existing mental health problems, such as anxiety or PTSD.

The risk is higher during the initial weeks of therapy or during dosage changes.

4. Suicidal Thoughts or Behaviors

Like many antidepressants, Paxil carries a boxed warning that alerts doctors to the increased risk of suicidal thoughts, especially in adolescents and young adults. Bupropion, while often used to treat depression, can also contribute to mood instability in vulnerable individuals.

Taken together, the combined effect on emotional regulation and neurotransmitters may heighten this risk.

5. Serotonin Syndrome

Though rare, serotonin syndrome is a serious and potentially life-threatening condition caused by excess serotonin in the brain. Paxil increases serotonin levels directly, and while Contrave is not classified as an SSRI, bupropion can interfere with serotonin pathways indirectly.

Symptoms of serotonin syndrome include confusion, muscle rigidity, rapid heart rate, high fever, and tremors. Prompt medical attention is essential if these symptoms appear.

Dr. Matthew Olesiak, MD, Chief Medical Director at SANE MD, explains:

“When two drugs affect neurotransmitter systems—like bupropion and paroxetine—the overlap can disrupt balance and heighten side effects. Patients on both medications should be monitored closely, especially during the first weeks of combined treatment.”

These Contrave drug interactions are particularly concerning in individuals with a seizure disorder, bipolar disorder, or severely high blood pressure—all of which significantly increase the risk of complications when these medications are combined.

Why This Combination May Increase Side Effect Risks

Using both Contrave and Paxil can increase the risk of overlapping or amplified side effects because both medications directly impact the central nervous system. Each drug influences neurotransmitters that regulate mood, appetite, and stress responses.

When combined, their effects may interact in ways that the body isn’t equipped to handle, especially without careful monitoring.

Here’s how the risks can compound:

• Bupropion hydrochloride can increase blood pressure, and Paxil may also cause cardiovascular changes in some individuals. When used together, the risk of high blood pressure or rapid heart rate becomes more pronounced, which is particularly concerning in people with heart disease or those already taking medications to treat high blood pressure.
• Both medications affect mood and mental state, which may worsen mental health problems or trigger suicidal thoughts, especially in patients with a history of bipolar disorder, panic attacks, or other mental health conditions. Abrupt changes in dosage or inconsistent adherence can make these effects more unpredictable.
• Certain behaviors Contrave is designed to reduce—such as emotional or stress-related eating—can become harder to manage if Paxil dosing is altered. Since Paxil is a certain antidepressant that influences serotonin, any fluctuation in its effects may impact mood stability, appetite control, and weight management.

These overlapping drug effects can lead to a higher risk of side effects, particularly in the early stages of starting Contrave treatment, during dose changes, or when combining it with other antidepressants like Paxil. The FDA warns of such side effects in its patient labeling insert.

 

Common and Serious Side Effects to Watch For

When taking Contrave, especially in combination with Paxil or similar weight loss drugs, it’s important to be aware of both common and potentially serious reactions.

Many Contrave side effects result from the body adjusting to this drug’s active ingredients—bupropion hydrochloride and naltrexone—as well as the way those compounds may interact with other drugs that affect neurotransmitters, such as Paxil.

Side effects that may occur include:

• Increased blood pressure – May occur with either drug and should be closely monitored.
• Headache – Often reported during the first few weeks of Contrave treatment.
• Anxiety or mood swings – Can result from overstimulation or poor neurotransmitter balance.
• Dizziness – May be due to changes in blood pressure or drug effects on the brain.
• Nausea or vomiting – A common response when starting Contrave, especially without food.
• Low blood sugar – More likely in patients with diabetes; monitor levels regularly.
• Skin rash or signs of allergic reaction – Could indicate sensitivity to one of the active ingredients or other components of the medications.
• Difficulty sleeping – Often related to bupropion hydrochloride, especially when taken too late in the day.
• Tremors – Can be a sign of nervous system overstimulation.
• Visual changes – Blurred vision or visual distortion, though rare, should be reported immediately.

Dr. Matthew Olesiak, MD, emphasizes the importance of recognizing emotional shifts alongside physical symptoms:

“One of the most overlooked complications is the potential for Contrave to interfere with mental health stability. It’s not just about physical symptoms—emotional changes can be subtle at first but become dangerous quickly.”

If you experience warning signs of serotonin syndrome—such as high fever, muscle stiffness, confusion, rapid heart rate, or agitation—seek medical attention or call your local emergency number immediately.

This is a true medical emergency and must be addressed quickly to prevent complications.

Who Should Avoid Combining These Medications?

Some patients face a higher risk of Contrave interactions and should avoid this drug combination unless specifically guided by a provider.

Avoid combining these medications if you have:

• A seizure disorder or a history of head trauma
• Severely high blood pressure or uncontrolled heart disease
• History of bipolar disorder
• Active liver problems
• A history of eating disorders
• Mental health changes linked to medications
• Use of monoamine oxidase inhibitors (MAOIs) in the past 14 days

This combination may also be unsuitable for those who suddenly stop drinking alcohol, as bupropion can increase the risk of seizures during alcohol withdrawal.

Alcohol Use and Medication Safety

Patients who drink alcohol regularly or have recently stopped drinking alcohol should be cautious. Both Paxil and bupropion hydrochloride can increase the risk of seizures, and alcohol intensifies this effect.

For those who suddenly stop drinking alcohol, even a small dosage of Contrave may be dangerous.

It is essential to speak with your doctor or pharmacist before starting Contrave if alcohol is part of your lifestyle.

Blood Pressure and Heart Risks

One of the most important concerns with taking Contrave is the potential to increase blood pressure. When combined with Paxil—which may also affect cardiovascular responses—the risks can multiply. Other blood pressure medications, such as Lisinopril, Propranolol, and Losartan, may also negatively affect blood pressure when used with Contrave. Read more about Contrave hypertension risk in our detailed guide.

If you’re already taking medication to treat high blood pressure, your provider may recommend extra monitoring or adjustments. High blood pressure and heart rate may go unnoticed at first, but can increase the risk of cardiovascular events if left unmanaged.

 

Other Medications and Hidden Risks

In addition to Paxil, Contrave may interact with many other medications, including:

• Other antidepressants
• Certain beta blockers
• Over-the-counter cold remedies
• Drugs that affect liver enzymes
• Vitamins and supplements (e.g., vitamin interactions)

Be cautious of other drugs you may be taking, even if they seem unrelated. Some weight loss treatments, hormonal medications, or even lab tests may be affected by Contrave. A false positive result on drug tests is also possible when taking Contrave.

Always inform your provider of your health history, including any health conditions, mental health problems, or previous medication reactions.

What to Discuss With Your Doctor or Pharmacist

Before you begin Contrave treatment, it’s important to have an open and thorough conversation with your doctor or pharmacist.

This helps ensure the medication is safe for your individual needs and reduces the chance of dangerous drug interactions or unexpected side effects.

Be sure to discuss:

• All other medications you’re taking: This includes prescriptions, over-the-counter drugs, and recent treatments. Some other medications, including antidepressants, seizure medications, and certain blood pressure drugs, may interact with Contrave or increase the risk of adverse reactions.
• Any known allergic reactions: Let your provider know if you’ve ever had a skin rash, difficulty breathing, or any other allergic reaction to medications, especially bupropion, naltrexone, or similar compounds.
• Your history of heart disease, liver problems, or bipolar disorder: These health conditions can affect how your body handles Contrave and may increase the risk of complications like high blood pressure, mood swings, or liver strain.
• Whether you’re pregnant, breastfeeding, or planning to become pregnant: Since Contrave passes into breast milk, it may not be recommended for use while nursing or during pregnancy. Your doctor can help weigh the risks and benefits based on your situation.
• If you’re using any over-the-counter supplements or natural products: Herbal products, vitamins, or over-the-counter supplements can cause vitamin interactions or interfere with Contrave’s effects. Even seemingly harmless items like caffeine pills or St. John’s Wort can pose a risk.

This conversation is essential for tailoring your weight loss treatment safely and effectively. It helps your provider make informed decisions and minimizes your risk of side effects—especially if you’re also managing other health conditions or taking other drugs.

Tips for Taking Contrave Safely

Taking Contrave can support long-term weight loss and weight management, but it’s important to use the medication carefully to reduce your risk of side effects and avoid serious drug interactions.

Whether you’re using Contrave on its own or with medications like Paxil, following safety guidelines is essential.

Here are key safety tips:

• Never combine with monoamine oxidase inhibitors (MAOIs): Taking Contrave with MAOIs—such as phenelzine or tranylcypromine—can cause dangerous spikes in blood pressure or trigger serotonin syndrome. Wait at least 14 days after stopping an MAOI before starting Contrave treatment.
• Avoid high-fat foods, which may increase side effects: Meals high in fat can boost the absorption of Contrave too quickly, increasing the likelihood of nausea, vomiting, and other side effects. Stick to balanced, low-fat meals while on Contrave treatment to help your body tolerate the medication.
• Don’t abruptly stop or start either medication without guidance: Suddenly discontinuing Contrave or other medications like antidepressants may lead to withdrawal symptoms, mood changes, or increased seizure risk. Always consult your doctor or pharmacist before making changes to your treatment plan.
• Monitor your blood pressure regularly: Contrave may increase blood pressure and heart rate, especially during the early stages of use. If you already treat high blood pressure, your provider may need to adjust your treatment or monitor your cardiovascular health more closely.
• Report any signs of allergic reaction or mental health changes: Be alert for signs like rash, itching, swelling, or changes in mood, behavior, or thoughts. These could signal an allergic reaction, worsening mental health problems, or rare but serious side effects like suicidal thoughts.

In addition:

• Be consistent with your weight loss and weight management goals by following your provider’s full plan, including dietary guidance and physical activity.
• Remember that Contrave comes in extended-release tablets—they must be swallowed whole. Do not cut, crush, or chew them, as this can release the medication too quickly and increase the risk of side effects.

Frequently Asked Questions (FAQ)

When it comes to combining medications for weight loss, mood regulation, or chronic conditions, safety is key. Many patients taking Contrave, Paxil, or both have questions about possible drug interactions and how to manage their prescriptions without increasing their risk of side effects.

Below are answers to some of the most common concerns about Contrave interactions, antidepressants, and safe medication use.

1. What drugs cannot be taken with Paxil?

Paxil (paroxetine) should not be combined with monoamine oxidase inhibitors (MAOIs), including drugs like phenelzine or selegiline, due to the risk of serotonin syndrome, which can be life-threatening. Other medications to avoid include pimozide, thioridazine, and certain NSAIDs or blood thinners, which may increase the risk of bleeding. Caution is also advised when taking other SSRIs, SNRIs, or certain beta blockers.

Always consult your doctor or pharmacist before adding any other medications, including over-the-counter products or supplements, to avoid potentially serious drug interactions.

2. Can you take bupropion and Paxil together?

Yes, bupropion (an active ingredient in Contrave) and Paxil are sometimes prescribed together, but the combination can pose risks. Because both drugs influence neurotransmitters in the brain, taking them at the same time may increase the risk of seizures, mental health changes, and suicidal thoughts in certain individuals.

Close monitoring is especially important when starting treatment, adjusting doses, or if the patient has a history of mental health conditions like bipolar disorder or panic attacks. This combination should only be used under medical supervision.

3. Can you take Contrave with Paxil?

Taking Contrave with Paxil is possible but comes with important safety considerations. Since Contrave contains bupropion hydrochloride, it can interact with Paxil to increase the chances of high blood pressure, seizure disorder symptoms, and serotonin-related side effects.

Both medications can also affect mood, which may trigger mental health problems or emotional instability in sensitive individuals. This combination is not uncommon, but it requires careful dose management and regular check-ins with a healthcare provider.

4. What medications should not be taken with Contrave?

Contrave should not be taken with monoamine oxidase inhibitors (MAOIs), other bupropion-containing drugs, or medications that can increase the risk of seizures, such as certain antipsychotics, stimulants, and corticosteroids.

It’s also important to avoid using Contrave with opioids or drugs used to treat opioid dependence, as naltrexone can block their effects. People who have recently suddenly stopped drinking alcohol or taking benzodiazepines should avoid Contrave due to seizure risk.

Tell your doctor about all other medications, including over-the-counter products and supplements, to prevent harmful drug interactions.

5. Can you take Contrave while on antidepressants?

In some cases, yes—Contrave treatment may be combined with certain antidepressants, but it depends on the specific medication and the individual’s health history. Combining Contrave with SSRIs like Paxil may increase the risk of side effects such as suicidal thoughts, mood swings, and high blood pressure.

These risks are higher in people with mental health conditions, bipolar disorder, or a history of drinking alcohol heavily. If your provider decides to prescribe Contrave alongside an antidepressant, you’ll need careful dose adjustments and monitoring to minimize adverse effects.

Final Thoughts on Contrave and Paxil Together

Combining Contrave and Paxil together can be risky, but it’s not always unsafe—especially under close supervision. Still, it’s critical to understand the risk of side effects, monitor your mental health, and work with a trusted healthcare provider.

While Contrave may offer benefits for weight loss, especially in patients with obesity or related health conditions, it’s not for everyone. The combination with Paxil requires caution, monitoring, and a personalized approach.

If you experience troubling side effects, seek medical advice promptly. When in doubt, call your doctor, pharmacist, or your local emergency number if you suspect a serious reaction.

References

Clinical Neuropharmacology

FDA