Contrave and Propranolol Drug Interactions & Side Effects

Understanding Contrave and propranolol drug interactions is crucial for individuals using these medications for weight loss and blood pressure management. According to the FDA, Contrave is a prescription weight-loss medication that combines bupropion naltrexone to help certain individuals with a reduced-calorie diet and increased physical activity (FDA).

Propranolol, a beta-blocker, is commonly prescribed for high blood pressure, heart conditions, and anxiety medicines (NIH). When used together, these medications can result in possible interactions, which may affect blood pressure, blood sugar, and mental health.

Dr. Matthew Olesiak, Chief Medical Director at SANE MD, states, “Patients should inform their healthcare provider about all other drugs and dietary supplements they are taking before starting Contrave treatment, as beta-blockers like propranolol may interact with bupropion naltrexone in ways that require medical supervision.”

Key Takeaways

• According to the CDC, combining Contrave and propranolol may result in an increased risk of irregular heartbeat, high blood pressure, and changes in blood sugar (CDC).
• Both bupropion and propranolol affect neurotransmitters, potentially leading to worsening depression, mood swings, and mental health changes.
• Consulting a healthcare provider before initiating bupropion and propranolol together is essential to avoid serious skin reactions and cardiovascular risks.

What is Contrave?

According to the FDA’s prescribing information, Contrave is an FDA-approved prescription medication for weight loss. It is designed for compatible individuals with a high body mass index (BMI) or weight-related medical conditions (FDA).

It combines two active ingredients:

• Bupropion – An aminoketone antidepressant that helps regulate appetite and energy balance. It is also used to treat depression and aid in smoking cessation.
• Naltrexone – An opioid antagonist primarily used in treating opioid dependence and alcohol addiction, but in Contrave, it helps modify cravings.

Contrave, shown to help individuals lose weight, is prescribed in combination with a reduced-calorie diet and increased physical activity. However, the FDA warns that it comes with potential risks, such as increased blood pressure, risk of seizures, and serious skin reactions (FDA).

Patients should avoid alcoholic beverages and narcotic medicines, as these can lead to possibly dangerous interactions.

What is Propranolol?

According to the NIH, propranolol is a non-selective beta-blocker that is widely prescribed for high blood pressure, heart conditions, and anxiety medicines (NIH).

Propranolol blocks beta-adrenergic receptors, diminishing the effects of adrenaline and lowering blood pressure and heart rate.

Uses of Propranolol:

• High blood pressure management – Helps reduce hypertension and cardiovascular risk factors (CDC).
• Heart rhythm disorders – Used to control irregular heartbeat and prevent heart attacks.
• Migraine prevention – Can help reduce the frequency and severity of migraines.
• Anxiety treatment – Often prescribed to manage symptoms of anxiety medicines, including rapid heartbeat and tremors.
• Thyroid storm – Used in hyperthyroid patients to control symptoms such as palpitations.

Although propranolol is effective, the NIH notes that it may cause serious skin reactions, flu-like symptoms, and worsening depression in some patients (NIH). Individuals taking propranolol should avoid alcoholic drinks, as alcohol can enhance its sedative effects.

Healthcare providers must monitor for blood sugar fluctuations and possible interactions with other drugs, especially when used with Contrave. Patients should follow prescribed dosages and never stop propranolol suddenly, as it may result in a rebound effect, increasing blood pressure and heart rate (NIH).

Contrave and Propranolol Drug Interactions & Risks

Interaction Type	Potential Effect	Recommendation
Blood Pressure Variations	Unpredictable fluctuations, dizziness, irregular heartbeat	Regular blood pressure monitoring, consult a healthcare provider
Mental Health Changes	Increased risk of worsening depression, anxiety, mood swings	Monitor for mental health changes, report concerns to a doctor
Cardiovascular Risks	Higher risk of irregular heartbeat, chest pain, fainting	Discuss cardiovascular history before taking both drugs
Risk of Seizures	Bupropion naltrexone lowers seizure threshold, increasing risk of seizures	Avoid sudden medication changes, stay hydrated, consult a doctor
Effects on Blood Sugar	Can cause low or high blood sugar, especially in diabetics	Regular blood sugar checks, adjust medications as needed
Serious Skin Reactions	Rash, flu-like symptoms, systemic exposure reactions	Stop medication if symptoms occur, seek emergency care
Alcohol Interactions	Increased drowsiness, risk of seizures, worsened mood changes	Avoid alcoholic beverages, discuss with a doctor
Medication Adjustments	Propranolol should not be stopped suddenly, risk of rebound high blood pressure	Gradual dose adjustments under medical supervision

Possible Drug Interactions

When taking Contrave and propranolol together, understanding their possible interactions is essential for safe medication use.

While Contrave is primarily prescribed for losing weight, it affects multiple neurotransmitters, metabolism, and blood pressure regulation. Propranolol, a beta-blocker, alters cardiovascular function and is often used for high blood pressure, anxiety, and heart conditions.

Because both medications impact the central nervous system, cardiovascular system, and metabolic pathways, combining them may increase the risk of seizures, cause mental health changes, or trigger serious skin reactions.

Below are key possible interactions that patients should discuss with their healthcare provider before starting Contrave treatment alongside propranolol. These side effects of Contrave and propranolol drug interactions can be severe, so you should seek medical attention if needed.

1. Blood Pressure Variations

Since bupropion naltrexone in Contrave can increase blood pressure, while propranolol works to lower it, their combined effects may result in unpredictable fluctuations. Individuals with high blood pressure or pre-existing cardiovascular conditions should take extra caution, as these changes can cause symptoms such as:

• Dizziness or lightheadedness due to sudden blood pressure shifts
• Rapid or irregular heartbeat
• Chest discomfort or shortness of breath
• Headaches or blurred vision associated with high blood pressure episodes

To prevent complications, regular blood pressure monitoring is recommended. If unexpected blood pressure fluctuations occur, a healthcare provider may adjust the dosage or recommend an alternative treatment plan.

2. Mental Health and Mood Changes

Combining these medications may lead to new or worsening depression, anxiety, or mental health changes, particularly in individuals with a history of bipolar disorder or previous suicide attempts.

• Bupropion naltrexone influences dopamine and norepinephrine levels, which can elevate mood but may also increase agitation or restlessness.
• Propranolol, though often prescribed for anxiety medicines, can cause fatigue, low energy, or mood swings, which may counteract Contrave’s stimulating effects.

Some patients may experience:

• Mood instability, such as irritability, nervousness, or emotional blunting
• Increased anxiety or panic attacks
• Worsening depression or feelings of hopelessness
• Mental fog, memory issues, or difficulty concentrating

If any mental health changes occur, it is crucial to consult a healthcare provider immediately.

3. Cardiovascular Risks

Contrave and propranolol both impact heart function, increasing the risk of cardiovascular complications, especially in patients with underlying heart disease.

Potential concerns include:

• Irregular heartbeat (arrhythmia), which can lead to palpitations or fainting
• Fluctuating blood pressure, increasing the risk of seizures or heart strain
• Chest pain or discomfort, indicating the need for immediate medical attention

Patients should discuss their cardiovascular risk factors with their healthcare provider before combining these medications.

4. Risk of Seizures

Taking both bupropion (a component of Contrave) and propranolol may increase the risk of seizures, particularly in individuals with a history of:

• Epilepsy or other neurological disorders
• Bipolar disorder
• Alcohol or drug abuse (as suddenly stopped drinking alcohol can also trigger seizures)

Bupropion naltrexone lowers the seizure threshold, meaning even mild triggers—such as dehydration, sleep deprivation, or high blood pressure fluctuations—can provoke a seizure episode. Healthcare providers should assess seizure risk factors before prescribing Contrave in combination with propranolol.

5. Effects on Blood Sugar

Both medications can affect blood sugar, posing a concern for individuals with diabetes or metabolic disorders.

• Contrave treatment may alter glucose metabolism, increasing the likelihood of low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia) episodes.
• Propranolol can mask symptoms of low blood sugar, such as a racing heart, making it harder for diabetic patients to recognize when their sugar levels drop dangerously low.

Symptoms to watch for:

• Shakiness, dizziness, or confusion (low blood sugar)
• Excessive thirst, frequent urination, or fatigue (high blood sugar)

Routine blood sugar monitoring is advised, especially in individuals taking insulin or other medications for diabetes.

6. Serious Skin Reactions

Both medications have been linked to serious skin reactions, including:

• Skin rash or itching
• Flu-like symptoms, such as fever, muscle aches, and chills
• Severe allergic reaction, including swelling or trouble breathing

These reactions could indicate systemic exposure to an adverse immune response, requiring immediate medical evaluation. Patients should discontinue the medication and seek urgent care if they notice any severe skin reactions.

7. Interactions with Alcohol

Alcohol consumption can worsen side effects when taking Contrave and propranolol. Patients should:

• Avoid alcoholic beverages, as alcohol increases drowsiness and impairs judgment.
• Be cautious about suddenly stopping drinking alcohol, as withdrawal effects combined with Contrave can increase the risk of seizures or mood instability.
• Avoid alcoholic drinks entirely while adjusting to the medication to minimize possible interactions.

Individuals with a history of alcoholic beverage dependence should discuss alternative treatment options with their healthcare provider.

Safety Guidelines

Consultation with a Healthcare Provider

Before starting Contrave treatment, it is essential for patients to have an in-depth discussion with their healthcare provider to evaluate potential risks, especially if they have a history of:

• High blood pressure or cardiovascular conditions
• Drug abuse or a past history of substance dependence
• Mental health conditions, including bipolar disorder, new or worsening depression, or a previous suicide attempt
• Seizure disorders or other neurological conditions
• Diabetes or metabolic disorders that could be impacted by blood sugar fluctuations
• Liver or kidney disease, which may alter medication metabolism
• Allergies or a history of serious skin reactions, such as a skin rash or flu-like symptoms

A healthcare provider will assess risk factors, monitor for possible interactions, and determine the safest way to prescribe Contrave alongside propranolol.

Dr. Matthew Olesiak advises, “Patients should be aware of the possible interactions between bupropion naltrexone and propranolol. A healthcare provider can assess the risk factors and determine the safest approach for weight loss and blood pressure management.”

Why This Consultation Matters

Since Contrave medicine affects blood pressure, mood regulation, and blood sugar, and propranolol influences cardiovascular and nervous system function, taking both medications together may increase the risk of severe side effects.

A healthcare provider can:

• Adjust dosages or recommend alternative medications to lower cardiovascular risks.
• Monitor for high blood pressure or abnormal irregular heartbeat fluctuations.
• Identify signs of serious skin reactions or flu-like symptoms that may indicate an adverse immune response.
• Offer safer alternatives for losing weight in patients with contraindications.
• Guide patients on managing mental health changes, including new or worsening depression or anxiety medicines effects.
• Provide recommendations on avoiding over-the-counter drugs, dietary supplements, and alcoholic beverages that may lead to certain drug interactions.

When to Seek Immediate Medical Attention

Patients should contact their healthcare provider immediately if they experience:

• Severe dizziness or fainting due to blood pressure instability
• Worsening depression or suicidal thoughts
• Flu-like symptoms, skin rash, or other serious skin reactions
• Unexplained changes in blood sugar levels
• Irregular heartbeat or persistent chest pain
• Symptoms of opioid withdrawal symptoms, especially if they have a history of opioid dependence

By consulting a healthcare provider before and during Contrave treatment, patients can minimize possible interactions, optimize their weight loss efforts, and reduce the risk of severe side effects.

Medication Adjustments

To minimize possible interactions and reduce the increased risk of adverse effects, other medications may need to be adjusted when taking Contrave and propranolol together. Since bupropion naltrexone affects blood pressure, blood sugar, and neurotransmitter activity, and propranolol influences cardiovascular and nervous system functions, careful supervision by a healthcare provider is necessary.

Gradual Medication Changes

• Propranolol should not be stopped suddenly, as this may cause rebound high blood pressure, rapid heart rate, and an irregular heartbeat. Instead, tapering the dose gradually under medical supervision is recommended.
• If Contrave treatment is causing serious skin reactions or flu-like symptoms, a healthcare provider may adjust the dosage or explore alternative weight loss treatments.
• Patients taking other drugs, such as anxiety medicines or medications for diabetes, may require dose adjustments to account for changes in blood sugar levels.

Avoiding Drug and Dietary Interactions

Since Contrave and propranolol interact with alcoholic beverages, certain foods, and over-the-counter drugs, patients should take steps to avoid possible interactions:

Avoiding Alcohol:

• Patients should avoid alcoholic drinks, as alcohol may increase the risk of drowsiness, dizziness, and mood changes.
• Those who have suddenly stopped drinking alcohol may experience withdrawal effects, increasing the risk of seizures when taking bupropion naltrexone.
• Individuals with a history of drug abuse or mental health changes should be especially cautious, as alcohol can worsen depression or anxiety.

Reviewing Dietary Supplements & Medications:

• Dietary supplements, including herbal products, may interact with both medications. Patients should consult their healthcare provider before using over-the-counter drugs or supplements.
• Certain over-the-counter drugs, such as decongestants, can raise blood pressure, leading to complications when combined with bupropion naltrexone.

Watching Food Intake:

• High–fat meals can increase systemic exposure to Contrave, making side effects like nausea, dizziness, or headache more severe.
• Eating a reduced-calorie diet with balanced macronutrients can help improve the effectiveness of Contrave treatment and minimize blood sugar fluctuations.

Monitoring for Allergic and Skin Reactions

Contrave and propranolol can trigger serious skin reactions, so patients should be vigilant for the following symptoms:

• Skin rash, itching, or swelling
• Flu-like symptoms such as fever, chills, or muscle aches
• Unusual or allergic reaction, including difficulty breathing or swelling of the face, lips, or throat

If any of these symptoms occur, patients should discontinue medication and seek emergency care immediately.

Handling Unused Medicine

Proper disposal of unused medicine is essential to prevent accidental ingestion and protect public safety. Patients should:

• Follow FDA guidelines or local pharmacy recommendations for safe medication disposal.
• Avoid flushing unused medicine down the toilet unless specifically instructed to do so in the patient package insert.
• Store medications away from children and pets to prevent accidental ingestion.

By taking these precautions, patients can ensure safer medication use while losing weight and managing blood pressure effectively.

Frequently Asked Questions (FAQ)

When taking Contrave and propranolol together, it is important to understand their possible interactions and potential side effects.

Below are answers to common questions regarding the safety, risks, and medication interactions associated with these two drugs. If you have concerns about your specific health situation, consult your healthcare provider for personalized guidance.

1. Can I take propranolol with Contrave?

It is possible to take propranolol with Contrave, but it requires medical supervision due to potential drug interactions. Bupropion naltrexone in Contrave can increase blood pressure, while propranolol is designed to lower it, potentially leading to unpredictable fluctuations in blood pressure.

Additionally, Contrave may affect mental health changes, and propranolol can influence mood stability, which could contribute to worsening depression or anxiety in some individuals.

If you are considering starting Contrave treatment while taking propranolol, consult a healthcare provider to assess risks and monitor for adverse effects.

2. Can you take BuPROPion and propranolol together?

Yes, BuPROPion and propranolol can be taken together, but caution is advised. BuPROPion naltrexone in Contrave can lower the seizure threshold, while propranolol affects heart rate and blood pressure, which could increase the risk of side effects such as dizziness, drowsiness, or an irregular heartbeat.

Patients with a history of bipolar disorder, previous suicide attempts, or mental health changes should be closely monitored, as the combination of these drugs may contribute to new or worsening depression.

Always consult a healthcare provider before combining these medications, and report any unusual symptoms immediately.

3. What medications should not be taken with Contrave?

Certain medications should not be taken with Contrave due to possible interactions that can impact blood pressure, mood stability, or seizure risk.

These include:

• Opioid medications, such as morphine, oxycodone, fentanyl, codeine, or tramadol, due to Contrave’s opioid withdrawal symptoms effects.
• Monoamine oxidase inhibitors (MAOIs), used to treat depression, as they may cause dangerously high blood pressure.
• Other drugs that lower the seizure threshold, such as antipsychotics, certain antidepressants, or over-the-counter drugs like antihistamines, which could increase the risk of seizures.
• Dietary supplements that interact with bupropion naltrexone, particularly herbal weight loss supplements or stimulant-based products.
• Certain antibiotics can also interact with Contrave. These include clarithromycin and linezolid.

(See our guide for more medications that can interact with Contrave.)

Always inform your healthcare provider of all other medications or over-the-counter drugs you are taking before starting Contrave treatment.

4. What not to mix with propranolol?

Propranolol should not be mixed with certain medications or substances that may cause serious drug interactions or increase the risk of adverse effects.

These include:

• Alcoholic beverages, as they can enhance propranolol’s sedative effects and lower blood pressure too much.
• Other blood pressure medications, unless prescribed together under medical supervision, to avoid excessive blood pressure drops.
• Asthma medications, particularly beta-agonists like albuterol, since propranolol can block their effects, worsening breathing difficulties.
• Narcotic medicines and sedatives, as they can cause excessive drowsiness or dizziness.
• High-fat meals, which may affect propranolol’s absorption and metabolism.

If you are taking propranolol, consult your healthcare provider before adding any new medications or supplements to your routine.

5. Can I take Contrave with a beta blocker?

Contrave can be taken with a beta blocker like propranolol, but patients should be aware of potential possible interactions. Since bupropion naltrexone in Contrave may increase blood pressure, and beta blockers work to lower it, this combination requires close monitoring to avoid irregular heart beat or excessive cardiovascular strain.

Additionally, Contrave affects neurotransmitter activity, which can interact with the calming effects of beta-blockers, potentially influencing mental health changes such as new or worsening depression.

Patients should have regular blood pressure checks and discuss concerns with a healthcare provider to ensure the combination is safe for their individual health needs.

If you are considering taking Contrave and propranolol together or have concerns about their possible interactions, consult a healthcare provider before making any medication changes.

Regular monitoring and open communication with your doctor can help prevent adverse effects while maximizing the benefits of both medications.

Final Thoughts

The contrave interactions with propranolol present potential concerns, especially for individuals managing high blood pressure, mental health, and weight loss. Healthcare providers must weigh the benefits and risks before prescribing these medications together. Individuals should report flu-like symptoms, mental health changes, and any allergic reaction to ensure safe use.

By staying informed and working closely with a healthcare provider, patients can navigate these possible interactions safely while optimizing their health goals.

References

1. U.S. Food and Drug Administration (FDA) – Contrave Prescribing Information
2. National Institutes of Health (NIH) – Propranolol Drug Profile
3. Centers for Disease Control and Prevention (CDC) – Blood Pressure Management