A scientific rendereing of Contrave and Wellbutrin Drug Interactions

Contrave and Wellbutrin Drug Interactions: Is It Safe?

Dr. Matthew Olesiak
SANE MD Chief Medical Director at SANESolution

Dr. Matthew Olesiak, MD, is the Chief Medical Director at SANESolution, a renowned wellness technology company dedicated to providing evidence-based solutions for optimal living. Dr. Olesiak earned his medical degree from the prestigious Jagiellonian University Medical College in Kraków, Poland, where he developed a strong foundation in medicine.

Contrave and Wellbutrin are two medications that influence the body’s neurological and metabolic systems. Contrave and Wellbutrin drug interactions are a critical concern for individuals who are prescribed both medications, as they share an active ingredient, bupropion, which affects neurotransmitters related to mood and appetite.

People taking Contrave, a combination medication of naltrexone and bupropion, typically use it for chronic weight management alongside a reduced-calorie diet and an exercise program. On the other hand, Wellbutrin is primarily prescribed to treat depression and assist with smoking cessation. While both medications can be beneficial on their own, using them together may increase the risk of certain side effects and complications. Indeed, Contrave drug interactions are quite common. 

Key Takeaways

  • Contrave and Wellbutrin interaction occurs due to their shared component, bupropion, which can elevate the risk of seizures and high blood pressure.
  • Contrave is primarily used for chronic weight management, while Wellbutrin is commonly prescribed to treat depression and assist in smoking cessation.
  • People with a history of seizure disorder, cardiovascular disease, or uncontrolled high blood pressure should consult their healthcare provider before combining these medications.

Understanding Contrave and Wellbutrin

What is Contrave?

Contrave is a combination medication that consists of naltrexone and bupropion, designed to aid in chronic weight management for compatible overweight and obese adults. It functions by helping to control cravings and suppress appetite, making it easier to adhere to a reduced-calorie diet and an exercise program.

What is Wellbutrin?

Wellbutrin, also containing bupropion, is an extended-release antidepressant prescribed to treat depression, assist with smoking cessation, and manage symptoms of bipolar disorder. It affects dopamine and norepinephrine levels in the brain, contributing to improved mood and cognitive function.

Contrave and Wellbutrin Drug Interaction Table

Category Contrave Wellbutrin
Active Ingredients Naltrexone & Bupropion Bupropion
Primary Use Chronic weight management Treat depression, smoking cessation
Common Side Effects Nausea, constipation, headache, increased heart rate Dry mouth, insomnia, agitation, dizziness
Interaction Risk Increased risk of seizures, high blood pressure, mood instability Increased seizure risk, elevated blood pressure, anxiety
Who Should Avoid This Combination? Patients with seizure disorders, uncontrolled high blood pressure, opioid dependency Patients with seizure disorders, bipolar disorder, eating disorders
Recommended Alternatives GLP-1 agonists (Ozempic, Wegovy), lifestyle changes, behavioral therapy Other antidepressants (SSRIs, SNRIs), cognitive therapy

Reason for Contrave and Wellbutrin Drug Interactions

The interaction between Contrave and Wellbutrin stems from their shared active ingredient, bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI). Bupropion works by increasing the levels of dopamine and norepinephrine in the brain, which can influence mood, appetite, and energy levels. However, when taken together, the combined dosage of naltrexone and bupropion can lead to several physiological and neurological effects, some of which may pose serious health risks.

Bupropion is known to increase blood pressure and lower the seizure threshold, meaning that individuals taking both medications may be at a heightened risk of hypertension, anxiety, and seizures. Additionally, naltrexone, an opioid antagonist in Contrave, can further alter the body’s stress response, potentially exacerbating certain side effects.

Given these risks, healthcare providers carefully evaluate whether the benefits of taking Contrave and Wellbutrin together outweigh the potential adverse effects. It is crucial for individuals taking both medications to monitor their symptoms closely and report any unusual reactions to their healthcare provider.

Potential Risks of the Interaction

Increased Risk of Seizures

Bupropion is known to lower the seizure threshold, meaning that individuals taking it are more prone to experiencing seizures. The risk is dose-dependent, meaning that the higher the dose of bupropion, the greater the likelihood of a seizure occurring.

This is particularly concerning for individuals with a history of seizure disorder, epilepsy, or head injury, as they are already at an elevated risk. Additionally, combining Contrave and Wellbutrin may amplify seizure susceptibility, especially if other risk factors—such as alcohol use, electrolyte imbalances, or abrupt discontinuation of either medication—are present.

Elevated Blood Pressure and Heart Risks

Bupropion has stimulant-like properties that can increase heart rate and elevate blood pressure. When used in combination with Contrave, which also contains bupropion, the likelihood of hypertension and cardiovascular stress increases.

For individuals with a history of high blood pressure, heart disease, or stroke, this combination can pose a significant risk. In some cases, patients taking both medications may develop palpitations, arrhythmias, or even hypertensive crises, which require immediate medical attention.

Mood and Mental Health Changes

Since bupropion affects dopamine and norepinephrine levels, it plays a role in regulating mood and emotional stability. While Wellbutrin is commonly prescribed to treat depression, high doses of bupropion from multiple sources may lead to mood swings, increased anxiety, and even worsening depression.

In some cases, patients may experience suicidal thoughts, paranoia, agitation, or hallucinations, particularly if they have a history of bipolar disorder or severe depression. Young adults are especially susceptible to these mood fluctuations, making it imperative that patients on Contrave and Wellbutrin undergo regular mental health evaluations.

Digestive System Disruptions

Naltrexone and bupropion in Contrave influence appetite and digestion, leading to gastrointestinal side effects such as nausea, vomiting, and constipation. These symptoms can worsen if the medication is taken on an empty stomach or alongside a high-fat meal, which increases bupropion absorption and intensifies side effects.

Individuals may also experience loss of appetite, diarrhea, bloating, constipation, and stomach cramps, especially during the initial weeks of treatment. Staying hydrated, maintaining a balanced diet, and eating smaller meals can help mitigate these effects. If you’d like to learn more about potential constipation symptoms, our guide on Contrave constipation specifically addresses this issue. 

Interactions with Other Medications

Taking Contrave and Wellbutrin alongside certain medicines can increase the likelihood of dangerous interactions. These include:

  • MAO Inhibitors (e.g., phenelzine, tranylcypromine) – Can lead to hypertensive crisis and serotonin syndrome if taken within the past two weeks.
  • Anti-Seizure Medicines (e.g., gabapentin, topiramate) – May counteract the effects of bupropion, increasing the likelihood of seizures.
  • Opioid Medications (e.g., oxycodone, morphine) – Naltrexone blocks opioid receptors, making these painkillers ineffective and potentially triggering opioid withdrawal.
  • Over-the-Counter Drugs (e.g., decongestants, NSAIDs) – Some common cold medications and pain relievers can increase blood pressure when combined with bupropion.

Who Should Avoid Taking Contrave and Wellbutrin Together?

Patients who have any of the following conditions should consult their healthcare provider before combining Contrave and Wellbutrin:

  • Uncontrolled High Blood Pressure – This combination can worsen hypertension and increase the risk of cardiovascular complications.
  • Cardiovascular Disease – Individuals with heart disease, a history of stroke, or arrhythmias may experience increased blood pressure and heart strain.
  • Seizure Disorder or Head Injury – Since bupropion lowers the seizure threshold, anyone with a history of epilepsy or brain trauma should avoid this combination.
  • Eating Disorders (e.g., anorexia nervosa, bulimia) – Patients with a history of disordered eating face a higher risk of electrolyte imbalances and seizures when taking bupropion.
  • Opioid Use or Dependence – Naltrexone blocks opioid receptors, meaning that anyone dependent on opioids may experience withdrawal symptoms if taking Contrave.

Patients considering Contrave for weight loss should be mindful of its active ingredient, bupropion, which is also found in Wellbutrin. If both medications are taken together, the risk of seizures, high blood pressure, and mood disturbances increases. For those interested in how Contrave affects weight loss, including expected results and factors that influence effectiveness, our guide on how fast you lose weight on Contrave provides valuable insights.

Contrave and Wellbutrin Drug Interactions

Dosage and Administration Guidelines

Proper Use of Contrave

Contrave is taken in extended-release tablets, usually following this titration schedule:

  • Begin with one tablet daily, then gradually increase to two tablets taken twice a day over a period of four weeks.
  • The medication should be taken with a reduced calorie diet and exercise program to optimize weight loss.
  • Avoid high-fat meals, as they increase bupropion absorption and heighten side effects.
  • Alcoholic beverages should be avoided to prevent serious injury and adverse reactions.

Proper Use of Wellbutrin

Wellbutrin is prescribed in extended-release tablets, with dosage adjusted based on individual needs:

  • The typical dose for depression is 150-300 mg daily in one or two doses.
  • For smoking cessation, patients follow a regular dosing schedule over several weeks.
  • Missing a dose can result in worsening depression or withdrawal symptoms, so it is important to follow a consistent routine.

Potential Side Effects and Warning Signs

While Contrave and Wellbutrin can be effective for weight loss and depression management, they come with the risk of side effects that require medical attention. The likelihood and severity of these side effects depend on factors such as dosage, medical history, and individual response to treatment.

Certain patients taking naltrexone and bupropion should be particularly vigilant about changes in their physical and mental well-being. If any of the following symptoms occur, immediate consultation with a healthcare provider is recommended.

Symptoms to Monitor

1. Trouble Breathing or Skin Reactions Such as Skin Rash

Difficulty breathing can be a sign of a serious allergic reaction to either naltrexone or bupropion, requiring immediate medical attention. In rare cases, this could indicate anaphylaxis, a life-threatening condition characterized by swelling of the throat, hives, and wheezing.

Skin reactions, including skin rash, hives, or blistering, can also signal a severe allergic response or drug intolerance. If the rash spreads, becomes painful, or is accompanied by fever and swelling, this could indicate Stevens-Johnson syndrome, a rare but life-threatening skin condition requiring emergency care.

2. Flu-Like Symptoms or Unusual Tiredness

Some patients experience flu-like symptoms when taking Contrave and Wellbutrin, including body aches, fever, chills, and fatigue. While mild symptoms are common during the initial adjustment period, persistent or worsening flu-like symptoms could suggest a serious underlying issue, such as liver disease or an immune reaction to the medication.

Unusual tiredness that is persistent and unexplained may also indicate low blood sugar, electrolyte imbalances, or liver function impairment. If exhaustion interferes with daily activities, a medical evaluation is recommended to rule out serious side effects.

3. Eye Pain or Visual Disturbances

Sudden eye pain, changes in vision, or pressure in the eyes could indicate acute angle-closure glaucoma, a rare but dangerous side effect of bupropion. Symptoms include blurry vision, halos around lights, and severe headaches.

Patients who notice worsening eyesight, sensitivity to light, or unexplained eye discomfort should seek urgent medical attention, particularly if they have a history of glaucoma or eye disorders.

4. Opioid Withdrawal Symptoms, Including Restlessness, Muscle Pain, or Tremors

Since naltrexone in Contrave is an opioid antagonist, it blocks opioid receptors in the brain. This means that individuals who have recently used opioid medications (such as oxycodone, hydrocodone, or fentanyl) may experience sudden opioid withdrawal symptoms when taking Contrave.

Withdrawal symptoms can include:

  • Restlessness and anxiety
  • Sweating and chills
  • Severe muscle aches or cramps
  • Tremors and shaking
  • Nausea, vomiting, and diarrhea

Patients with a history of opioid use disorder should disclose this information to their healthcare provider before starting naltrexone and bupropion, as opioid withdrawal can be severe and even life-threatening in some cases.

5. Severe Worsening Depression or Suicidal Thoughts

Bupropion affects dopamine and norepinephrine levels, which can improve mood but may also lead to unexpected mood changes in some individuals. Patients with a history of bipolar disorder, major depressive disorder, or anxiety disorders should be closely monitored for signs of worsening depression, paranoia, or suicidal ideation.

Warning signs include:

  • Persistent sadness or hopelessness
  • Increased irritability or agitation
  • Sudden mood swings or emotional numbness
  • Thoughts of self-harm or suicide
  • Withdrawing from loved ones or daily activities

If new or worsening depression develops, or if suicidal thoughts arise, immediate support from a healthcare provider, therapist, or emergency services is critical. In young adults, the risk of suicidal ideation may be particularly elevated during the first few months of taking bupropion-based medications.

Final Note on Monitoring Side Effects

While many side effects of Contrave and Wellbutrin are mild and temporary, some can signal serious health risks requiring immediate intervention. Patients should follow their prescription label instructions carefully, report any unusual or severe symptoms to their healthcare provider, and seek emergency medical attention if they experience difficulty breathing, vision changes, or severe mood disturbances.

For those at higher risk—such as individuals with cardiovascular disease, seizure disorder, or a history of opioid use—it is especially important to have regular check-ups while using these medications.

Frequently Asked Questions (FAQ)

When considering Contrave and Wellbutrin, patients often have questions about drug interactions, weight loss options, and dosage concerns.

Below, we provide comprehensive answers to some of the most commonly asked questions regarding these medications.

1. What should you not mix with Wellbutrin?

Wellbutrin should not be mixed with monoamine oxidase inhibitors (MAOIs) such as phenelzine, tranylcypromine, or isocarboxazid, as this can lead to dangerous increases in blood pressure and a condition known as serotonin syndrome. It should also not be combined with other medications containing bupropion, including Contrave, as doing so can increase the risk of seizures. Additionally, individuals should avoid alcoholic beverages, as Wellbutrin lowers the seizure threshold, making alcohol withdrawal effects more pronounced. Anti-seizure medicines, benzodiazepines, and opioid medications may also have dangerous interactions when taken with Wellbutrin. Always discuss potential interactions with your healthcare provider.

2. What weight loss pill can I take with Wellbutrin?

Patients taking Wellbutrin for depression or smoking cessation should be cautious when considering weight loss medications. While Contrave (naltrexone and bupropion) contains Wellbutrin’s active ingredient, bupropion, it is generally not recommended to take them together unless approved by a healthcare provider due to an increased risk of seizures. Safer alternatives for weight loss include GLP-1 receptor agonists such as Ozempic, Wegovy, or Saxenda, which help regulate appetite without significantly impacting dopamine and norepinephrine levels. Patients should also consider a reduced calorie diet and an exercise program as non-medication alternatives to enhance weight loss safely.

3. Are Wellbutrin and Contrave the same thing?

No, Wellbutrin and Contrave are not the same medication, but they share a common ingredient: bupropion. Wellbutrin is an antidepressant used to treat depression, aid in smoking cessation, and manage symptoms of bipolar disorder. Contrave, on the other hand, is a weight loss medication that combines bupropion with naltrexone, an opioid antagonist that helps control cravings and reduce appetite. While both medications impact neurotransmitter activity, Contrave is specifically designed for chronic weight management, whereas Wellbutrin is intended to treat mood disorders.

4. How much Wellbutrin is in one Contrave pill?

Each Contrave tablet contains 90 mg of bupropion hydrochloride, which is the same active ingredient found in Wellbutrin. However, Contrave is an extended release formulation that also includes 8 mg of naltrexone, which is not found in Wellbutrin. Since Contrave is taken at a maximum dose of two tablets twice daily, the total bupropion intake can reach 360 mg per day, which is close to some Wellbutrin dosages but still different in formulation and intended use.

5. Can you take Contrave and Wellbutrin together?

Taking Contrave and Wellbutrin together is generally not recommended without medical supervision, as both medications contain bupropion, which increases the risk of seizures, high blood pressure, and mood disturbances. If a patient is already on Wellbutrin and is considering Contrave for weight loss, their healthcare provider may need to adjust the Wellbutrin dosage or explore alternative weight loss medications that do not contain bupropion. Close monitoring for side effects, including worsening depression and cardiovascular changes, is necessary if both medications are prescribed concurrently.

6. What can be combined with Wellbutrin for weight loss?

For individuals taking Wellbutrin who are looking for additional weight loss support, GLP-1 receptor agonists such as Wegovy, Ozempic, or Saxenda may be safer alternatives than Contrave. These medications work by reducing appetite and controlling blood sugar levels without interfering with dopamine and norepinephrine. Phentermine, a stimulant-based weight loss drug, may also be an option for short-term use under strict medical supervision. Additionally, a reduced calorie diet, increased physical activity, and behavioral therapy should always be part of a comprehensive weight loss strategy for patients on Wellbutrin.

7. Can you take Contrave while on Wellbutrin?

It is generally not recommended to take Contrave while on Wellbutrin, as both medications contain bupropion, which can increase the risk of seizures, anxiety, and high blood pressure. However, in some cases, a healthcare provider may prescribe Contrave and Wellbutrin together with strict dosage adjustments and frequent monitoring for side effects. Patients should never combine these medications without medical approval, as doing so could result in serious side effects related to bupropion overdose.

8. How many mg of Wellbutrin is in Contrave?

Each Contrave tablet contains 90 mg of bupropion hydrochloride. Since Contrave is taken at a maximum daily dose of four tablets (two tablets twice daily), the total bupropion intake from Contrave alone can reach 360 mg per day. This amount is close to the upper dosage range for Wellbutrin XL (extended release), which is typically 300-450 mg per day for depression treatment. However, because Contrave also contains naltrexone, it is formulated specifically for weight loss and appetite control, making it distinct from Wellbutrin.

Final Thoughts

When considering Contrave and Wellbutrin, it is essential to understand your weight loss drug type (quiz here), as well as the differences, risks, and potential interactions between the two medications. Since both contain bupropion, their combined use can increase the risk of seizures, high blood pressure, and mental health side effects.

Patients interested in weight loss while taking Wellbutrin should explore safer alternatives, such as GLP-1 agonists, lifestyle modifications, and behavioral therapy. Always consult a healthcare provider before making any changes to medication regimens to ensure safety and effectiveness in achieving both mental health and weight management goals.