Contrave and Buspar Drug Interactions: Safe to Combine?
Combining medications can sometimes lead to unintended consequences. For individuals using Contrave for weight loss and Buspar (buspirone) for anxiety, it’s important to understand how these two drugs might interact. While both can be helpful in managing separate conditions, certain drug interactions may increase the risk of side effects, reduce effectiveness, or require monitoring by a healthcare provider.
This article takes an objective look at Contrave and Buspar drug interactions, with guidance on how to take both medications safely—if at all. We’ll cover known risks, overlapping side effects, and what to discuss with your health care professional before starting or combining these prescriptions.
Key Takeaways
- Combining Contrave and Buspar may increase the risk of side effects such as dizziness, confusion, and blood pressure changes.
- Patients with a history of seizures, mental health changes, or high blood pressure should consult a healthcare professional before combining these medications.
- Careful monitoring and potential dosage adjustments may be needed when taking Contrave and Buspar together.
What Is Contrave?
Contrave is a prescription medication approved for chronic weight management in certain adults with a BMI over 30—or over 27 with a weight-related health condition such as type 2 diabetes or high blood pressure. It combines two active ingredients: naltrexone hydrochloride and bupropion hydrochloride, each with unique effects on the brain.
- Bupropion is an antidepressant also used to help patients quit smoking and treat depression.
- Naltrexone is traditionally used to treat alcohol and opioid withdrawal.
Together, these compounds target hunger and cravings in the brain. To achieve maximum results, patients taking Contrave are encouraged to follow a reduced-calorie diet and increase physical activity.
What Is Buspar?
Buspar, the brand name for buspirone, is an anti-anxiety medication. Unlike benzodiazepines, Buspar does not cause sedation or dependency. It works by affecting serotonin and dopamine receptors in the brain, and is often used to treat generalized anxiety disorder.
Buspar is typically taken multiple times a day and may take several weeks to become effective. It’s generally well-tolerated but can cause side effects like dizziness, headaches, nausea, and restlessness.
While there’s no official contraindication that forbids taking Contrave and Buspar together, combining these medications may increase the risk of certain side effects or cause overlapping central nervous system (CNS) effects, such as:
- Dizziness
- Drowsiness
- Confusion
- Difficulty concentrating
- Increased blood pressure
Both medications influence brain chemistry. Contrave affects norepinephrine and dopamine, while Buspar acts mainly on serotonin receptors. In rare cases, this could lead to serotonin syndrome, a potentially life-threatening condition. Symptoms of serotonin syndrome include agitation, rapid heartbeat, hallucinations, and trouble breathing.
“There’s no blanket answer for whether it’s safe to take Contrave and Buspar together,” says Dr. Matthew Olesiak, Chief Medical Director at SANE MD. “It depends on the patient’s full medical history, current medications, and health goals. A health care professional must evaluate all risks and benefits before prescribing both drugs at once.”
Risk Factors to Consider
1. Seizure Risk
One of the most serious concerns when taking Contrave is its well-documented risk of seizures. This risk is primarily linked to bupropion hydrochloride, which is known to lower the seizure threshold—especially at higher doses or in individuals with specific medical conditions. People with a history of seizures, head injury, eating disorders (such as anorexia nervosa or bulimia), or those who suddenly stop drinking alcohol are at significantly higher risk. Additionally, concurrent use of over-the-counter drugs or stimulants that impact the nervous system, such as modafinil, or lower the seizure threshold, such as Tramadol and codeine, may exacerbate the issue.
Although Buspar (buspirone) is not typically associated with seizures, it does have effects on the central nervous system and may interact in unpredictable ways when combined with Contrave. The increased risk is particularly concerning in those with a neurological history or other health conditions that influence brain function. This potential interaction qualifies as one of several drug interactions that necessitate caution and close medical supervision.
Before starting Contrave treatment, patients should discuss any past head injury, loss of consciousness, or seizure activity with their health care professional. A detailed health history is critical, especially if you’re also taking other drugs that influence neurological activity. If a seizure occurs, taking Contrave should be discontinued immediately, and medical help should be sought.
2. Mental Health Changes and Suicidal Thoughts
Another major safety concern associated with Contrave is the boxed warning that alerts doctors about the risk of suicidal thoughts and mental health changes. These adverse reactions are especially likely in younger adults and during the first few months of therapy or during dosage adjustment. As bupropion is an antidepressant, it can cause behavioral shifts, particularly in those with pre-existing psychiatric diagnoses.
Buspar is often prescribed to treat depression and generalized anxiety disorder. While it tends to be well-tolerated and non-sedating, it still alters neurotransmitter activity—particularly involving serotonin. When paired with Contrave, the overlapping effects on dopamine, norepinephrine, and serotonin can increase the risk of emotional volatility or destabilize existing mental health conditions. See our guide to learn how Contrave can be used for depression.
This is particularly dangerous in patients with bipolar disorder, where certain medications can trigger manic episodes or deepen depressive ones. Additionally, if you or a family member has a history of mental health disorders, suicidal behavior, or mood swings, this should be discussed before combining these medications.
It’s essential to be aware of early warning signs, such as sudden mood changes, aggression, insomnia, impulsivity, or worsening depression. If you notice these behaviors while taking Contrave or after starting Contrave treatment, consult your healthcare provider immediately. Regular check-ins during the initial months of Contrave treatment can help prevent the escalation of symptoms.
3. Blood Pressure Changes
High blood pressure is a known side effect of Contrave and should not be taken by individuals with uncontrolled hypertension, according to the FDA-approved prescribing information.
Bupropion, by increasing norepinephrine levels, can lead to elevated blood pressure and heart rate, especially during the start of treatment phases or when combined with other drugs affecting cardiovascular function.
Buspar, while generally benign regarding cardiovascular effects, can occasionally cause fluctuations in blood pressure, particularly in those sensitive to changes in stress hormones or CNS stimulants. When used in combination with Contrave, there’s a potential increased risk of cardiovascular side effects, including rapid heartbeat, chest discomfort, and dizziness.
The concern is even greater in patients already dealing with high blood pressure or those using medications to manage it. Buspirone may also interact with certain over-the-counter medications, like decongestants, that can further elevate blood pressure or heart rate. These Contrave interactions are often overlooked but could result in serious injury if not properly managed.
“If you’re taking Contrave and notice symptoms like rapid heartbeat, chest pain, or blurred vision, talk to your doctor immediately,” adds Dr. Olesiak. “These could be signs of high blood pressure or other serious complications that require dosage adjustment or discontinuation.”
Routine monitoring of blood pressure is essential throughout the course of Contrave treatment, especially if you are also using Buspar or any other drugs that impact cardiovascular function. Keep track of symptoms and follow all guidance in the medication guide or patient package insert.
Overlapping Side Effects
Taking Contrave and Buspar at the same time may increase the risk of shared or enhanced side effects. Both medications act on the brain and nervous system, which can lead to cumulative effects in certain individuals.
Common overlapping side effects of Contrave and Buspar include:
- Nausea or vomiting
- Headaches
- Dry mouth
- Dizziness
- Sweating
- Tremors
- Insomnia or restlessness
These symptoms can vary in intensity but may be more disruptive during the early stages of taking Contrave or when initiating a new dose adjustment. For some patients, side effects like tremors, nausea, or dizziness can impair driving or routine activities, increasing the risk of accidents or falls—especially in older adults.
In a smaller subset of patients, more serious complications may develop. These include serious skin reactions, a broad category that encompasses conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis—both of which are life-threatening and require emergency care.
Signs of a serious skin reaction may include:
- Skin rash or blistering
- Peeling skin
- Red or purple lesions
- Fever
- Sore throat
Additionally, signs of an allergic reaction include swelling of the face or throat, trouble breathing, severe itching, or eye pain. These symptoms require immediate cessation of medication and urgent medical care.
If you experience any of these symptoms—particularly swelling, hives, or labored breathing—call your local emergency number right away. These could indicate a medical emergency and should never be ignored. Let your provider know if you’ve ever had an allergic reaction to medications in the past, including weight loss drugs or medications used to treat alcohol or mood disorders.
Because these symptoms may also occur with systemic exposure to other medications or environmental allergens, it’s critical to have a full understanding of your health factors and any behaviors Contrave may amplify. In rare cases, even lab tests may be needed to determine the cause of your reaction or confirm drug safety.
Who Should Avoid Combining These Drugs?
The combination of Contrave and Buspar should be avoided or used with caution in people with:
- History of seizures or head injury
- Diagnosed bipolar disorder
- Uncontrolled high blood pressure
- History of eating disorders
- Recent use of monoamine oxidase inhibitors
- Current use of opioids (due to naltrexone and bupropion effects)
Additionally, people who suddenly stop drinking alcohol or who are undergoing opioid withdrawal face an increased risk of adverse reactions when taking Contrave, according to the FDA-approved prescribing information.
This risk may be compounded if Buspar is also involved.
Considerations When Taking Contrave
Contrave is provided in extended-release tablets, which should not be crushed, chewed, or split. Doing so may alter the absorption rate, leading to an increased risk of side effects. It is also important to avoid high-fat meals when taking Contrave, as they may increase the risk of seizure by raising drug levels in the blood.
Contrave is not recommended for use with certain other drugs—including over-the-counter stimulants, psychiatric medications, and weight loss supplements. Make sure your health care professional knows about all medications and supplements you take, including vitamin interactions or over-the-counter drugs.
You’ll also want to keep track of:
- Missed dose instructions (do not double up)
- Patient package insert and medication guide updates
- Changes to mental health, mood, or energy
- Whether you are pregnant or breastfeeding (breast milk transfer risk)
Blood Sugar and Caffeine Considerations
For individuals with diabetes or metabolic conditions, Contrave treatment may lower blood sugar levels. This could pose a danger if you’re also taking Buspar, which can sometimes cause dizziness or lightheadedness.
Hypoglycemia (low blood sugar) can mimic side effects of both medications, making it harder to determine the cause. Regular blood sugar monitoring and adjustment to any insulin or diabetes medications are advised.
Contrave has been shown to reduce hemoglobin A1c and fasting glucose levels in people with type 2 diabetes, according to FDA-approved clinical data, which may result in low blood sugar for some individuals.
Patients should also avoid excessive caffeine intake. Both drugs can cause insomnia, jitteriness, or restlessness—effects that may be amplified with high doses of caffeine.
How to Safely Start Treatment
Starting Contrave treatment—especially when combining it with Buspar—requires thoughtful planning and clear communication with your health care professional. Because both medications affect the central nervous system and can influence mood, blood pressure, and energy levels, it’s important to take a proactive, informed approach from the very beginning.
Before starting Contrave and Buspar together:
- Review your health history and health conditions with your provider. This includes any past or current issues such as high blood pressure, bipolar disorder, mental health diagnoses, seizures, or eating disorders. Full disclosure of your medical conditions helps your doctor determine whether it’s safe to combine these drugs or if alternative treatments are a better fit.
- Ask about potential Contrave interactions with other drugs, supplements, or foods. Both prescription and over-the-counter medications—including vitamins, herbal products, and cold medicines—may interact with naltrexone and bupropion, leading to adverse reactions or reduced effectiveness. Your provider can help identify certain drug interactions and review the medication guide or patient package insert for up-to-date safety guidance.
- Be honest about your use of alcoholic beverages and whether you plan to quit smoking. People who suddenly stop drinking alcohol or are actively detoxing from opioid withdrawal may face an increased risk of seizures or mood instability while on Contrave. Additionally, bupropion hydrochloride is sometimes used to help quit smoking, so the dosage must be carefully tailored to avoid overlapping effects or accidental duplication.
- If needed, request a dosage adjustment or consider staggering medication start times. Your doctor may recommend slowly introducing Contrave while maintaining a stable Buspar regimen, especially if you’ve recently made changes to your mental health medications. This approach allows your body to adjust gradually and reduces the likelihood of serious side effects, such as the risk of seizures, high blood pressure, or worsening mental health symptoms.
Your doctor will evaluate whether to prescribe Contrave based on a combination of factors, including your health conditions, current treatments, lifestyle, and long-term goals for chronic weight management. They may also monitor for warning signs like skin rash, low blood sugar, or trouble breathing, and recommend regular check-ins during the early phases of taking Contrave.
If you’re already on Buspar, your provider might choose to introduce Contrave using a step-up approach—starting with the lowest dose of extended-release tablets and gradually increasing it over several weeks. This titration helps limit side effects and allows your provider to intervene early if contrave-interaction symptoms appear.
In all cases, clear and ongoing communication with your healthcare provider is key. Report any new symptoms, emotional changes, or difficulties tolerating the medication. Whether your goal is to lose weight, reduce anxiety, or improve your quality of life, a safe and strategic start sets the foundation for long-term success.
Frequently Asked Questions (FAQ)
Combining medications can be confusing, especially when managing multiple health conditions like anxiety, depression, or obesity.
Below are answers to common questions related to Contrave, Buspar (buspirone), and their possible interactions. Always consult your health care professional before starting, stopping, or combining any medications.
1. What medications should not be taken with Contrave?
Contrave should not be taken with monoamine oxidase inhibitors (MAOIs), as this combination can cause dangerous spikes in blood pressure or other severe reactions. Contrave drug interactions can also occur if used with other forms of bupropion, including those used to quit smoking (like Zyban), because doing so may increase the risk of seizures. Contrave should not be taken with benzodiazepines like Xanax without medical supervision, as the combination may lead to dangerous interactions.
Additionally, opioid medications must be stopped at least 7–10 days before starting Contrave due to the naltrexone component, which can cause opioid withdrawal. Use caution with over-the-counter drugs, stimulant-containing products, and medications that may raise blood pressure or impact seizure threshold.
2. Can you take bupropion and BuSpar together?
In some cases, bupropion and Buspar may be taken together under medical supervision, but this combination requires caution. Both drugs affect brain chemistry and may increase the risk of side effects such as dizziness, confusion, anxiety, or even serotonin-related complications. People with a history of mental health conditions, seizures, or high blood pressure should be closely monitored.
Your provider may recommend dosage adjustment or staggered administration to minimize overlapping side effects.
3. What medications cannot be taken with BuSpar?
Buspar should not be combined with MAO inhibitors, as this may lead to dangerously high blood pressure. It also interacts with serotonergic drugs, increasing the risk of serotonin syndrome—a rare but serious condition. Use caution with antidepressants, antipsychotics, certain antibiotics (like linezolid), and even herbal products like St. John’s Wort.
Always disclose your full medication list, including over-the-counter and vitamin interactions, to your healthcare provider before starting treatment with Buspar.
4. Can I take Contrave if I take bupropion?
Contrave already contains bupropion hydrochloride, one of its two active ingredients. If you’re already taking bupropion for treating depression, smoking cessation, or another reason, taking Contrave at the same time could cause dangerously high bupropion levels and significantly increase the risk of seizures. Your doctor may recommend switching to Contrave or adjusting your dose, but you should never take both at the same time without professional guidance.
Be especially cautious if you have a history of head injury, eating disorders, or use alcoholic beverages regularly.
The Bottom Line
Combining Contrave and Buspar can be safe for some patients, but it carries real risks—especially if you have medical conditions like high blood pressure, a history of seizures, or current mental health challenges.
Speak with a trusted healthcare provider about the safest path forward. Do not attempt to mix or adjust medications without professional input. If you suspect an adverse reaction, reach out to your doctor or call your local emergency number immediately.
When taken carefully and with oversight, both medications can play a role in achieving better health—whether that means managing anxiety, supporting chronic weight management, or helping you lose weight safely.
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Contrave and Suboxone Drug Interactions: Dangerous Combo?
Combining medications always requires caution, especially when the drugs affect the brain’s reward system, metabolism, and pain pathways. Contrave and Suboxone are both powerful prescription treatments used for different health conditions—weight loss and opioid dependence, respectively—but their effects can overlap in ways that may not be safe.
This article explores the potential Contrave and Suboxone drug interactions, breaking down what you need to know about risks, symptoms, and how to talk to your doctor if you’re currently prescribed or considering treatment with either of these drugs.
Key Takeaways
- Combining Contrave and Suboxone may increase the risk of central nervous system depression, seizures, withdrawal symptoms, and liver stress.
- These two medicines should not be used together without close monitoring by a healthcare provider familiar with both.
- People with mental health conditions, eating disorders, or a seizure disorder face a higher risk when using either medication, especially in combination.
Understanding Contrave and Suboxone
Contrave is an FDA-approved combination of bupropion (also known by the brand Wellbutrin SR) and naltrexone, used to support weight loss in certain adults with obesity or weight-related health conditions. It works by acting on areas of the brain involved in hunger and cravings.
Suboxone, on the other hand, is a combination of buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. It’s prescribed to treat opioid dependence and manage opioid withdrawal.
Both drugs act on the brain’s chemical systems, and both involve extended release tablets in some formulations, which can complicate timing and dosing when used together.
Why This Combo May Be Risky
Combining Contrave and Suboxone may result in complex and potentially harmful drug interactions due to the way each medication affects the brain, liver, and central nervous system. Both drugs are prescribed for serious health conditions—weight loss and opioid dependence, respectively—but when taken together, they can produce unpredictable side effects. The interaction can alter blood pressure, increase the chance of liver problems, heighten the risk of seizures, and trigger dangerous withdrawal symptoms or mental health conditions.
Below are the most concerning risks associated with taking these two medicines at the same time.
1. Central Nervous System Depression
While bupropion, one of Contrave’s main ingredients, is typically a mild stimulant used to treat depression, Suboxone contains buprenorphine, which has sedative properties that can suppress the central nervous system. When used together, the push-pull effect on brain activity can cause a rollercoaster of symptoms—some individuals may feel overly stimulated, while others experience profound drowsiness, confusion, or even episodes of dissociation. It’s important to note that taking opioids like morphine or codeine with Contrave can have the same effect on the central nervous system.
In rare cases, this combination may lead to impaired motor control or slowed breathing, especially if other medications or alcohol are also in the system.
“Mixing medications that target the brain’s dopamine and opioid receptors increases the complexity and risk. It’s not something patients should attempt without close supervision,” says Dr. Matthew Olesiak, MD, Chief Medical Director at SANE MD.
These neurological effects may be magnified in older adults or anyone with mental health conditions, a history of depression, or sensitivity to psychiatric medications. Always consult your doctor before combining Contrave with any other drugs affecting the nervous system.
2. Seizure Risk
Contrave may increase the risk of seizures, particularly in individuals with a seizure disorder, eating disorders, or those who drink alcohol regularly. Bupropion alone has a known dose-dependent seizure risk, which is why it’s often contraindicated in individuals with predisposing factors. Meanwhile, Suboxone can occasionally lower the seizure threshold, although this is a rare side effect.
When combined, these effects may increase the risk of neurological instability, especially during treatment initiation or dosage changes.
Many studies, including one published by the Canadian Medical Association Journal (CMAJ), found strong evidence that bupropion can lower the seizure threshold, making a seizure more likely.
This concern is heightened during opioid withdrawal, when the brain is already under stress from chemical fluctuations. Symptoms such as muscle twitching, disorientation, or unusual tiredness should be reported to your healthcare provider immediately.
Patients who are also on other medications that affect the brain may face a higher risk of complications.
3. Liver Strain
Both Contrave and Suboxone are metabolized through the liver, and prolonged or combined use can increase the workload on this vital organ. Contrave may increase the risk of liver damage, especially when used in patients who drink alcohol or are taking other medications processed by hepatic enzymes. Suboxone has also been linked to elevated liver enzymes, indicating potential stress or damage.
Taking the two together may compound the toxic burden, resulting in serious complications over time.
Symptoms of liver problems include:
- Dark urine
- Pale stools
- Unusual tiredness
- Skin rash
- Pain in the upper right abdomen
Indeed, a study published in the Annals of Pharmacotherapy demonstrated that Suboxone can elevate liver enzymes, especially when taken intravenously, potentially causing liver damage.
Individuals with pre-existing medical conditions like hepatitis, fatty liver disease, or those who take over-the-counter pain relievers frequently are especially vulnerable.
If you develop any of these symptoms, you should seek medical attention without delay.
4. Risk of Precipitated Withdrawal
One of the most serious dangers of combining Contrave and Suboxone is the possibility of precipitated withdrawal—a sudden onset of severe opioid withdrawal symptoms triggered by naltrexone, which blocks opioid receptors.
If a patient is still physically dependent on opioids or currently taking Suboxone, the presence of naltrexone can override the stabilizing effects of buprenorphine, resulting in immediate and intense withdrawal symptoms.
These symptoms may include:
- Muscle aches
- Chills and sweating
- Vomiting or diarrhea
- Mood swings or irritability
- Anxiety or suicidal thoughts
This effect not only causes immense discomfort but may also lead to relapse in individuals trying to overcome opioid dependence. That’s why most healthcare providers require a full detox period before starting Contrave in any patient with a history of opioid use. Skipping this step can increase the risk of a life-threatening situation, particularly in unsupervised settings.
5. Overlapping Side Effects and Mental Health Impact
Each medication carries its own risk profile for psychiatric symptoms, but the risks may multiply when they’re taken together. Both drugs can affect mood and cognition—Contrave may contribute to anxiety, irritability, or suicidal thoughts, while Suboxone has been associated with emotional blunting and, in some cases, false beliefs or paranoia. It’s important to note that taking Contrave with Buspar can also trigger anxiety and other side effects.
For patients with a history of depression, bipolar disorder, or other mental health conditions, the combination may destabilize mood regulation and cloud judgment.
Additional overlapping side effects include:
- Low blood sugar, especially in patients with diabetes
- Unusual tiredness or lethargy
- Nausea and gastrointestinal discomfort
- Persistent skin rash
- Confusion or hallucinations
These effects can be exacerbated by high-fat meals, polypharmacy (use of multiple other medications), or underlying medical conditions like liver damage or seizure disorders. Monitoring these signs closely during the first few weeks of treatment is crucial, especially for older adults or any vulnerable age group.
Important Considerations Before Taking Contrave with Suboxone
Before starting any new treatment, especially involving prescribed medications like Contrave and Suboxone, it’s essential to understand how the combination may affect your body. Both drugs are powerful and act on different systems, but when used together without proper oversight, the risk of complications increases substantially.
Below are the critical steps you should take to stay safe and avoid potentially serious health issues.
Talk to Your Doctor First
Never combine Contrave with Suboxone—or any other medications—without first discussing it thoroughly with your doctor or healthcare provider. This step is vital because your provider will evaluate the full picture of your medical conditions, lifestyle, and past medication use to identify potential drug interactions or health risks.
Some of the factors your provider will review include:
- Your history of seizures or seizure disorder
- Whether you drink alcohol regularly
- Any mental health conditions, such as bipolar disorder or depression
- Use of over-the-counter supplements, herbs, or other drugs
- Past experience with opioid withdrawal or opioid dependence
- Current or recent use of CNS-active agents such as sedatives, stimulants, or other antidepressants
“The risk isn’t just theoretical—it’s well documented. When prescribing Contrave, I ask about current or past use of opioid antagonists, mood stabilizers, and any other CNS-active drugs,” says Dr. Olesiak.
This conversation is especially important if you’re considering starting Contrave while still on Suboxone or recovering from opioid use. You may need to taper off Suboxone completely before it’s safe to begin a reduced-calorie diet supported by Contrave.
Read the Medication Guide Thoroughly
Every patient should carefully read the medication guide included with both Contrave and Suboxone. These documents outline crucial safety warnings, side effects, dosing schedules, and specific health conditions that may increase the risk of complications. For example, high-fat meals can alter how extended-release Contrave tablets are absorbed, potentially leading to adverse reactions. Similarly, starting Contrave without understanding the presence of naltrexone—a potent opioid antagonist—can result in life-threatening withdrawal symptoms if you’re still dependent on opioids.
Don’t rely solely on internet forums or anecdotal advice. Follow the prescribing information, ask your doctor questions, and make sure you fully understand both medications before combining them.
Watch for These Symptoms
Once you begin taking either medication—or both under medical guidance—you should monitor your body closely for warning signs.
The following symptoms may signal a serious allergic reaction, liver problems, or central nervous system issues, and could indicate that your body is not tolerating the drug interactions well:
- Dark urine or pale stools (potential signs of liver damage)
- A persistent or spreading skin rash
- Sudden onset of withdrawal symptoms, such as shaking, sweating, or intense cravings
- Shortness of breath or difficulty breathing (may signal a serious allergic reaction)
- Chest tightness or pain (could point to a rare but possible heart attack)
- Severe mood changes, aggressive or unusual behavior
- Confusion, hallucinations, or false beliefs
These symptoms should never be ignored. If you experience one or more, especially in the early stages of treatment, seek emergency help or contact your healthcare provider immediately. Delayed action could result in worsening of the condition or long-term harm.
Common Conditions That May Increase the Risk
You may face an increased risk of complications if you:
- Have a seizure disorder
- Are currently detoxing from opioids
- Are trying to quit smoking
- Take other antidepressants
- Have diabetes and are managing low blood sugar
- Follow a reduced calorie diet with high fat meals
- Are dealing with bipolar disorder
- Use over the counter pain relievers or other medications
What to Tell Your Healthcare Provider
Be transparent about:
- All medications (including other drugs and supplements)
- Whether you plan to stop taking Contrave
- If you have a history of mental health conditions
- Any signs of liver problems, such as dark urine or pale stools
- If you are pregnant or breastfeeding (some components pass into breast milk)
This is especially vital before you start treatment with one tablet, then increase to two tablets daily as part of extended release dosing.
When It’s Not Safe to Combine
You should avoid combining Contrave and Suboxone if:
- You are on a monoamine oxidase inhibitor
- You’re in active opioid withdrawal
- You’ve experienced a serious allergic reaction to either drug
- You’ve had liver damage from other medications
- You have uncontrolled high blood pressure
Tips for Safe Use
If your healthcare provider determines that using Contrave and Suboxone together is appropriate for your situation, you should take several critical precautions to minimize risk and ensure safer treatment.
These tips are designed to help you avoid harmful drug interactions, manage side effects, and recognize early warning signs of trouble.
Follow Your Doctor’s Instructions for Dosing
Always take each medication exactly as prescribed. This includes sticking to the dosing schedule, not adjusting the number of one tablet or two tablets taken per day without approval, and following titration instructions when starting Contrave. These medications may come in extended-release tablets, which are meant to be swallowed whole—do not crush or split them.
Improper dosing can increase the risk of side effects, reduce effectiveness, or trigger dangerous events like seizures or withdrawal symptoms.
Avoid High-Fat Meals While Taking Contrave
While on Contrave, it’s important to avoid high-fat meals, as these can increase the medication’s absorption rate and lead to more intense side effects. A spike in bupropion levels could contribute to high blood pressure, dizziness, or a serious allergic reaction.
Stick to a reduced-calorie diet with balanced macronutrients, as recommended by your healthcare provider, to promote weight loss while reducing the chance of complications.
Do Not Suddenly Stop Taking Contrave or Suboxone
Abruptly discontinuing either medication may lead to withdrawal symptoms, worsened mental health conditions, or relapse. Stop taking Contrave or Suboxone only under medical supervision, as your doctor may need to taper your dose gradually to reduce the chance of seizures, mood instability, or other health conditions flaring up.
This is especially important if you’re also on other medications that influence brain chemistry, such as other antidepressants or mood stabilizers.
Report Symptoms Like Unusual Tiredness or Mental Fog
Notify your healthcare provider if you notice unusual tiredness, trouble concentrating, or other new or worsening symptoms. These may indicate problems such as low blood sugar, early signs of liver damage, or a developing allergic reaction.
Catching these effects early can help your doctor make necessary adjustments before serious harm occurs.
Do Not Drink Alcohol While on Either Medication
Both Contrave and Suboxone interact poorly with alcohol. Drinking while on either drug can significantly increase the risk of seizures, sedation, or liver problems such as dark urine, pale stools, and upper abdominal pain.
Additionally, alcohol may worsen mental health side effects such as depression, anxiety, and suicidal thoughts. If you currently drink alcohol, talk to your healthcare provider about safe limits—or whether it’s best to abstain entirely during treatment.
Frequently Asked Questions (FAQ)
Before starting or combining any medications, it’s essential to understand potential risks and interactions. Contrave and Suboxone affect brain chemistry in powerful ways and should not be taken together without explicit approval and oversight from your healthcare provider.
Below are answers to some of the most common questions people have about these medications and their possible interactions.
1. Can you take Contrave and Suboxone?
Taking Contrave and Suboxone together is not recommended without close medical supervision. Contrave contains naltrexone, an opioid antagonist, which can interfere with buprenorphine in Suboxone, potentially triggering severe opioid withdrawal. The combination may also increase the risk of liver stress, seizures, or mental health side effects.
Always talk to your healthcare provider before combining these medications to avoid dangerous outcomes.
2. Can you take Suboxone and bupropion together?
Suboxone and bupropion can be taken together in certain cases, but doing so carries a higher risk of seizures, especially in people with a history of seizure disorders or other medical conditions. Bupropion is a stimulant-like antidepressant that lowers the seizure threshold, and Suboxone may further increase this risk when combined.
Your doctor will weigh the benefits against the risks and monitor for symptoms like unusual tiredness, confusion, or agitation. Do not combine these medications without medical guidance.
3. What medications should not be taken with Contrave?
There are many Contrave drug interactions to be aware of. Here are just a few of them: Contrave should not be taken with opioids, opioid-containing medications, or any drugs that lower the seizure threshold, such as other antidepressants, antipsychotics, or corticosteroids. Avoid using it with monoamine oxidase inhibitors (MAOIs), NSAIDs, certain diabetes medications that increase the risk of low blood sugar, and alcohol. High-fat meals should also be avoided during dosing, as they may increase drug absorption and side effects.
Always provide your doctor with a complete list of prescription, over-the-counter, and herbal medications before starting Contrave.
4. What should you not mix with Suboxone?
Suboxone should not be mixed with alcohol, sedatives, benzodiazepines, or other central nervous system depressants, as the combination may lead to life-threatening respiratory depression. It also interacts with certain antifungal drugs, antibiotics, and antiviral medications that affect liver enzymes. Opioid antagonists like naltrexone can block the effects of Suboxone and may precipitate withdrawal.
Check with your healthcare provider before combining Suboxone with any other medications.
5. What happens if you take naltrexone while on Suboxone?
Taking naltrexone while on Suboxone can cause immediate and intense opioid withdrawal symptoms. Naltrexone is a full opioid antagonist and blocks opioid receptors, effectively reversing the effects of buprenorphine in Suboxone. This can result in nausea, vomiting, muscle cramps, sweating, anxiety, and other uncomfortable or dangerous withdrawal symptoms.
If you are on Suboxone, you should not start naltrexone (or Contrave) until you’ve been fully detoxed under medical supervision.
Final Thoughts
While both Contrave and Suboxone can be effective when used alone under the guidance of a healthcare provider, their combination presents significant safety concerns. Patients with mental health conditions, a seizure disorder, or a history of opioid dependence should exercise extreme caution.
Contrave may be right for some people trying to lose weight as part of a reduced-calorie diet, but not if they’re currently on opioid therapy. The drug interactions are serious enough to require individualized assessment before proceeding.
Always review the prescribing information, read the medication guide, and talk openly with your doctor about your full medical history and goals for treatment.
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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.
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