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Introduction

Weight loss is one of the most common challenges facing people with hypothyroidism. Losing weight is hard enough, but when you add in a slow metabolism due to an underactive thyroid, it can feel downright impossible!

If you are one of the many people with hypothyroidism struggling with your weight, one option is to incorporate prescription medications into your overall treatment plan. Only a handful of weight loss medications are currently available on the market, but one that you may not be familiar with is Contrave. In this article, let’s explore Contrave and whether it might benefit you.

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Contrave is an extended-release combination of naltrexone – an addiction-treatment drug and opioid antagonist –and bupropion, an antidepressant. The drugs work together to suppress appetite, curb cravings, make you feel less hungry, and increase your energy. Contrave is prescribed for weight loss and management as part of a program that includes a reduced-calorie balanced diet and increased physical activity.

Bupropion – known by the brand name Wellbutrin – is a medication used to treat depression and seasonal affective disorder. It is also used for smoking cessation when branded as the drug Zyban.

Naltrexone is a drug that, at high doses, is prescribed as part of alcohol and drug addiction treatment. At very low doses, it’s used off-label as “Low Dose Naltrexone” (LDN) to treat chronic pain and autoimmune diseases, including Hashimoto’s thyroiditis.

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The specific mechanism of how Contrave works to help achieve weight loss is not entirely understood. But researchers theorize that Contrave works by targeting two areas of the brain that regulate appetite and food cravings: the hypothalamus and mesolimbic reward system. The hypothalamus controls hunger and the feeling of fullness. At the same time, the mesolimbic reward system is responsible for releasing dopamine, a neurotransmitter that controls the brain’s pleasure and reward system. By targeting these areas, Contrave helps reduce appetite and cravings, promotes feelings of satisfaction and fullness, decreases food intake, and increases energy expenditure.

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You’re a candidate for Contrave if you are obese, with a body mass index (BMI) of 30 or higher – or overweight, with a body mass index (BMI) of 27 or higher and at least one weight-related health condition such as high blood pressure, type 2 diabetes mellitus, or elevated cholesterol and triglycerides. (You can calculate your BMI at this NIH web page.)

         

           

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According to clinical trials, Contrave has been shown to help patients achieve 5% to 10% weight loss compared to placebo.

One of the most extensive clinical trials, the 56-week COR-BMOD study, evaluated treatment with Contrave, along with a reduced-calorie diet, increased physical activity, and behavioral counseling. Among the study participants who completed the study, 62% of patients taking Contrave lost 5% or more of their body weight -- and an average weight loss of 25 pounds -- versus only 23% who were taking a placebo.

Contrave also appears to help maintain the weight that’s already been lost. Some research into the longer-term efficacy of Contrave found that patients were better able to maintain the weight they’d lost due to behavior modification before starting the medication.

It is important to note that Contrave is not a miracle pill. It works best when it is combined with a healthy diet and regular exercise. Also, not everyone who takes Contrave finds it effective. The effectiveness of the medication varies from person to person.

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According to guidelines, it’s recommended that patients start Contrave at the lowest dose and increase the dosage over four weeks. Initially, one tablet of Contrave is taken in the morning. Each tablet contains 8 mg of naltrexone and 90 mg of bupropion. After a week, a second tablet is added in the evening. A second morning tablet is added during week three, and a second evening tablet is added in week four. By week four, you’ll take two tablets twice daily, for a total dose of 32 mg of naltrexone and 360 mg of bupropion.

You’ll know fairly soon if Contrave is working for you because, after 12 weeks of treatment, you should typically have achieved at least a 5% weight loss. If you have not lost weight after 12 weeks, your practitioner may recommend discontinuing treatment with Contrave.

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Contrave, like all medications, comes with some possible adverse effects.

Common side effects of bupropion can include drowsiness, dizziness, difficulty sleeping, constipation, decreased appetite, stomach pain, headache, dry mouth, and nausea.

Common side effects of naltrexone can include vivid dreams, trouble sleeping, stomach pain, restlessness, nausea, and headache.

No evidence exists in the literature of interactions between Contrave and thyroid hormone replacement drugs. 

A caution: When taking naltrexone at any dosage, if you require surgery or treatment with opioid pain medication, you must discontinue using Contrave until your course of opioid medication is completed.

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User reviews for Contrave are mixed. At Drugs.com, there are almost 2,000 reviews of Contrave from patients taking the drug. Some report positive results and significant weight loss. Others had limited success or stopped taking Contrave due to side effects they deemed intolerable. It’s definitely worth reading through these reviews for first-hand reports of patient experiences with this medication.

Contrave is often not covered by insurance, and according to GoodRx, without insurance coverage, the cost is steep, running from $500 to almost $800 for 120 tablets. The drug manufacturer does have a special program that makes the medication available for $99 a month. To find out more, visit GetContrave and CurAccess for details.

There’s also a popular workaround to reduce the cost of Contrave treatment. Some patients online report working with their doctors to have the two component drugs prescribed separately. In many cases, the bupropion and naltrexone prescriptions are partially or fully covered by insurance. Even without insurance, the cost for separate bupropion and naltrexone could be as little as $40 to $50 per month.

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In addition to the separate or combined use of Wellbutrin and Naltrexone (LDN), several other prescription drugs may be helpful in weight loss. Paloma has information to help you explore more on these medications:

• Topamax – an anticonvulsant drug that is prescribed off-label to aid in weight loss
• Metformin (Glucophage) – a type 2 diabetes drug
• Semaglutide (Ozempic) – a once-weekly injectible type 2 diabetes drug
• Phentermine – the “Phen” of the famed “Fen-Phen” weight loss drug combination popular in the past

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If hypothyroidism is untreated or poorly managed, medications and lifestyle changes face an uphill battle. To stay on top of your thyroid levels, consider getting Paloma’s convenient at-home thyroid test kit. This affordable panel measures TSH, Free T4, Free T3, and Thyroid Peroxidase Antibodies (TPOAb). You can also add on a Reverse T3 and Vitamin D test. The home kits make it easy to evaluate your thyroid function periodically.

Our Paloma nutritionists can also work with you to develop a plan to improve your diet for optimal thyroid health and weight loss. 

Most importantly, meeting your weight loss goals as a patient with hypothyroidism requires optimal treatment of your thyroid condition. For the most effective results, you can work with one of Paloma Health’s top thyroid healthcare providers. Our team of experts will help you understand your test results and oversee your personalized – and effective – treatment plan for an underactive thyroid. Convenient virtual visits with thyroid doctors are available from the comfort of your home.

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What is Contrave and how does it work?

Contrave is an extended-release combination of naltrexone, used at a low dose to curb cravings, and bupropion, an antidepressant. Together they target the hypothalamus and mesolimbic reward system, brain areas that control hunger, cravings, and the brain's pleasure response, to reduce appetite and food intake while increasing energy expenditure.

Who is a good candidate for Contrave?

Contrave is generally prescribed for people who are obese, with a BMI of 30 or higher, or overweight with a BMI of 27 or higher and at least one weight-related condition, such as high blood pressure, type 2 diabetes, or elevated cholesterol.

How effective is Contrave for weight loss?

Clinical trials show Contrave can help patients lose 5% to 10% more weight than placebo. In one major 56-week trial that combined Contrave with a reduced-calorie diet, exercise, and counseling, 62% of patients lost at least 5% of their body weight, with an average loss of 25 pounds, compared to 23% on placebo. It works best combined with diet and exercise, and effectiveness varies from person to person.

What are the side effects of Contrave?

Common side effects include drowsiness, dizziness, trouble sleeping, constipation, decreased appetite, stomach pain, headache, dry mouth, nausea, and vivid dreams. Anyone who needs surgery or opioid pain medication must stop taking Contrave first, since it contains an opioid antagonist.

What are the alternatives to Contrave for weight loss with hypothyroidism?

Other prescription options include bupropion and naltrexone prescribed separately, Topamax, Metformin, Semaglutide (Ozempic), and Phentermine. Whichever medication is used, keeping hypothyroidism optimally treated is an important part of reaching weight loss goals.