Contrave dosage: Form, strength, how to take, and more

Quick note before we dive in: This article is for general information only and is not medical advice. Contrave is a prescription medication, and any decisions about starting, stopping, or changing your dose must be made with your healthcare professional.

What is Contrave, exactly?

Contrave is a brand-name prescription weight-loss medication that combines two drugs in a single extended-release tablet: naltrexone and bupropion. It’s approved for adults with obesity, or those who are overweight and have at least one weight-related condition, to use alongside a reduced-calorie diet and increased physical activity.

Naltrexone is an opioid receptor antagonist, and bupropion is an antidepressant that also affects dopamine and norepinephrine. Together, they’re thought to act on brain regions involved in hunger, cravings, and reward. The idea is not “magic skinny pill,” but rather a tool that may help some people better manage appetite and emotional eating when combined with healthy habits.

Contrave form and strength

Contrave is pretty simple in terms of how it comes:

• Dosage form: Extended-release oral tablet
• Strength per tablet: 8 mg naltrexone hydrochloride + 90 mg bupropion hydrochloride (often written as 8/90)

The tablets are typically blue, round, and film-coated. Because they are extended-release, the medication is released gradually over time. That’s why you’ll see very firm instructions not to split, crush, or chew themdoing so can dump the medication too quickly into your system and increase the risk of side effects such as seizures.

Standard Contrave dosage for adults

Contrave dosing doesn’t start at full strength on day one. Instead, it follows a step-by-step schedule over the first four weeks. This gradual increase helps your body get used to the medicine and can reduce side effects like nausea or headache.

The typical 4-week titration schedule

According to the FDA-approved prescribing information, healthcare professionals usually follow a weekly titration plan that gradually increases the dose to a target maintenance level. The schedule is based on how many tablets are taken in the morning and in the evening.

By the start of week 4, the total daily amount reaches 4 tablets per day, which equals 32 mg of naltrexone and 360 mg of bupropion in 24 hours. This is considered the usual maximum daily dose in adults.

Again, this schedule is a description of how the medication is generally prescribed, not a DIY dosing plan. Your doctor may decide this medication is not appropriate for you at all, may follow a different approach, or may stop treatment earlier based on how you respond.

Your maintenance dose

For adults who tolerate Contrave and continue treatment, the maintenance dose is typically:

• 2 tablets in the morning and 2 tablets in the evening (for a total of 4 tablets daily).

Daily amounts greater than this are not recommended. Taking more increases the risk of serious side effects, especially seizures. If your current dose isn’t working well, that’s a conversation point with your prescriber, not a reason to self-adjust.

Situations where your dose may be different

Your healthcare professional may use a lower maximum dose or avoid Contrave entirely in certain situations, including:

• Kidney problems: People with moderate or severe renal impairment are often limited to a lower maximum daily dose, and those with end-stage kidney disease are typically advised not to use Contrave at all.
• Liver problems: People with moderate hepatic impairment may need a reduced maintenance dose, and those with severe impairment usually should not take this medication.
• Drug interactions: Medications that strongly affect how bupropion is broken down in the body (such as certain CYP2B6 inhibitors) can change how much drug is in your system, so the Contrave dose may need adjustment.
• Side effects or blood pressure issues: If your blood pressure or heart rate go up, or you have side effects that are hard to tolerate, your provider may pause the titration, lower the dose, or stop the drug.

The key message: Contrave dosing is not one-size-fits-all. The standard schedule is only a starting framework that a clinician adapts to your health situation.

How to take Contrave: practical tips

Contrave comes with several dosing “rules” that are more than fine print. These details matter for safety and effectiveness.

Timing your doses

• Twice daily: After the first week, Contrave is usually taken in the morning and in the evening.
• Regular timing: Try to take your doses at about the same times every day to keep drug levels steady.
• Spacing doses: There should be several hours between the morning and evening doses; your prescriber will give you exact guidance, but “evenly spaced” is the concept.

If Contrave interferes with your sleep, your prescriber may recommend taking the evening dose earlier in the day (while still keeping enough time between doses). Don’t change timing on your own without checking in first.

Food: what to know

Contrave is usually taken with food, but there’s an important catch:

• Avoid high-fat meals when taking a dose. High-fat meals can significantly increase how much bupropion and naltrexone your body absorbs, which may raise the risk of seizures and other side effects.
• Think “normal meal or snack,” not “I just ordered a triple bacon cheeseburger with extra mayo.”

Don’t crush, chew, or split the tablets

Because Contrave tablets are extended-release, they’re designed to release medication slowly over time. Crushing, chewing, or splitting them can destroy that mechanism and cause a large dose to hit your system all at once.

If you have trouble swallowing pills, let your doctor or pharmacist know. They may have specific strategies or may decide that Contrave is not the best option for you rather than having you modify the tablets yourself.

If you forget a dose

Medication guides and major drug references typically advise people not to double up on Contrave to make up for a missed dose. Instead, they describe skipping the missed dose and taking the next dose at the regular time.

However, because seizure risk with bupropion-containing products is closely linked to total daily exposure and dose pattern, it’s safest to confirm with your prescribing clinician or pharmacist how they want you to handle missed doses in your specific situation.

Safety reminders that affect dosing

Contrave isn’t appropriate for everyone. Some of the most important safety considerations are closely tied to how the drug is dosed.

Seizure risk and maximum daily dose

Bupropion, one of the components of Contrave, is known to increase seizure risk at higher doses or in people who already have certain risk factors. This is a major reason why there is a strict maximum daily Contrave dose (4 tablets per day for most adults) and why high-fat meals are discouraged around dosing.

People with a history of seizures, eating disorders such as bulimia or anorexia nervosa, abrupt withdrawal from alcohol or benzodiazepines, or certain brain injuries may be advised to avoid Contrave entirely.

Mental health warning

Bupropion also carries a boxed warning about suicidal thoughts and behaviors, especially in children, adolescents, and young adults taking antidepressants. Although Contrave is not approved for use in children and teens, adults still need careful monitoring for mood changes, agitation, or unusual behaviorparticularly when starting the drug or changing the dose.

Blood pressure and heart rate

Contrave can raise blood pressure and pulse in some people. That’s why many clinicians:

• Check blood pressure and heart rate before starting the medication;
• Monitor them regularly during treatment, especially during dose increases;
• Use caution or avoid Contrave in people with uncontrolled hypertension or certain heart conditions.

How long do people usually stay on Contrave?

Contrave is meant for chronic weight management, not just a two-week quick fix. However, most guidelines and the prescribing information recommend regular checkpoints to see whether the medicine is actually helping.

One common benchmark your provider may use:

• After about 12 weeks at the full maintenance dose, if you haven’t lost a certain percentage of your starting body weight (often around 5% or more), your clinician may recommend stopping Contrave because the benefit may not justify continued risks and cost.

These decisions are individualized. Some people stop earlier due to side effects, while others may continue longer if they’re meeting weight-loss goals and doing well with the medication.

Important: Don’t stop Contrave suddenly or change your schedule without speaking to your prescriber. They may have a plan for adjusting or tapering your dose based on your overall health.

Who should not take Contrave?

Your exact dose is only one part of the safety picture. Some people should not take Contrave at all, regardless of dose. Contraindications commonly include:

• Current or past seizure disorder.
• Uncontrolled high blood pressure.
• Use of chronic opioids or opioid agonist therapy (naltrexone can block their effects and trigger withdrawal).
• Using other bupropion-containing medications.
• Eating disorders such as bulimia or anorexia nervosa.
• Recent abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs.
• Certain serious liver or kidney problems.
• Current or recent use of monoamine oxidase inhibitors (MAOIs).

This is not a complete list. Your provider will review your full medical history, current medications, and lab results before deciding whether Contraveand at what dosemakes sense for you.

Real-life experiences with Contrave dosing

Because weight, appetite, and cravings are deeply personal, experiences with Contrave dosage can vary widely. Still, there are some recurring themes many patients report when they talk with healthcare teams or share their journeys in clinical settings and patient support communities.

Getting through the first month

The initial four-week titration period can feel like a test run. Some people describe the first week on just one morning tablet as “no big deal,” while others notice changes right awaysometimes positive (like feeling full sooner), sometimes less pleasant (like nausea or a dry mouth).

As the dose increases, people often pay attention to:

• Nausea and stomach upset: This is one of the most common early side effects. Taking Contrave with a modest meal instead of on an empty stomach can make a difference for some, so long as the meal is not high in fat.
• Sleep: A few patients feel more alert or “wired” at first, especially once the evening dose is added. In collaboration with their provider, some adjust the timing of the evening tablet earlier in the day to reduce nighttime insomnia.
• Headaches: Mild headaches may appear during the titration phase and sometimes fade as the body adapts to the new dose.

Because the dose changes every week, many people find it helpful to use a pill organizer or calendar reminders so they don’t lose track of which week they’re in. Accidentally jumping ahead or staying on a higher dose longer than intended isn’t just confusingit may also increase side-effect risk.

Partnering with your healthcare team

From a practical standpoint, Contrave tends to work best when patients think of it as a team project rather than a solo mission. Common patterns reported in real-world care include:

• Frequent early check-ins: Some clinicians like to see or message patients a few weeks into treatment to hear how they’re tolerating the dose increases. This is a good time to talk about nausea, sleep, mood, or any “weird feelings” that are hard to describe.
• Adjusting expectations: Providers often remind patients that Contrave isn’t a replacement for lifestyle changes, but a tool to help them stick with healthier patterns such as eating smaller portions or avoiding late-night snacking.
• Monitoring blood pressure: People who already have borderline or elevated blood pressure might be asked to monitor their readings at home during the first few months of therapy.

When weight loss is modest or stalls, prescribers and patients frequently review what’s happening day to day: sleep, stress, meal timing, activity, and whether the dose is still appropriate. Sometimes the answer is to keep going a bit longer; other times, the decision is made to stop and explore a different plan.

Making the dose “work” in everyday life

Contrave dosing has to fit into real schedules. Many patients juggle the medication with work, childcare, travel, and social plans. Based on typical clinic feedback, some practical strategies people use (under the guidance of their clinicians) include:

• Pairing doses with routines: Morning doses may be tied to breakfast or another consistent habit, like making coffee. Evening doses might be linked to dinner or a specific after-work routine.
• Planning around side effects: If someone tends to feel a bit queasy after taking a tablet, they might avoid scheduling intense workouts immediately afterward.
• Choosing food wisely: Since very high-fat meals are discouraged around dosing, some people naturally shift toward lighter, balanced meals with lean protein, vegetables, and whole grains.

Many people also notice that the psychological relationship to food can change at the maintenance dose. Some report fewer “food noise” thoughts during the day, which can make it easier to stick with a meal plan. Others feel only subtle differences and rely heavily on habit-building and environmental changes (for example, keeping tempting snack foods out of the house) to get the full benefit of therapy.

Knowing when to reassess

One of the most empowering parts of using Contrave thoughtfully is recognizing that staying on it is not automatic. At follow-up visits, patients and clinicians often ask:

• Is the current dose well tolerated?
• Is my weight trending in a direction that feels meaningful and sustainable?
• Are my blood pressure, mood, and lab values staying within the desired range?

If the answers are “not really,” the conversation may shift to tapering off Contrave and considering other optionswhether that’s a different weight-loss medication, a renewed focus on nutrition and exercise, or, in some cases, evaluation for bariatric surgery. The point is that your dose and duration of Contrave use should always be part of an ongoing dialogue, not something set in stone on day one.

Bottom line

Contrave dosage is more than a simple “take this pill twice a day” instruction. It involves a carefully structured 4-week titration schedule, a clear maximum daily dose, and a cluster of safety rules around things like seizure risk, food, and blood pressure. While this article can help you understand the logic behind the dosing, only your own healthcare professional can decide whether Contrave is appropriate for you and exactly how it should be used in your case.

If you’re curious about Contrave, bring your questionsincluding concerns about dose, schedule, and side effectsto your next appointment. Arriving informed and curious is one of the best side effects of all.