Contrave interactions: safe choices, alcohol tips, and meds to watch

If you're starting Contrave (the combo of bupropion and naltrexone) and wondering, "Can I still have a glass of wine?" or "Will it clash with my antidepressant?"you're not alone. Let's talk honestly: Contrave interactions matter. They can raise seizure risk, mute opioid pain meds, and nudge your heart rate and blood pressure. But with a few smart moves and a little planning, you can use Contrave safely and confidently.

My goal isn't to scare you. It's to help you feel informed, empowered, and ready to get results. In this guide, we'll walk through what to avoid, what's usually okay, and how to check your own meds and supplements. Think of this as the friendly, practical rundown you'd get from a clinician who actually listensand cares.

Quick takeaways

The 30second summary

Contrave combines two medicines that work on the brain's reward system and appetite. Because of that, certain drugs and habits can crank up risks or cancel out benefits. Here's the quick snapshot:

Highest-risk combos to avoid

Skip mixing Contrave with MAOIs (within 14 days), opioids or partial agonists (like hydrocodone, oxycodone, methadone, buprenorphine), and avoid starting Contrave during abrupt withdrawal from alcohol, benzodiazepines, or barbiturates. These are red flags for serious reactions like hypertensive crisis, opioid withdrawal, or seizures.

Everyday meds to doublecheck

Antidepressants, stimulants, seizure medications, diabetes meds, and betablockers deserve a closer look. They're not automatic "no's," but they often need a plan, dose tweaks, or extra monitoring.

Contrave and alcohol

"Limit or avoid" isn't a buzzkill; it's a safety net. Alcohol can raise seizure risk and swing mood and blood pressure. Some people should skip alcohol entirelymore on that below.

Easy safety steps

Follow the slow dosetitration schedule, avoid highfat meals with your doses, and run your list through a reliable interaction checker before you start or add anything new (according to Drugs.com and guidance summarized by WebMD).

How it works

The bupropion + naltrexone duo

Contrave combines bupropion (an antidepressant that also affects dopamine and norepinephrine) and naltrexone (an opioid receptor blocker). Together, they help curb cravings and reduce the "reward" from overeating. Powerful, yesbut because both touch key brain pathways, Contrave interactions can be a bigger deal than with many other meds.

Bupropion: seizure threshold, blood pressure, CYP2D6

Bupropion can lower the seizure threshold, especially at higher doses or when combined with alcohol or other seizurelowering drugs. It can also nudge blood pressure and heart rate upward. And it inhibits the CYP2D6 enzyme in the liver, which can raise levels of certain other medications (like some antidepressants and betablockers). That's why we monitor, adjust, and go slow.

Naltrexone: opioids don't "work"

Naltrexone blocks opioid receptors. Good news: it doesn't cause euphoria or dependence. The tradeoff: opioid pain meds stop working properly, and if you're physically dependent on opioids, it can precipitate withdrawal. Planning around procedures and pain control becomes essential while you're on Contrave.

Alcohol

Can you drink on Contrave?

The safest advice: limit or avoid alcohol. Bupropion plus alcohol can be a bad dancethink increased seizure risk, mood changes, poor sleep, and blood pressure spikes. If you're someone who drinks lightly and occasionally, you may be able to carefully test your personal tolerance once you're stable on your dose. But some people should avoid alcohol entirely: if you have a seizure history, uncontrolled hypertension, heavy or binge drinking patterns, or you've recently stopped alcohol use (withdrawal risk).

What "limit or avoid" really means

It means skip the nightly large pour and especially avoid binge drinking. If you do drink, wait until after the initial titration phase, stick to a small amount, eat beforehand, hydrate, and avoid stacking other risks like sleep deprivation.

Risks and saferuse tips

Main risks: seizures, mood swings or irritability, blood pressure elevations, and impaired judgment. If you choose to drink: start with one standard drink max, avoid driving, don't combine with sedatives, and stop if you feel strange or "off."

Reallife scenarios

Social drinker? You might be fine with an occasional halfglass of wine after a few stable weeksjust go slow and monitor how you feel. Heavy use or recent cessation? This is a different ballgame. Talk with your clinician first. Abrupt alcohol withdrawal is high risk for seizures and is a nogo zone when starting Contrave.

Food note: highfat meals

A quirky but important detail: avoid taking Contrave with highfat meals because this can increase bupropion levels and raise seizure risk (as explained on consumer resources like WebMD). Keep meals balanced around dosing.

Drug interactions

Absolute avoid or generally "don't mix"

Some combinations are truly problematic.

Opioids and partial agonists

Hydrocodone, oxycodone, morphine, methadone, and even partial agonists like buprenorphine can be blocked by naltrexone, causing poor pain control and potential withdrawal. If you're on opioids, you'll need a supervised washout before starting Contrave and a plan for nonopioid pain management (summarized by medically reviewed sources like Medical News Today).

MAOIs within 14 days

Mixing bupropion with monoamine oxidase inhibitors (like phenelzine, tranylcypromine, isocarboxazid, linezolid, or methylene blue) can trigger dangerously high blood pressure. A 14day washout is the standard safety window (as noted in consumer medical summaries and prescribing information).

Other bupropioncontaining products

Wellbutrin, Aplenzin, and products like Auvelity also contain bupropion. Doubling up boosts seizure risk and side effects. Stick with one bupropion source at a time unless your prescriber intentionally designs a plan (which is uncommon).

High caution and monitoring

These aren't automatic dealbreakers, but they deserve respect and a monitoring strategy.

Seizurethresholdlowering meds

Antipsychotics, many antidepressants (especially TCAs and some SSRIs), stimulants, theophylline, amantadine, and others can nudge seizure risk. Most people can still use some of these with Contravebut titrate carefully, avoid alcohol, and report any neurological symptoms promptly.

Antiseizure inducers

Carbamazepine, phenytoin, and oxcarbazepine can rev up liver enzymes and potentially reduce Contrave's effectiveness. You might need dose adjustments or alternative strategies, and seizure risk must be weighed in both directions.

Diabetes medications

As weight and insulin sensitivity improve, your blood glucose can drop more than expected. Hypoglycemia is no jokecoordinate with your clinician to adjust insulin or sulfonylureas and check sugars more often during the first months (a practical note echoed by consumer guidance like WebMD).

Betablockers and other CYP2D6 substrates

Bupropion inhibits CYP2D6. That can raise the levels of certain drugs like metoprolol, some antidepressants (like nortriptyline), and others. Translation: you may feel side effects at lower doses. Your prescriber may adjust doses and monitor more closely.

Digoxin

There are reports that Contrave might reduce digoxin levels, which could blunt its effect. If you're on digoxin, your clinician may check levels and symptoms after starting or changing Contrave.

Common meds people ask about

Antidepressants (fluoxetine, paroxetine, amitriptyline)

Can you combine them? Often yes, with thoughtful monitoring. Watch for blood pressure changes, agitation, insomnia, and seizure risk. Because fluoxetine and paroxetine also affect CYP2D6, your prescriber might finetune doses to keep side effects in check.

ADHD stimulants (lisdexamfetamine, methylphenidate)

This combo is fairly common in real life. Just monitor blood pressure and heart rate, prioritize sleep, and avoid alcohol. If you notice anxiety or racing heart, check in about dose timing or adjustments (tips that align with general consumer guidance on stimulant combinations).

Pain relievers (ibuprofen, meloxicam, naproxen)

Good news: nonopioid pain relievers are generally fine with Contrave. Still, NSAIDs can affect blood pressure and the stomach. Use the lowest effective dose, take with food if needed, and keep an eye on your BP if you have hypertension.

Blood pressure meds (lisinopril, losartan, amlodipine)

You can take Contrave with these. Because Contrave may increase BP/HR in some people, home monitoring is smart during the first 812 weeks. If numbers creep up, your clinician can tweak your plan.

Thyroid meds (levothyroxine)

No major direct interaction, but timing matters. Take levothyroxine on an empty stomach, separate from other meds. If weight changes significantly, you might need a thyroid dose reviewsymptoms and labs will guide you.

GLP1s (semaglutide/Ozempic)

Can you use them together? Sometimes, with clinical judgment. Appetite and nausea can "stack," which some people find helpful and others find rough. If used together, titrate slowly, focus on hydration and protein, and communicate about side effects.

Scope check

There are hundreds of potential Contrave interactions catalogedover 700 pairs are listed in some databases, including more than 200 major ones (according to Drugs.com). Don't panic. Not all will apply to you. But do run your exact combo through a checker and review it with your clinician.

Supplements

What we know (and don't)

Supplements can be sneaky. Labels hide stimulants; blends change often. Here's a practical rundown:

Melatonin

Usually okay. It's not known to interact significantly with Contrave. Just be mindful of morning grogginess and adjust timing/dose as needed.

Vitamins B12, C, D

Typically low concern. If you have a sensitive stomach, take with food (but remember to avoid highfat meals near Contrave doses). Space out any iron or calcium supplements from levothyroxine if you take it.

St. John's wort, 5HTP, SAMe

These can influence mood pathways and, in some cases, lower seizure threshold. Not guaranteed trouble, but worth a pause and a conversation with your clinician before using.

Caffeine and "fat burners"

Extra caffeine, synephrine, or yohimbine can push heart rate, blood pressure, and anxiety higher. If you already take coffee or tea, avoid stacking with stimulant blends. Your nervous system will thank you.

Omega3s, magnesium

Generally safe. Just watch for GI upset. Magnesium can relax the bowelssome welcome that, others don't. Adjust timing to suit your routine.

How to vet a supplement on Contrave

Read labels like a detective. Look for hidden stimulants and proprietary blends. Then run each item through an interaction checker and share it with your care team. Two quick clicks now can prevent two weeks of side effects later.

Disease risks

Who should be extra careful

Some health conditions change the risk/benefit balance with Contrave.

Seizure disorders, eating disorders, recent sedative/alcohol withdrawal

These are classic "do not use" scenarios for bupropioncontaining meds. If you have a history of anorexia or bulimia, seizures, or you've recently stopped alcohol, benzodiazepines, or barbiturates, talk with your clinician about alternatives (as reflected in consumer medical references and prescribing information).

Uncontrolled hypertension or cardiovascular disease

Because Contrave can raise BP/HR, don't start until your BP is well controlled. If you have cardiovascular disease, build in more frequent monitoring during titration.

Liver or kidney impairment

These organs handle medication processing and elimination. You might need dose adjustments and lab monitoring. Go slow, check in often.

Glaucoma and psychiatric history

Angleclosure glaucoma risk can be nudged by medications that influence pupil dilation. And with any psychiatric historybipolar disorder, psychosis, or suicidalityclose followup is essential. Report mood shifts promptly.

Pregnancy, breastfeeding, older adults

Pregnancy

Weightloss medications aren't recommended. If you're planning pregnancy or become pregnant, talk with your clinician about stopping Contrave and focusing on nutrition and activity supports.

Older adults

Start low, go slow. Sensitivity to side effects can be higher, and the medication list is often longer. That's all the more reason to check interactions and monitor BP, sleep, and mood.

Safety checklist

Before you start

Make a clean, honest list: all meds, supplements, and your alcohol pattern. Note your last opioid dose if you've used any in the past month. Get a baseline BP/HR, talk through your seizure risk, and plan for how you'll handle dental or surgical pain without opioids while on Contrave.

During treatment

Follow the slow titration scheduledon't rush it. Avoid highfat meals with your doses. Check BP/HR weekly at home for the first few months. Track your sleep, mood, and cravings in a quick note on your phone. If you miss a dose, skip it if it's close to the next onedon't double up. Call your clinician for persistent insomnia, big mood shifts, severe nausea, or BP spikes.

Tools that help

Use a druginteraction checker whenever you add something new (resources like Drugs.com or summaries on WebMD are handy). Keep a simple medication list on your phone and share it at every visit. The fewer surprises, the smoother your journey.

How we know

Evidence and guidance

The interaction landscape for Contrave is well documented across reputable databases and consumer medical sites. For example, more than 700 drug pairs are listed for bupropion/naltrexone, broken down into major, moderate, and minor categories (according to Drugs.com). These classifications are guides, not gospelyour realworld risk depends on your health history, doses, and timing. Consumer summaries from sources like WebMD and medically reviewed articles on Medical News Today can help translate the jargon into plain language. Your clinician's judgment pulls it all together for your individual situation.

Bottom line: when we say "avoid opioids" or "limit alcohol," we're not being dramaticwe're reflecting patterns seen in research, FDAlabel warnings, and realworld clinical practice. It's about stacking the odds in your favor so you can get the benefits you're after.

Bringing it together

Contrave can be a strong ally in weight management. Like any powerful tool, it works best with respect and a plan. The biggest red flags are opioids, MAOIs, other bupropion products, heavy alcohol use, uncontrolled blood pressure, and any history that lowers your seizure threshold. That said, many everyday medicinesantidepressants, stimulants, diabetes meds, betablockerscan be used safely with monitoring and a collaborative approach.

If you remember just a few things: avoid highfat meals with your doses, limit or skip alcohol, check every new med or supplement, and keep your care team in the loop. You deserve a plan that fits your life. Have a specific combination you're worried about? Share your list and questions. We can walk through it togetherstep by stepso you feel clear, supported, and ready to move forward.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.