Many of you have probably seen the commercials for Contrave of overweight women in leotards lying in a circle talking about the brain and how dysfunction in the brain leads to hunger and cravings. I personally find the ad somewhat sexist because there is not one man in the circle but that is another story for another time.
What I would like to do is talk about Contrave and answer any questions you might have including how it works, dosage, side effects and contraindications.
If you think about the brain in its simplest terms, there are many parts that control what is called Hedonic/Pleasure Reward System. These range from environmental factors to emotions and even in-utero exposures can alter food/flavor preferences over a lifetime.
What Contrave focuses on are the 2 “chemical messengers” that control eating.
- Dopamine is a neurotransmitter in the brain also referred to as “the gas pedal of pleasure”. It lights up for food , gambling, water, reward as well as a sense of well-being
- Opiods are released by the consumption of highly palatable foods (think sugar, white flour) which in turn causes the release of dopamine thus activating the “reward circuitry”
Contrave works on both these messengers and is comprised of Wellbutrin (dopamine ) and a drug that blocks Opiods (naltrexone or as some of you may know Narcan).
The idea behind the drug is that if we block these 2 mechanisms of action then there are less cravings and less desire for food.
The drug is prescribed in incremental dosages on a weekly basis.
WEEK 1: take 1 pill in the am and nothing in the pm
WEEK 2: take 1 pill in the am and 1 in pm
WEEK 3: take 2 pills in the am and 1 pm
WEEK 4: take 2 pills in am and 2 in pm
BY the time you are at week 4, you are essentially on 360mg of Wellbutrin and 32mg of naltrexone.
It does not have to be increased this way every week. If you feel good on week 2 dosages then stay on that for as long as you want until you feel you need to increase.
The #1 side effect is nausea, followed by constipation, headache, vomiting, dizziness, insomnia, dry mouth. These are usually self-limiting and subside after time.