Contrave Vs. Suboxone: Drug Comparison

Contrave^® (naltrexone hydrochloride and bupropion hydrochloride) is a prescription medication used for weight management in adults, combining two active ingredients: naltrexone, which affects the brain's reward system, and bupropion, which influences appetite and cravings. It works by targeting the hypothalamus to reduce hunger and the mesolimbic reward system (a pathway in the brain that plays a key role in regulating feelings of pleasure, motivation, and reinforcement) to curb food cravings. Contrave is FDA-approved for chronic weight management. Common side effects include nausea, constipation, headache, and insomnia, while drug interactions can occur with MAO inhibitors, opioid pain medications, and drugs that lower the seizure threshold. Contrave carries a boxed warning for an increased risk of suicidal thoughts and behaviors, particularly in young adults, due to its bupropion component.

Suboxone^® is a combination of buprenorphine and naloxone used to treat opioid dependence by reducing withdrawal symptoms and cravings while discouraging misuse. Buprenorphine is a partial opioid agonist that helps ease opioid withdrawal and cravings, while naloxone is an opioid antagonist that prevents misuse by causing withdrawal if injected. Its FDA-approved indication is for the treatment of opioid dependence, usually as part of a comprehensive treatment program that includes counseling and psychosocial support. Suboxone is available as a sublingual film or tablet taken daily. Common side effects include headache, nausea, sweating, and constipation, and it carries a warning for the risk of respiratory depression, misuse, and dependence, especially when used with central nervous system (CNS) depressants such as alcohol or benzodiazepines.

Naltrexone: opioid antagonist

Bupropion: aminoketone antidepressant

Buprenorphine: partial‐opioid agonist

Naloxone: opioid antagonist

Contrave (naltrexone hydrochloride and bupropion hydrochloride) is indicated:

• As an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:

  • 30 kg/m² or greater (obese)

  • 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia)

Suboxone (buprenorphine hydrochloride and naloxone hydcrochloride) is indicated:

• For treatment of opioid dependence

Suboxone sublingual film should be used as part of a complete treatment plan that includes counseling and psychosocial support

• Typically taken orally twice daily

• Comes as 8 mg/90 mg extended-release tablets

• Typically taken as a sublingual film once daily

• Comes in 2 mg/0.5 mg, 4 mg/1 mg, 8 mg/2 mg, and 12 mg/3 mg sublingual films

Most common adverse reactions (greater than or equal to 5%):

• Nausea

• Constipation

• Headache

• Vomiting

• Dizziness

• Insomnia

• Dry mouth

• Diarrhea

Adverse events commonly observed with the sublingual/buccal administration of the Suboxone sublingual film are:

• Oral loss of sensation

• Pain in the tongue

• Oral mucosal redness

• Headache

• Nausea

• Vomiting

• Excessive sweating

• Constipation

• Signs and symptoms of withdrawal

• Insomnia

• Pain

• Swelling of the extremities

• Uncontrolled hypertension

• Seizure disorders, anorexia nervosa or bulimia, or undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs

• Use of other bupropion-containing products

• Chronic opioid use

• During or within 14 days of taking monoamine oxidase inhibitors (MAOI)

• Known allergy to any of the ingredients in Contrave

• Drug interactions: MAOIs, antidepressants (e.g., selective serotonin reuptake inhibitors and many tricyclics), antipsychotics (e.g., haloperidol, risperidone, and thioridazine), beta-blockers (e.g., metoprolol), type 1C antiarrhythmics (e.g., propafenone and flecainide), digoxin, CYP2B6 inhibitors (e.g., ticlopidine or clopidogrel), CYP2B6 inducers (e.g., ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital, and phenytoin), drugs that lower seizure threshold, dopaminergic drugs (levodopa and amantadine)

• Hypersensitivity to buprenorphine or naloxone

• Drug interactions: benzodiazepines, CYP3A4 inhibitors and inducers, antiretrovirals, serotonergic drugs

• Suicidal behavior and ideation

• Neuropsychiatric adverse events during smoking cessation

• Risk of seizure may be minimized by adhering to the recommended dosing schedule and avoiding coadministration with high-fat meal

• Increase in blood pressure and heart rate

• Liver toxicity

• Angle-closure glaucoma

• Use of antidiabetic medications: Weight loss may cause hypoglycemia

• Pregnancy: Weight loss during pregnancy may cause fetal harm. Discontinue when a pregnancy is recognized

• Addiction, abuse, and misuse

• Respiratory depression

• Unintentional pediatric exposure

• Neonatal opioid withdrawal syndrome

• Adrenal insufficiency

• Risk of opioid withdrawal with abrupt discontinuation

• Risk of hepatitis, hepatic events

• Precipitation of opioid withdrawal signs and symptoms

• Risk of overdose in opioid‐naïve patients

• Breastfeeding: Buprenorphine passes into mother's milk

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for major depressive disorder and other psychiatric disorders. Monitor for worsening and emergence of suicidal thoughts and behaviors.

Contrave has not been studied in pediatric patients.

*This information is from the label for brand name Contrave^®. See the Full Prescribing Information for more complete information. Naltrexone and bupropion, the active ingredients in Contrave, may also be the active ingredients in other medications, and this information may not be accurate for all medications that include the active ingredients naltrexone and bupropion.

*This information is from the label for brand name Suboxone^®. See the Full Prescribing Information for more complete information. Buprenorphine and naloxone, the active ingredients in Suboxone, may also be the active ingredients in other medications, and this information may not be accurate for all medications that include the active ingredients buprenorphine and naloxone.