Contrave Vs. Vyvanse: 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.

Vyvanse^® (lisdexamfetamine) is a stimulant medication used to treat attention-deficit hyperactivity disorder (ADHD) and binge eating disorder (BED) by increasing available levels of dopamine and norepinephrine in the brain, which helps improve focus, attention, and impulse control. Its FDA-approved indications include the treatment of ADHD in patients 6 years and older and moderate to severe binge eating disorder in adults. Vyvanse is available in capsule and chewable tablet forms, typically taken once daily in the morning. Common side effects include decreased appetite, insomnia, dry mouth, and increased heart rate, with serious risks including potential cardiovascular issues and psychiatric side effects like anxiety. Vyvanse carries a boxed warning for the high risk of abuse, dependence, and serious cardiovascular events, particularly in individuals with a history of heart problems.

Naltrexone: opioid antagonist

Bupropion: aminoketone antidepressant

Central nervous system (CNS) stimulant

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)

Vyvanse (lisdexamfetamine dimesylate) is indicated for the treatment of:

• Attention deficit hyperactivity disorder (ADHD) in adults and pediatric patients 6 years and older

• Moderate to severe binge eating disorder (BED) in adults

• Typically taken orally twice daily

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

• Typically taken orally once daily

• Comes in 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, and 70 mg capsules and 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg chewable tablets

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

• Nausea

• Constipation

• Headache

• Vomiting

• Dizziness

• Insomnia

• Dry mouth

• Diarrhea

Most common adverse reactions (incidence ≥5% and at a rate at least twice placebo) in pediatric patients ages 6 to 17 years, and/or adults with ADHD were:

• Anorexia

• Anxiety

• Decreased appetite

• Decreased weight

• Diarrhea

• Dizziness

• Dry mouth

• Irritability

• Insomnia

• Nausea

• Upper abdominal pain

• Vomiting

Most common adverse reactions (incidence ≥ 5% and at a rate at least twice placebo) in adults with BED were:

• Dry mouth

• Insomnia

• Decreased appetite

• Increased heart rate

• Constipation

• Feeling jittery

• Anxiety

• 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)

• Known hypersensitivity to amphetamine products or other ingredients in Vyvanse

• Use with monoamine oxidase (MAO) inhibitor, or within 14 days of the last MAO inhibitor dose

• Drug interactions: Acidifying and alkalinizing agents

• 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

• Risks to patients with serious cardiac disease

• Increased blood pressure and heart rate

• Long-term suppression of growth in pediatric patients

• Peripheral vasculopathy, including Raynaud's phenomenon

• Serotonin syndrome

• Motor and verbal tics, and worsening of Tourette's syndrome

• Pregnancy: May cause fetal harm

• Breastfeeding: Breastfeeding not recommended

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.

WARNING: ABUSE, MISUSE, AND ADDICTION

Vyvanse has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants, including Vyvanse, can result in overdose and death:

• Before prescribing Vyvanse, assess each patient's risk for abuse, misuse, and addiction.

• Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug.

• Throughout treatment, reassess each patient's risk and frequently monitor for signs and symptoms of abuse, misuse, and addiction.

*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 Vyvanse^®. See the Full Prescribing Information for more complete information. Lisdexamfetamine, the active ingredient in Vyvanse, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient lisdexamfetamine.