Short answer: It can, though rarely. Contrave contains bupropion, which can cause seizures, and the risk rises with dose. In clinical trials about 0.1% of people on Contrave had a seizure, against 0% on placebo. The label rules it out for people with a seizure disorder or an eating disorder, lists dosing rules meant to keep the risk low, and says anyone who has a seizure on it stops and does not restart.
Contrave is a tablet that combines naltrexone with bupropion. Its seizure warning comes from the bupropion part (section 5.3). The label says the risk of seizure is dose-related, and that in clinical trials it was approximately 0.1% on Contrave versus 0% on placebo.
The label adds that the risk also depends on the person, the situation and other medicines that lower the seizure threshold, and that these are weighed before starting. If a seizure happens during treatment, Contrave is stopped and not restarted. See naltrexone-bupropion.
Contrave is contraindicated (not to be used) in people with a seizure disorder or a history of seizures, a current or past diagnosis of anorexia or bulimia, or who are abruptly stopping alcohol, benzodiazepines, barbiturates or seizure medicines (sections 4, 5.3). It is also contraindicated with any other bupropion product, which the label names as including Wellbutrin, Wellbutrin SR, Wellbutrin XL, Aplenzin and Zyban.
The label asks for caution in people with factors that raise seizure risk:
The label says the risk may be kept low by sticking to the recommended dosing (sections 2, 5.3):
| Rule | What the label says |
|---|---|
| Daily maximum | No more than 360 mg of bupropion a day, which is four tablets |
| Splitting | The daily dose is taken in two doses, morning and evening |
| Starting | Raised gradually: 1 tablet in week 1, 1 + 1 in week 2, 2 + 1 in week 3, 2 + 2 from week 4 |
| Per dose | No more than two tablets at one time |
| Meals | High-fat meals are avoided, because they raise drug levels |
| Missed dose | Wait for the next scheduled dose rather than doubling up |
| Kidney or liver problems | Moderate or severe kidney impairment, or moderate liver impairment: maximum two tablets a day. Not recommended in end-stage kidney disease or severe liver impairment |
| CYP2B6 inhibitors | With clopidogrel or ticlopidine, which raise bupropion levels, no more than one tablet twice a day |
Low blood sugar appears twice in the label: as a seizure risk factor, and in a separate warning that weight loss may raise the risk of low blood sugar in type 2 diabetes treated with insulin or sulfonylureas (section 5.10). See weight-loss pills and low blood sugar.
A full list of current medicines, including antidepressants, steroids and any bupropion for smoking, helps the prescriber check for overlap. Dose Track keeps each medicine, dose and time in one log, which also shows whether two Contrave tablets were taken together.
Read more on Dose Track: Contrave side effects · Contrave dosing schedule · Naltrexone-bupropion · Contrave vs phentermine