Contraindications
The manufacturer recommends against its use in people that have/are:
History of seizures
History of an eating disorder such as bulimia nervosa or anorexia nervosa
Taking opioid pain medicines, taking medicines to stop opioid addiction, or are in opiate withdrawal
Taking an MAOI or have taken an MAOI in the last 14 days
Pregnant
Abruptly stopped using: alcohol, benzodiazepines, barbiturates, or antiepileptic drugs

Adverse effects
The U.S. Food and Drug Administration (FDA) has put a boxed warning onto this medicine because it may affect mood and increase the likelihood of suicidal thoughts in people under 25 years old. This is attributed to the bupropion component, as antidepressants have been associated with increased risk of suicidal thoughts, but not suicide, and only in people younger than 25.The safety and effectiveness in children under the age of 18 has not been studied. Mechanism of action
Individually, naltrexone and bupropion each target pathways in the central nervous system that influence appetite and energy use. Bupropion is a reuptake inhibitor and releasing agent of both norepinephrine and dopamine, and a nicotinic acetylcholine receptor antagonist, and it activates proopiomelanocortin (POMC) neurons in the hypothalamus which give an effect downstream, resulting in loss of appetite and increased energy output. The POMC is regulated by endogenous opioids via opioid-mediated negative feedback. Naltrexone is a pure opioid antagonist, which further augments bupropions activation of the POMC.Combined, naltrexone/bupropion has an effect on the reward pathway that results in reduced food craving.
The early data release reported a reduction in heart attacks that was no longer observed when a more complete view of the data was analyzed.In 2018, Orexigen sold its assets, including Contrave, to Nalpropion Pharmaceuticals. Marketing and sales
The sustained-release formulation, Contrave, is marketed by Takeda under license from the combination medications developer, Orexigen Therapeutics. As of 2015, Orexigen received 20% of net sales from Takeda.At the time of its approval by the FDA, Wells Fargo analyst Matthew Andrews estimated that Contraves U.S. sales would reach approximately US$200,000,000 in 2016, exceeding that of the dominant alternative obesity medications lorcaserin and phentermine/topiramate. Despite being initially impeded by technical issues, the growth in filled prescriptions in the first months after approval was very rapid — substantially exceeding the equivalent early uptake of either of the two alternative medications just cited. The first quarter of sales for Contrave (Q1 2015) showed net sales of US$11,500,000.Despite having been approved for use in Europe in March 2015, sales of Contrave have not begun as Orexigen has not yet found a marketing partner. See also
Bupropion/zonisamide
Bupropion/dextromethorphan

References
External links
"Bupropion mixture with naltrexone". Drug Information Portal. U.S. National Library of Medicine.