The “90 8 pill” primarily refers to Contrave, a prescription fixed-dose combination extended-release tablet containing Bupropion Hydrochloride (90 mg) and Naltrexone Hydrochloride (8 mg). It is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults.
While it is commonly referred to by its dosage ratio (90 mg / 8 mg), the authentic tablet is imprinted with NB-890.
Pill Identification & Physical Characteristics
Property – Description
- Active Ingredients – Bupropion HCl (90 mg) & Naltrexone HCl (8 mg)
- Imprint –
NB-890debossed on one side; plain on the reverse - Shape & Color – Round, biconvex, film-coated; Blue
- Drug Class – Aminoketone Antidepressant (NDRI) / Opioid Antagonist Combination
- Formulation – Extended-release (ER / XR)
- Manufacturer / Distributor – Currax Pharmaceuticals LLC
- (Note: Other pills with related numbers include generic Furosemide 20 mg marked
TEVA 2908or2908, and L-Methylfolate 7.5 mg markedB 908. A blue round tablet with “90” and “8” represents Contrave.)
Mechanism of Action
Contrave combines two centrally acting compounds that work synergistically in the hypothalamus and the mesolimbic dopamine circuit to reduce appetite and control food cravings:
- Hypothalamic Appetite Regulation (POMC Stimulation):
- Bupropion acts as a weak norepinephrine and dopamine reuptake inhibitor (NDRI). It stimulates pro-opiomelanocortin (POMC) neurons in the arcuate nucleus of the hypothalamus, prompting the release of melanocyte-stimulating hormone , which signals satiety.
- Normally, POMC activation simultaneously releases endorphin, which binds to opioid receptors on POMC neurons, creating a negative feedback loop that shuts down the satiety signal.
- Naltrexone is a pure opioid receptor antagonist. By blocking the opioid receptor, naltrexone prevents endorphin from inhibiting POMC neurons, allowing sustained bupropion-induced satiety signaling.
- Mesolimbic Reward Circuit Modulation:
- The combination modulates the dopamine-driven mesolimbic reward system, attenuating food cravings and emotional/hedonic eating behaviors.
Indications & Dosage
Approved Indications
- Chronic weight management in adults with an initial Body Mass Index (BMI) of:
- obesity, or
- overweight in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia).
- Adult Dosing & Titration Schedule To reduce gastrointestinal side effects (especially nausea), dosing is titrated weekly to the maintenance target of 4 tablets daily (360 mg bupropion / 32 mg naltrexone):
- Week 1: 1 tablet once daily in the morning.
- Week 2: 1 tablet in the morning, 1 tablet in the evening.
- Week 3: 2 tablets in the morning, 1 tablet in the evening.
- Week 4 and beyond (Maintenance): 2 tablets twice daily (2 tablets in the morning, 2 tablets in the evening).
Administration Rules
- Swallow whole; do not cut, crush, or chew the tablets (destroying the extended-release matrix risks rapid drug dumping and seizure).
- Avoid High-Fat Meals: Taking Contrave with high-fat meals significantly increases systemic absorption of bupropion and naltrexone, increasing the risk of adverse events and seizures.
- Evaluation: If a patient has not lost at least 5% of baseline body weight after 12–16 weeks on maintenance therapy, discontinuation is recommended
Side Effects
Common Adverse Reactions
- Nausea (the most frequent side effect; typically transient during titration) and vomiting
- Constipation, dry mouth (xerostomia), and diarrhea
- Insomnia and sleep architecture disruption (avoid taking evening doses too close to bedtime)
- Headache, dizziness, and tremors
- Hot flashes, sweating (hyperhidrosis), and dysgeusia (altered taste)
Severe & Emergent Adverse Reactions
- Seizures: Dose-dependent bupropion risk.
- Precipitated Opioid Withdrawal: Severe, acute withdrawal if taken by patients dependent on opioids.
- Elevated Blood Pressure & Heart Rate: Noradrenergic stimulation can cause significant increases in resting pulse and blood pressure.
- Hepatotoxicity: Naltrexone can cause transaminase elevations and liver injury at excessive doses.
- Neuropsychiatric Symptoms: Hallucinations, psychosis, panic attacks, or mania in vulnerable individuals.
- Angle-Closure Glaucoma: Pupillary dilation triggered by bupropion can precipitate acute angle closure.
Precautions & Contraindications
- Strict Opioid Contraindication: Patients must be completely opioid-free (including tramadol, codeine, methadone, or buprenorphine) for at least 7 to 14 days prior to starting Contrave. Naltrexone blocks the analgesic efficacy of opioids and will precipitate immediate, severe opioid withdrawal.
- Seizure Disorders: Contraindicated in patients with epilepsy, a history of seizures, or conditions that lower seizure threshold (e.g., arteriovenous malformations, severe head trauma, or acute withdrawal from alcohol, benzodiazepines, or antiepileptic drugs).
- Eating Disorders: Strictly contraindicated in patients with a current or prior diagnosis of anorexia nervosa or bulimia nervosa due to an elevated risk of seizures.
- Monoamine Oxidase Inhibitors (MAOIs): At least 14 days must elapse between discontinuing an MAOI and initiating Contrave to avoid hypertensive crisis.
- Uncontrolled Hypertension: Blood pressure and pulse must be monitored before starting and periodically during treatment.
- Pregnancy: Weight loss offers no clinical benefit during pregnancy and may cause fetal harm; contraindicated during pregnancy and lactation.
Black Box Warnings
- FDA Boxed Warnings:
- Suicidal Thoughts and Behaviors: Bupropion is an antidepressant component. Antidepressants increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults ( 24 years). Contrave is not approved for pediatric use or for the treatment of depression/bipolar disorder. Patients should be closely monitored for neuropsychiatric symptoms or emergent suicidality.
- Neuropsychiatric Reactions in Smoking Cessation: While Contrave is not approved for smoking cessation, bupropion-containing products have been associated with mood changes, psychosis, agitation, aggression, and panic.