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The drug may also raise blood pressure and heartbeat, and really should not be used in individuals with a history of cardiac arrest or stroke in the previous six months. Blood pressure and pulse should also be measured before commencing the drug and throughout therapy with all the drug. The FDA also warned that Contrave can raise hypertension and heart rate and must not used in patients with uncontrolled high blood pressure levels, as well as by a person with heart-related and cerebrovascular (circulatory dysfunction impacting your brain) disease. Patients with a history of heart attack or stroke in the last six months, life-threatening arrhythmias, or congestive heart failure were excluded in the clinical trials. Those taking Contrave should have their heart-rate and pulse monitored regularly. 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There is a formulation of buprenorphine without naloxone called subutex; I manipulate this formulation if the patient has apparent problems from naloxone, including headaches after dosing with suboxone. I also have treated addicts who may have had gastric bypass, the location where the first part of the intestine is bypassed and also the stomach contents empty in a more distal the main small intestine. In such cases the naloxone escapes ?first pass metabolism', the task with normal anatomy the location where the drug is taken up from the duodenum and transferred straight to the liver by the portal vein, where it really is quickly and completely destroyed. After gastric bypass naloxone can be taken on by portions of the intestine that aren't served with the portal system, causing blood degrees of naloxone sufficient to cause brief, relatively mild withdrawal symptoms.



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