Contrave vs. Other Weight‑Loss Drugs: Naltrexone‑Bupropion Compared

Quick Take

• Contrave combines two older drugs-naltrexone and bupropion-to curb appetite and cravings.
• It delivers about 5‑10% body‑weight loss after a year, similar to many FDA‑approved options.
• Alternatives such as Wegovy, Saxenda, Qsymia, Orlistat, and phentermine differ in route (injectable vs. oral), cost, and side‑effect profile.
• Choosing the right pill depends on medical history, insurance coverage, and willingness to use injections.

When you’re hunting for a prescription that can help you drop those stubborn pounds, the market feels crowded. One name that keeps popping up is Contrave. But is it really the best fit, or are there cheaper, safer, or more effective alternatives? This guide walks you through the science, the pros‑and‑cons, and a side‑by‑side look at the most common competitors.

What is Contrave?

Contrave is a combination pill approved by the U.S. FDA in 2014 for chronic weight management. It merges two older drugs with very different actions:

• Naltrexone - an opioid‑receptor antagonist originally used to treat alcohol and opioid dependence.
• Bupropion - a dopamine‑norepinephrine reuptake inhibitor best known as an antidepressant and smoking‑cessation aid.

The two ingredients work together to hit the brain’s reward pathways and the hypothalamic appetite center. In simple terms, they help you feel less hungry and make cravings less rewarding.

How Contrave Works

Imagine your brain as a thermostat for hunger. Bupropion nudges the thermostat down by boosting dopamine and norepinephrine, which reduces the urge to eat. Naltrexone then blocks the “reward” spike that usually follows a binge, so you’re less likely to overindulge again. The synergy is called the “dual‑action” mechanism, and clinical trials show it can lead to a 5‑10% reduction in body weight after 12 months of use.

Benefits and Drawbacks

Pros

• Oral tablet - no injection needed.
• Weight loss comparable to many other prescription options.
• Can improve blood‑sugar control in people with pre‑diabetes.

Cons

• Common side effects: nausea, constipation, headache, dry mouth.
• Contraindicated for patients with uncontrolled hypertension, seizure disorder, or chronic opioid use.
• Cost: $150‑$200 per month without insurance, making it pricey for long‑term use.

Top Alternatives to Contrave

Below are the most frequently prescribed competitors. Each has its own mechanism, dosing schedule, and price range.

Saxenda (liraglutide)

Saxenda is a GLP‑1 receptor agonist administered as a daily injection. It mimics a gut hormone that tells the brain you’re full, leading to an average 5‑10% weight loss over a year.

Wegovy (semaglutide)

Wegovy is the newer, higher‑dose version of the diabetes drug Ozempic. Given once‑weekly, it can produce 10‑15% body‑weight loss, the highest among approved meds. The downside? Injection‑related anxiety and a higher price tag ($1,300‑$1,500 per month).

Qsymia (phentermine/topiramate)

Qsymia blends a stimulant (phentermine) with an anti‑seizure drug (topiramate). It works by cutting appetite and enhancing satiety. Users typically lose 8‑10% of body weight, but the stimulant can raise heart rate and blood pressure.

Orlistat (Xenical)

Orlistat is an over‑the‑counter lipase inhibitor that blocks about 30% of dietary fat absorption. Weight loss averages 3‑5% in the first year. Side effects include oily stools and occasional vitamin‑A depletion, requiring supplemental vitamins.

Phentermine (Adipex‑P)

Phentermine is a short‑term appetite suppressant, similar to a mild amphetamine. It can produce 5‑8% weight loss in three months but is typically limited to 12 weeks due to habit‑forming potential.

Side‑by‑Side Comparison

How to Pick the Right Option

Think of the decision like a checklist. Ask yourself these core questions:

1. Do you have any heart‑related conditions or uncontrolled hypertension? If yes, avoid stimulants like phentermine and Qsymia.
2. Are you comfortable with injections? If not, stick to oral agents such as Contrave, Qsymia, or Orlistat.
3. How important is cost? Over‑the‑counter Orlistat is the cheapest, while GLP‑1 agonists (Wegovy, Saxenda) are the most expensive.
4. Do you have a history of seizures or are you on opioid therapy? Naltrexone‑based combos (Contrave) may not be suitable.
5. Do you need rapid results? Weekly semaglutide (Wegovy) often shows the biggest early drop.

Match your answers against the table above, and you’ll see a clear pattern emerge - for many users who want an oral pill without stimulant risks, Contrave or Qsymia are logical first picks.

Practical Quick‑Start Checklist

• Schedule a telehealth or in‑person visit with a primary‑care doctor or weight‑loss specialist.
• Bring a list of current meds, blood‑pressure readings, and any history of seizures or liver disease.
• Ask about insurance coverage; many plans cover GLP‑1 drugs only after a trial of oral agents.
• If prescribed Contrave, start with 1 tablet daily and titrate up to 2 tablets over 4 weeks to minimize nausea.
• Track weight, hunger scores, and side effects in a simple spreadsheet or app for the first 12 weeks.

Frequently Asked Questions

Next Steps & Troubleshooting

If you’ve started Contrave and the side effects feel too strong, pause the medication and talk to your prescriber. A short break (1‑2weeks) often resets tolerance, after which you can restart at a lower dose.

For anyone who doesn’t hit the 5% weight‑loss threshold after six months, consider switching to a GLP‑1 agent (Saxenda or Wegovy) if insurance permits. Many clinicians view oral combos as a “stepping‑stone” before moving to injectable therapies.

Finally, remember that medication works best when paired with sustainable diet changes and regular movement. Even the most potent drug won’t keep the weight off if old habits return.

About author Roger Baraldes

I'm a clinical pharmacologist with deep expertise in pharmaceuticals, working at the intersection of evidence and access. I evaluate drug safety and effectiveness and translate complex data into plain-language insights. I often write about affordable generics and head-to-head medication comparisons for common conditions. My aim is to help patients and clinicians make confident, cost-conscious choices.