Contrave vs Alternatives: Naltrexone‑Bupropion Comparison Guide

When you’re hunting for a prescription aid to shed extra pounds, Contrave is a combination of naltrexone and bupropion that promises to curb cravings and boost metabolism. It’s not a miracle pill, but it does sit in a unique spot among obesity drugs. This guide breaks down how Contrave stacks up against the most common alternatives, so you can see whether it’s the right fit for your health goals.

What exactly is Contrave?

Contrave is an FDA‑approved weight‑loss medication that blends two older drugs: Naltrexone, an opioid‑receptor antagonist, and Bupropion, an antidepressant that also sparks the release of dopamine and norepinephrine. The theory is simple: naltrexone dampens the reward signals that make you over‑eat, while bupropion lifts mood and energy, making it easier to stick to a calorie‑controlled plan.

How does the combo work?

• Appetite control: Naltrexone blocks the mu‑opioid receptors in the hypothalamus, reducing the urge to binge.
• Energy boost: Bupropion stimulates the central nervous system, which can increase basal metabolic rate by up to 5% in some users.
• Synergy: When taken together, the two compounds appear to amplify each other's effect, resulting in an average 5-10% body‑weight reduction over a year.

Clinical trials (FDA‑reviewed data from 2014) reported that participants on Contrave lost about 8 kg compared with 2 kg on placebo, assuming they also followed diet and exercise recommendations.

Pros and cons of Contrave

• Pros: oral tablet (no injections), works on both appetite and energy, relatively modest weight‑loss results for people who struggle with cravings.
• Cons: possible side effects include nausea, constipation, insomnia, and raised blood pressure; not suitable for people with uncontrolled hypertension or seizures; must be titrated over four weeks.

Major alternatives on the market

The weight‑loss arena has expanded rapidly, especially with the rise of GLP‑1 and GIP‑GLP‑1 agonists. Below are the most prescribed options you’ll encounter.

Saxenda (liraglutide)

Saxenda is a daily injectable GLP‑1 receptor agonist that mimics a gut hormone, slowing gastric emptying and boosting satiety. FDA approved in 2014, it can achieve 5‑10% weight loss in a year, but injections can be a barrier for some.

Wegovy (semaglutide)

Wegovy, a higher‑dose version of the diabetes drug Ozempic, is administered once‑weekly. Its weight‑loss numbers are the strongest so far-clinical trials showed an average 15% body‑weight reduction after 68 weeks.

Qsymia (phentermine/topiramate)

Qsymia pairs a sympathomimetic stimulant (phentermine) with an anti‑convulsant (topiramate). It’s taken as a mixed‑release capsule and can produce 9‑10% weight loss. However, it carries a boxed warning for birth defects and pulmonary hypertension.

Orlistat (Xenical)

Orlistat is a lipase inhibitor that prevents about 30% of dietary fat from being absorbed. It’s the only OTC prescription‑strength option, but gastrointestinal side effects (oily stools, flatulence) are common.

Mounjaro (tirzepatide)

Approved in 2024 for type 2 diabetes, tirzepatide also got a weight‑loss indication as Mounjaro. It acts on both GIP and GLP‑1 receptors, delivering up to 22% weight loss in trials-far outpacing older drugs.

Side‑by‑side comparison

Deciding which drug fits your life

Choosing a weight‑loss pill isn’t just about the headline % loss. Ask yourself these questions:

1. Do you mind injections? If not, GLP‑1 options (Saxenda, Wegovy, Mounjaro) often win on efficacy.
2. Is your blood pressure already high? Contrave may raise it, so a non‑stimulant like Orlistat or a GLP‑1 might be safer.
3. Are you planning pregnancy? Qsymia carries a teratogenic warning, whereas Contrave is contraindicated in pregnancy as well.
4. What’s your budget? Weekly injectables can cost $1,200 + yearly, while oral Contrave sits around $200‑$300 per month without insurance.
5. Do you have a history of seizures or eating disorders? Bupropion can lower the seizure threshold, making alternatives preferable.

Talking to a clinician who knows your medical history is crucial. Most doctors will start with the safest option-often an oral agent or low‑dose GLP‑1-then adjust based on response and side‑effects.

Practical tips for getting the most out of any weight‑loss medication

• Never rely on the pill alone; pair it with a 500‑calorie‑deficit diet and at least 150 minutes of moderate exercise per week.
• Track your weight weekly, not daily, to smooth out normal fluctuations.
• If side‑effects hit hard in the first two weeks, discuss dose adjustments rather than stopping abruptly.
• Set a realistic goal: most guidelines suggest aiming for 5% body‑weight loss in the first 3‑6 months.
• Keep a medication journal: note dose changes, meals, sleep, and any new symptoms. This data helps your doctor fine‑tune the regimen.

Safety warnings and drug interactions

All the drugs listed interact with other meds to varying degrees. Here are the red flags you should watch for:

• Contrave: avoid with monoamine‑oxidase inhibitors (MAOIs) or other drugs that raise seizure risk. Alcohol can increase the chance of liver injury when combined with naltrexone.
• Saxenda/Wegovy/Mounjaro: don’t mix with other GLP‑1 agonists or DPP‑4 inhibitors; risk of hypoglycemia spikes if you’re also on insulin.
• Qsymia: contraindicated with MAOIs, SSRIs, or other serotonergic agents due to serotonin syndrome risk.
• Orlistat: block absorption of fat‑soluble vitamins (A, D, E, K); supplement them at least 2 hours apart.

The FDA updates safety information annually, so ask your prescriber about any new alerts before refilling.

Bottom line: is Contrave right for you?

If you’re a non‑smoker with mild‑to‑moderate hypertension, struggle with emotional eating, and prefer a daily pill over injections, Contrave can be a solid middle‑ground choice. It won’t beat the dramatic results of Wegovy or Mounjaro, but it’s more affordable and easier to manage than a weekly injection for many patients.

For those needing rapid, high‑percent weight loss-especially if they have type 2 diabetes or severe obesity-GLP‑1 or GIP‑GLP‑1 agents are usually the first line now. If you have a history of seizures, uncontrolled blood pressure, or are pregnant, steer clear of Contrave and look at Orlistat or non‑pharmacologic programs.

Ultimately, the best drug is the one you can stick with while maintaining a balanced diet and active lifestyle. Use this comparison as a conversation starter with your healthcare provider, and let the data guide your next move.