Contrave vs Other Weight‑Loss Medications: Which One Fits Your Health Goals?

• September 24, 2025
• Kiera Masterson
• 2 Comments

Contrave is a prescription combo of naltrexone and bupropion approved for chronic weight management in adults with a BMI≥30 or≥27 with weight‑related conditions. When it comes to weight‑loss drugs, Contrave stands out because it targets both appetite and reward pathways, but it’s not the only option on the market. This guide breaks down how it stacks up against the most commonly prescribed alternatives, helping you decide which medication aligns with your lifestyle, health profile and budget.

Key Takeaways

• Contrave works by modulating brain signals that control hunger and cravings.
• Orlistat blocks fat absorption, while Phentermine stimulates the central nervous system.
• GLP‑1 agonists such as Liraglutide and Semaglutide offer the highest average weight loss but require injection.
• Safety profiles differ: Contrave may raise blood pressure; Orlistat can cause oily stools; GLP‑1 drugs often cause nausea.
• Cost, insurance coverage and BMI eligibility are decisive factors in real‑world prescribing.

Understanding Contrave’s Core Ingredients

Naltrexone is an opioid‑receptor antagonist that, at low doses, dampens the reward response to food (reducing cravings for high‑calorie, palatable foods). It’s traditionally used to treat alcohol and opioid dependence, but in the Contrave formula it plays a supportive role.

Bupropion is an atypical antidepressant that also acts as a norepinephrine‑dopamine reuptake inhibitor (boosting satiety and energy expenditure). In combination, the two drugs create a synergistic effect on appetite control.

Clinical trials (e.g., the COR‑I and COR‑II studies) showed an average 5-10% body‑weight reduction after one year when paired with diet and exercise. The FDA approved Contrave in 2014 for the UK market, making it one of the few oral weight‑loss combos available.

Big Players in the Weight‑Loss Landscape

Below are the main competitors you’ll encounter in a typical NHS or private‑prescription setting.

Orlistat is a lipase inhibitor that prevents about 30% of dietary fat from being absorbed (acting in the gut). It’s sold over‑the‑counter as Xenical (120mg) and as a prescription‑strength 60mg dose.

Phentermine is a sympathomimetic amine that suppresses appetite by increasing norepinephrine release (similar to stimulant effects). Often combined with topiramate in the brand Qsymia.

Qsymia (phentermine/topiramate) blends a stimulant with an anticonvulsant to curb hunger and promote satiety (approved for BMI≥30 or≥27 with comorbidities).

Liraglutide is a GLP‑1 receptor agonist administered daily via injection (originally marketed as Victoza for type2 diabetes). At the 3mg dose it’s branded as Saxenda for weight management.

Semaglutide is another GL‑1 agonist, given weekly, marketed as Wegovy for obesity (delivers the most robust weight‑loss results in large‑scale trials).

Side‑by‑Side Comparison

How Efficacy Differs by Mechanism

Orlistat’s gut‑focused action provides modest weight loss but has a clear advantage for patients who cannot tolerate central nervous system stimulants. Phentermine (and Qsymia) deliver quicker results because they act on brain pathways that regulate hunger, yet the stimulant effect limits long‑term use. GLP‑1 drugs (Liraglutide, Semaglutide) achieve the deepest reductions by mimicking an incretin hormone that tells the brain you’re full, but they require injections and careful monitoring for pancreatitis.

Contrave occupies a middle ground: it’s oral, works on both reward and satiety circuits, and can be used continuously. Its average 7% loss in the first year is solid, especially for patients who struggle with binge cravings rather than sheer appetite volume.

Safety Profiles - What to Watch For

Every medication carries trade‑offs.

• Contrave: May raise systolic blood pressure; contraindicated in uncontrolled hypertension, seizure disorders, or chronic opioid use.
• Orlistat: Can lead to fat‑soluble vitamin deficiencies (A, D, E, K); patients need a daily multivitamin.
• Phentermine/Qsymia: Cardiovascular stimulation - not ideal for people with heart disease, arrhythmia, or anxiety.
• GLP‑1 agonists: Gastro‑intestinal upset is common; rare cases of thyroid C‑cell tumors have been reported in animal studies.

Before starting any drug, a baseline assessment (BMI, blood pressure, liver/kidney function, psychiatric history) is essential. Shared decision‑making with a clinician ensures the risk‑benefit balance aligns with personal health goals.

Who Benefits Most From Each Option?

Think of medication choice as a Venn diagram of three circles: clinical eligibility, lifestyle compatibility, and cost tolerance.

Contrave shines for people with moderate obesity (BMI27‑35) who have strong food cravings, prefer an oral pill, and can monitor blood pressure.

Orlistat is suitable for patients who need a low‑cost, gut‑based option and can tolerate oily stools - often those with gallbladder disease where stimulants are risky.

Phentermine or Qsymia work best for younger adults (20‑45) with high‑energy lifestyles who want fast results and have no cardiac issues.

GLP‑1 agonists are the go‑to for severe obesity (BMI>35) or for individuals with type2 diabetes, given their glycemic benefits, but they demand injections and higher out‑of‑pocket expense.

Practical Considerations: Dosing, Monitoring, and Cost

All medications start at a low dose and titrate upward.

• Contrave: 8mg naltrexone+90mg bupropion (one tablet) twice daily after a 1‑week titration.
• Orlistat: One 120‑mg capsule with each main meal containing fat.
• Phentermine: 15-37.5mg once daily; Qsymia combines 3.75mg topiramate with 15mg phentermine (gradually increased).
• Liraglutide: 0.6mg daily, up‑titrated weekly to 3mg.
• Semaglutide: 0.25mg weekly, increased to 2.4mg over 16weeks.

Regular follow‑up (every 1‑3months) tracks weight change, side effects, and any lab abnormalities. In the UK, many of these drugs are prescribed under the NHS weight‑management pathways, but budget constraints often mean patients pay part‑way, especially for the newer GLP‑1 agents.

Beyond Medication - The Bigger Weight‑Loss Puzzle

Medications work best when paired with lifestyle changes. Behavioral therapy, high‑protein, low‑carb diets, and structured exercise programs amplify results by 30‑50% in most trials. For severe cases, bariatric surgery remains the most effective route, offering 25-35% weight loss, but it carries surgical risks and lifelong nutritional monitoring.

Key related concepts you’ll encounter include:

• Body Mass Index (BMI) - the standard metric used to qualify patients for pharmacotherapy (weightkg ÷ heightm²).
• Metabolic Syndrome - a cluster of risk factors (high blood pressure, triglycerides, low HDL, fasting glucose) that often drives drug selection (patients with this profile may favor GLP‑1 agents).
• Nutrition Counseling - evidence shows that regular dietitian visits double the odds of achieving ≥5% weight loss (especially when combined with medication).
• Physical Activity Guidelines - 150min of moderate‑intensity aerobic exercise per week is the baseline recommendation (helps maintain lean muscle during weight loss).

Exploring these adjacent topics will give you a rounded view of what sustainable weight management really looks like.

Making the Decision: A Simple Checklist

1. Confirm eligibility: BMI threshold, comorbidities, contraindications.
2. Identify priority: appetite suppression vs. fat absorption vs. satiety.
3. Consider side‑effect tolerance (e.g., blood pressure, GI upset).
4. Check insurance/NHS coverage and out‑of‑pocket cost.
5. Plan for lifestyle support: dietitian, exercise coach, behavioral therapist.

If you tick most boxes for Contrave and are comfortable with the modest cost, it’s a solid middle‑ground choice. If you need more aggressive loss or have diabetes, GLP‑1 drugs may be worth the higher price. For those who can’t swallow pills or need a gut‑centric approach, Orlistat remains viable.