Contrave vs. Wegovy for weight loss: side-by-side comparison

Wegovy and Contrave are two prescription medications used for weight loss and maintenance. Both are approved by the US Food and Drug Administration (FDA) for people with obesity or overweight, along with a reduced-calorie diet and increased exercise. But what are the differences between Wegovy vs. Contrave?

For one, Wegovy is given as a weekly injection under the skin, while Contrave is an oral tablet. Wegovy generally leads to more weight loss, but both can be effective options. And some people may feel more comfortable taking a weight loss pill than an injection.

Keep reading for an in-depth comparison of Contrave vs. Wegovy. 

Here’s an overview of how these two medications compare:

Both Contrave and Wegovy are FDA-approved weight loss medications. Each one is intended to be used as part of a comprehensive weight management plan that includes diet and exercise changes. But Wegovy is approved for additional uses and age groups. 

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Wegovy, as an injection, is FDA approved to:

• Reduce excess body weight and maintain long-term weight reduction in:

  • Adults with obesity and adolescents ages 12 years and older with obesity 

  • Adults with overweight plus at least one weight-related medical condition, such as high blood pressure, type 2 diabetes, or high cholesterol

• Treat a serious type of fatty liver disease called noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate to advanced liver scarring (stage F2 to F3 fibrosis) 

• Lower the risk of major cardiovascular problems (such as heart attack, stroke, and heart-related death) in adults with established cardiovascular disease and obesity or overweight

Contrave is FDA approved to:

• Reduce excess body weight and maintain long-term weight reduction in:

  • Adults with obesity, defined as a body mass index (BMI) of 30 or higher

  • Adults with a BMI of 27 or higher (overweight) plus at least one weight-related medical condition

To recap, here’s an at-a-glance comparison of FDA-approved uses for Wegovy vs. Contrave.

So, what if you don’t fit into any of these categories? That doesn’t necessarily mean you can’t take Wegovy or Contrave. Healthcare providers sometimes prescribe medications off-label if they think it would be safe and helpful, based on evidence or professional experience.

Wegovy generally leads to more significant weight loss than Contrave, according to the results of separate studies. However, there aren’t any head-to-head clinical trials comparing Wegovy vs. Contrave. So we don’t have definitive evidence to compare them directly.

Contrave: Across multiple clinical trials, people taking Contrave lost an average of 5%–9% of their starting body weight over 56 weeks compared to placebo. 

Here are more details about Contrave weight loss results:

• In the Contrave Obesity Research I (COR-I) study involving more than 1,000 people with obesity, people taking Contrave lost about 6% body weight vs. 1.3% with placebo at 56 weeks.

• In another COR study where all participants made intensive lifestyle modifications, weight loss averaged 9.3% with Contrave vs 5.1% with placebo at 56 weeks.

• A pooled analysis showed that people who lost at least 5% of their original body weight within the first four months on Contrave lost an average of 12% by 56 weeks.

• About half of Contrave trial participants lost at least 5% of their body weight.

Wegovy: Wegovy can lead to significantly larger weight reductions, averaging around 15% across multiple clinical trials:

• In the STEP 1 trial, adults using Wegovy lost 14.9% of their body weight over 68 weeks vs. 2.4% with placebo.

• In the STEP TEENS trial, adolescents using Wegovy saw a 16.1% reduction in body mass index (BMI) vs. 0.6% with placebo.

• In the STEP 4 trial, Wegovy users lost 10.6% of their body weight in the first 20 weeks and another 7.9% by week 68, while those switched to placebo regained about 6.9%.

• A third of Wegovy clinical trial participants lost at least 20% of their body weight.

Note that participants in the above trials used once-weekly injections of Wegovy in maintenance doses of up to 2.4 mg, which is currently the maximum recommended dose. 

An oral semaglutide tablet for weight loss (“Wegovy pill”) may be approved soon. In clinical trials, people taking oral semaglutide 25 mg daily lost an average of 13.6% of their body weight after 64 weeks.

Also, a new higher dose of the injectable version — 7.2 mg once weekly — may be approved in the near future. In the STEP UP trial, people using Wegovy 7.2 mg once weekly lost an average of 20.7% of their body weight after 72 weeks of treatment.

TL;DR: Both medications are effective for weight loss when used in recommended dosages and in combination with diet and exercise. But Wegovy generally helps people lose more weight than Contrave, based on separate studies. 

That doesn’t mean Wegovy is necessarily better for everyone. The choice of Contrave vs. Wegovy depends on many factors, such as:

• Your overall health

• How much weight you want to lose

• Other medical conditions

• Preference for an injection or pill

• Insurance coverage or budget

A healthcare provider can help determine if one is a better option for you.

Currently, the most obvious difference between Contrave and Wegovy is how they’re taken. Contrave is a tablet, while Wegovy is an injection. 

Contrave

Contrave is a tablet that’s typically taken by mouth twice daily. Be sure to follow a consistent schedule. Swallow the tablet whole — don’t chew, cut, or crush it. 

How to take it: Take Contrave by mouth with a meal. But avoid taking it with a high-fat meal as this could increase absorption too much and raise the risk of side effects. 

Doses: Contrave comes in one strength of 8 mg/90 mg. Each extended-release tablet contains 8 mg of naltrexone and 90 mg of bupropion. 

Dosing: Treatment starts at a low dose and increases each week for the first four weeks. Here’s the recommended dose escalation schedule:

• Week 1: 1 tablet in the morning

• Week 2: 1 tablet in the morning and 1 tablet in the evening

• Week 3: 2 tablets in the morning and 1 tablet in the evening

• Week 4 and on: 2 tablets in the morning and 2 tablets in the evening

Wegovy 

Wegovy is a once-weekly subcutaneous injection. However, an oral version of the drug (aka the “Wegovy pill”) is awaiting FDA approval and may be given the green light soon.

How to take it: Inject Wegovy on the same day each week at any time of day, without regard to the timing of meals. Rotate your injection site each week (abdomen, thigh, or upper arm). 

Doses: Wegovy comes in prefilled, single-dose pens in 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg strengths.

Dosing: The once-weekly dose increases every ~four weeks until you reach a maintenance dose that delivers the desired effects without too many or intolerable side effects. Here’s the recommended dose escalation timeline:

• Weeks 1–4: 0.25 mg 

• Weeks 5–8: 0.5 mg

• Weeks 9–12: 1 mg

• Weeks 13–16: 1.7 mg

• Weeks 17 and on: Stay at 1.7 mg or increase to 2.4 mg

Wegovy and Contrave have some overlap in their potential side effects, such as nausea. But since they work differently in the body, their side effect profiles differ. 

Contrave side effects 

Common side effects of Contrave include:

• Nausea

• Constipation

• Headache

• Dizziness

• Insomnia

• Dry mouth

• Vomiting

• Diarrhea

Less commonly, Contrave may cause serious side effects, such as increased blood pressure or heart rate, changes in mental health, seizures, and liver problems.  

Contrave carries a boxed warning for a rare risk of suicidal thoughts and behaviors. The FDA requires this warning for all medications that contain an antidepressant. (Contrave contains bupropion). 

Wegovy side effects 

Common side effects of Wegovy include: 

• Nausea

• Vomiting 

• Diarrhea

• Abdominal pain

• Headache

• Fatigue

• Constipation

• Dizziness

Serious side effects are uncommon. But Wegovy may increase the risk of pancreatitis, gallbladder disease, severe gastrointestinal side effects that may lead to dehydration or kidney injury, increased heart rate, and suicidal thoughts or behaviors. 

People with diabetes may also face an increased risk of diabetes-related eye problems and low blood sugar (if taking certain diabetes drugs).

Wegovy carries a boxed warning for a risk of thyroid tumors. The drug causes thyroid cancer in rodents, but the risk to humans is unknown. Do not use Wegovy if you have a personal or family history of thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN2).

Contrave is generally less expensive than Wegovy. Both Contrave and Wegovy are only available as brand-name drugs, which typically cost more than generics. 

When comparing the prices of Contrave vs. Wegovy, remember that cost can vary depending on insurance coverage, pharmacy, and whether you’re eligible for savings programs. 

Contrave

Contrave has a retail price of around $500-$700. Without insurance, it can cost about 

Without insurance, Contrave costs about $99–$199 per month with manufacturer coupon programs. 

Insurance coverage: Insurance plans may or may not cover Contrave. Some plans exclude weight loss drugs entirely.

Medicare Part D coverage: Not covered, since Medicare does not cover weight management medications.

How to save: The CuRxAccess Patient Support Program may lower monthly costs. 

• If you use the Contrave Savings Coupon Card at your pharmacy and have insurance coverage, you may pay as little as $20 for a 30-day supply. 

• You can pay $99 or less per month for Contrave regardless of insurance status and receive free home delivery.

Wegovy 

Wegovy has a list price of $1,349.02.

Insurance coverage: Coverage varies by plan. Many commercial and employer plans cover Wegovy for people who meet criteria related to the drug’s approved uses (obesity/overweight, cardiovascular risk reduction, or fatty liver disease). 

Medicare Part D coverage: Not commonly covered due to Medicare exclusions on weight loss medications. This is different if Wegovy is prescribed for another indication, such as heart disease.

How to save: 

• When you pay with cash through Ro or Novo Nordisk’s online pharmacy, NovoCare, you can get Wegovy for $199 per month for the first two months, then $349 per month thereafter. (The $199 offer is only available for a limited time and for 0.25 mg and 0.5 mg doses.) 

• The Novo Nordisk Savings Offer may allow eligible, commercially insured patients to pay as little as $0 per month for Wegovy. 

Both weight loss drugs aren’t safe for everyone. Here’s a comparison of Contrave vs. Wegovy in terms of contraindications (i.e., situations that make the drug unsafe) and major precautions. 

Who shouldn’t take Contrave?

Don’t take Contrave if you are: 

• Pregnant, planning to become pregnant, or breastfeeding

• Undergoing alcohol or sedative withdrawal, or have suddenly stopped use of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs

• Taking opioids or medications to treat opioid dependence

• Taking another medication that contains bupropion, such as Wellbutrin

• Taking an MAOI (monoamine oxidase inhibitor) currently or in the last 14 days

• Allergic to naltrexone, bupropion, or any ingredient in the medication

You also shouldn’t take Contrave if you have any of the following conditions:

• Uncontrolled high blood pressure (hypertension)

• Seizure disorder or a history of seizures

• Anorexia nervosa or bulimia

• Severe liver or kidney disease

Who shouldn’t take Wegovy?

You shouldn’t take Wegovy if you are:

• Pregnant or planning to become pregnant

• Taking another semaglutide product (Ozempic or Rybelsus) or any other GLP-1 medication

• Allergic to semaglutide or any ingredient in the medication

• Experiencing depression with suicidal thoughts or behaviors

You also shouldn’t take Wegovy if you have a history of:

• Medullary thyroid carcinoma (MTC), or if a family member has had it

• Multiple endocrine neoplasia syndrome type 2 (MEN2)

No, Contrave and Wegovy generally are not prescribed at the same time. 

There is no evidence supporting the combined use of Wegovy and Contrave. Using both may raise the risk of side effects like nausea or increased heart rate. 

Always consult your healthcare provider before combining weight loss medications or supplements.

Yes, you can switch between Wegovy and Contrave — as long as it’s under the guidance and care of a licensed healthcare provider. 

Your provider may recommend switching from Contrave to Wegovy (or vice versa) depending on how you respond to treatment. Usually, your provider will have you stop one weight loss medication before starting a new one to avoid overlapping side effects. 

Wegovy and Contrave aren’t the only FDA-approved weight loss medications. Other options include Zepbound, Saxenda, and Qsymia.

Besides the weight loss drugs described above, certain diabetes drugs can help people lose weight and may be prescribed off-label for this purpose. 

Other alternatives to Contrave or Wegovy include:

• Ozempic (semaglutide): once-weekly injection approved for people with type 2 diabetes, sometimes used off-label for weight loss

• Rybelsus (semaglutide): oral semaglutide tablet taken once daily

• Mounjaro (tirzepatide): once-weekly diabetes injection shown to produce significant weight loss

• Victoza (liraglutide): daily diabetes injection, available in a lower-cost generic version

• Metformin: generic diabetes medication that has shown modest amounts of weight loss in clinical studies, though it isn’t approved for weight management. 

Ro makes GLP-1s simple, from coverage to care

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When comparing Wegovy vs. Contrave, the first thing you should know is that both are effective prescription options for weight management. But they differ in several ways. Your healthcare provider can help you decide which drug may be a fit for you. Here’s a quick recap:

• Wegovy generally leads to more weight loss than Contrave, according to the results of separate placebo-controlled clinical trials.

• Wegovy is a once-weekly injection; Contrave is a twice-daily oral tablet that’s typically less expensive than Wegovy.

• Cost, insurance coverage, and whether you prefer a pill or an injection may influence which option is right for you.