Contrave vs Ozempic for weight loss— What's the difference?

Obesity is a complex, chronic disease that affects 41.9% of adults in the United States. Losing even 5-10% of total body weight can improve multiple weight-related chronic diseases such as type 2 diabetes, high blood pressure, and high cholesterol. Contrave® and Ozempic® are both medications that can be effective for weight management in adults. In this article, we will discuss the similarities and differences between Contrave vs. Ozempic, why one medication may be chosen over another, and how much weight loss is typical in patients who take these medications.

Contrave vs Ozempic? Get the facts to make your decision

While both Contrave and Ozempic can be used for weight management, these medications have different mechanisms of action, dosing, weight loss efficacy, side effects, FDA-approved indications, and cost.

What is Contrave?

Contrave is a combination medication of naltrexone and bupropion. Naltrexone is an opioid antagonist medication while bupropion is an antidepressant medication. Together, these medications act on the reward center in the brain to reduce food cravings. They also work in the appetite control center in the brain to reduce appetite.

What is Ozempic?

Ozempic, a brand name for semaglutide, is a GLP-1 receptor agonist which mimics gut hormones that our body naturally produces after meals. Like Contrave, Ozempic acts in the appetite control center of the brain to reduce appetite and in the reward center of the brain to reduce cravings.

Ozempic also works in the gut to slow stomach emptying to produce earlier and longer-lasting feelings of satiety or fullness. Additionally, Ozempic acts at the pancreas and other sites in the body to enhance insulin sensitivity and improve blood sugar regulation.

Ozempic vs Contrave: Comparing the medications

Different forms of dosage

While dosing may vary based on what a medical provider deems appropriate for their patient, typical dosing patterns for Contrave and Ozempic are as follows:

Contrave Dosing

Contrave comes in a tablet and is taken orally (either with food or on an empty stomach). Each tablet contains 8 mg of naltrexone and 90 mg of bupropion. Contrave is usually started at 1 tablet daily for the first week and then increases by 1 tablet/day each week until you reach the full dose of 2 tablets twice daily by week 4.

After the first week, dosing may then increase this way:

• Week 2: 1 tablet twice daily
• Week 3: 2 tablets in the morning and 1 tablet in the evening
• Week 4 and beyond: 2 tablets twice daily.

Ozempic Dosing

Ozempic, by contrast, comes in a pen device and is injected subcutaneously, or under the skin, once weekly. Typically, Ozempic is started at 0.25 mg weekly dosage for 4 weeks and the dose is then increased monthly until the maximum tolerated dose of either 1 or 2 mg weekly.

The dosing may progress this way:

• Month 2: 0.5 mg weekly
• Month 3: 1 mg weekly*
• Month 4 and on: 2 mg weekly).

*Note: Many patients choose to stay at the 1 mg dose long-term rather than increasing to 2 mg weekly, depending on their side effects and response to the medication.

Weight loss results: Contrave vs Ozempic

Contrave weight loss results

In clinical trials, participants taking the maximum dose of Contrave for weight loss (2 Contrave tablets twice daily for a total of 32 mg naltrexone / 360 mg bupropion per day) along with healthy lifestyle changes lost an average of 8.1% of their total body weight over 56 weeks, versus 4.9% weight loss in participants receiving a placebo plus healthy lifestyle intervention.

Of note, this percentage included patients who stopped taking Contrave early. Of the participants who stayed on Contrave for the entire 56 weeks, the average weight loss was higher at 11.5%.

Ozempic weight loss results

Ozempic has only been studied in the treatment of people with type 2 diabetes and not specifically for weight loss. Because Wegovy has the same active ingredient as Ozempic, semaglutide, and has been studied in people with obesity but without diabetes, we can look at trials on Wegovy to help understand the probable response to Ozempic for people without type 2 diabetes. It is important to note that  Wegovy and Ozempic have slightly different dosing. The dose of semaglutide used in Wegovy trials was 2.4 mg weekly, while Ozempic only goes up to 2 mg weekly dose.

In clinical trials, patients taking Wegovy 2.4 mg weekly lost an average of 14.9% of their total body weight in 68 weeks when combined with healthy lifestyle changes vs 2.5% weight loss in participants receiving a placebo plus healthy lifestyle intervention.

A follow-up study showed that this weight loss was sustained over 2 years (104 weeks) in participants who continued Wegovy, with 15.4% average weight loss at 2 years in the Wegovy group vs 2.6% in the placebo group. Again, these results are for Wegovy, the version of semaglutide FDA-approved for chronic weight management in individuals with obesity, rather than Ozempic, which is only FDA-approved for treating type 2 diabetes.

For all GLP-1 agonist medications, data suggests that people with type 2 diabetes tend to lose less weight, on average, than people without type 2 diabetes. In a study of people with overweight or obesity and type 2 diabetes, Ozempic 2 mg weekly produced, on average, a 14.1 pound weight loss over 40 weeks

Important note: This was a shorter study, and the percentage of was not reported, only pounds lost, as weight loss was not the focus of this study.

While these results are important to consider when choosing a treatment plan, weight loss results for Ozempic, Contrave or any other medications vary widely among individuals and can be affected by many factors, including:

• Other medical diagnoses
• Other medications
• Genetics
• Environment
• Lifestyle changes

It is important to work with a program that takes all of these factors into account when choosing a medication as part of a comprehensive weight loss plan.

Side effects of Contrave

The most common side effects of Contrave include:

• Nausea
• Constipation
• Headache
• Vomiting
• Tiredness
• Dizziness
• Trouble sleeping
• Dry mouth
• Diarrhea

Contrave is started at a low dose and increased slowly to build tolerance and minimize the risk of side effects. Contrave can cause an increase in heart rate and blood pressure so blood pressure and pulse rate should be monitored closely while on Contrave, especially if a patient has a history of high blood pressure.

Mood should also be monitored closely while on Contrave as this medication may cause mood disturbances and, very rarely, patients taking Contrave may experience suicidal ideation.

Contrave may not be taken with certain prescription pain medications or during most surgical procedures. Patients taking Contrave should notify their healthcare provider right away should they experience any side effects from the medication or have upcoming procedures.

Side effects of Ozempic

The most common side effects of Ozempic are gastrointestinal symptoms, including:

• Nausea
• Vomiting
• Constipation
• Diarrhea
• Stomach pain
• Tiredness

If combined with other blood-sugar-lowering medications, low blood sugar can occur, which may include symptoms such as:

• Lightheadedness
• Shakiness
• Sweating
• Blurred vision
• Irritability

For this reason, doses of insulin are often reduced prior to starting Ozempic to avoid the risk of low blood sugar. Rarely, cases of gallbladder disease and acute pancreatitis have been reported with this medication.
There are also studies showing an increased risk of medullary thyroid cancer in rats while on Ozempic. People with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 should not take this medication. Patients should monitor for side effects and notify their healthcare provider immediately if they experience any while taking Ozempic.

FDA-approval

Ozempic and bupropion/Contrave have different FDA approvals. Contrave is FDA-approved for treating adults with obesity (BMI 30+) or with overweight (BMI 27+) and at least one weight-related medical condition, such as:

• Type 2 diabetes
• High blood pressure
• High cholesterol

Ozempic is FDA-approved for treating adults with type 2 diabetes. Ozempic, when used for weight loss in a person without type 2 diabetes, is being used off-label. Off-label prescriptions are common and legal; in fact, 1 in 5 U.S. prescriptions are considered off-label prescriptions.

Ozempic has an additional FDA approval for lowering the risk of major cardiovascular events such as stroke, heart attack, or death in adults with type 2 diabetes and known heart disease. As noted above, Wegovy is a medication with the same active ingredient as Ozempic, semaglutide, which is FDA-approved for chronic weight management in individuals with obesity.  Therefore, Ozempic is sometimes prescribed instead of Wegovy due to availability and insurance coverage.

Insurance coverage: Contrave vs Ozempic

Anti-obesity medication coverage varies widely based on individual insurance plans. Most insurance companies that cover Ozempic and bupropion or Contrave require specific criteria to be met prior to approving these medications.

Contrave

The manufacturer of Contrave has an access program that offers Contrave for $99 or less per month via a mail-order pharmacy, regardless of insurance coverage. With insurance coverage, many patients may pay less.

Ozempic

For those with prescription coverage for Ozempic, the manufacturer has a coupon program that can take up to $150 off of the copay each month to bring the cost as low as $25 for a 1-3 month supply. For those without insurance coverage, Ozempic can be quite costly at around $900-$1000 per month.

A Form Health medical provider can help patients navigate the coverage options to help patients find the most effective and affordable medications available.

Choosing treatment: Contrave vs Ozempic

Both Contrave and Ozempic can be highly effective medications in helping patients lose weight and maintain a healthy weight long-term. Because obesity is considered a chronic disease, medications to treat it usually need to be continued long-term, first to help with weight loss and then to assist with weight loss maintenance.

Choosing a weight loss medication is an individualized decision made by a patient and their healthcare provider based on factors such as:

• A patient’s weight loss and health history
• A patient’s personal preferences
• Cost
• Other factors

A few notable scenarios in which a provider may suggest one of these medications over another include:

When a provider may recommend Ozempic

1. If a patient has a diagnosis of type 2 diabetes or other insulin resistance syndrome with or without cardiovascular disease, a provider may suggest Ozempic as it is FDA-approved for type 2 diabetes and for reducing the risk of cardiovascular events.
2. If a patient struggles with a lack of satiety with typical portions, Ozempic may be suggested to help with earlier and longer-lasting feelings of fullness.

When a provider may recommend Contrave

1. If a patient struggles with depression, Contrave may be suggested as the bupropion component of Contrave can help with moods (although it is not FDA-approved for this use).

If a patient struggles with significant cravings or emotional eating, Contrave may be suggested to help reduce these cravings (although Ozempic may also be helpful for craving reduction).

Contrave vs Ozempic: The final verdict

Contrave and Ozempic can both be effective medications to help patients achieve a healthy body weight and improve chronic medical conditions. There are many factors that go into deciding which medication is right for each individual.

At Form Health, all patients are under the care of a Board-Certified Doctor specializing in weight management who will complete a comprehensive medical evaluation, including laboratory testing, to determine which medication and treatment plan is best for them.

Throughout Form Health’s program, patients participate in frequent visits with their doctor and Registered Dietitian, who provide an individualized nutrition plan, accountability, and support for long-term behavior change that promotes weight loss.

To discover more Ozempic comparisons, check out our article on Saxenda vs Ozempic. If you are interested in learning more about Form Health,  send a message today for more information. You can also take our quiz to see if you are eligible to join Form Health.

Ozempic® is a registered trademark of Novo Nordisk A/S.

Contrave® is a registered trademark of Currax Pharmaceutical LLC.