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 or 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 is deemed appropriate for a patient by their medical provider, typical dosing patterns for Contrave and Ozempic are as follows:
Contrave comes in a tablet and is taken orally. 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 (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, 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 (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 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
In clinical trials, participants taking the maximum Contrave dose (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 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 percent weight loss 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 all medications vary widely between individuals and can be affected by many factors, including other medical diagnoses, other medications, genetics, environment, and 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.
The most common side effects of Contrave include nausea, constipation, headache, vomiting, dizziness, trouble sleeping, dry mouth, and diarrhea. Contrave is started at a low dose and increased slowly to build tolerance and minimize 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 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.
The most common side effects of Ozempic are gastrointestinal symptoms, including nausea, vomiting, constipation, diarrhea, and stomach pain. If combined with other blood-sugar lowering medications, low blood sugar can occur which may include symptoms such as lightheadedness, shakiness, sweating, blurred vision, or irritability. For this reason, doses of insulin are often reduced prior to starting Ozempic to avoid the risk for 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 this medication. Those 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.
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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 or 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 and therefore Ozempic is sometimes prescribed instead of Wegovy due to availability and insurance coverage.
Anti-obesity medication coverage varies widely based on individual insurance plans. Most insurance companies that cover these medications require specific criteria to be met prior to approving these medications.
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.
For those with prescription coverage for Ozempic, the manufacturer has a coupon program that can take up $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 medical provider can help patients navigate the coverage options to help patients find the most effective and affordable medications available to them.
Choosing Treatment between Contrave vs Ozempic
Both Contrave and Ozempic can be highly effective medications in helping patients to lose weight and maintain a healthy weight long-term. Because obesity is considered a chronic disease, medications to treat the disease 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 a patient’s weight loss and health history, personal preferences, cost, and other factors. A few notable scenarios in which a provider may suggest one of these medications over another include:
- 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.
- If a patient struggles with depression, Contrave may be suggested as the bupropion component of Contrave can help with moods (although not FDA approved for this use).
- If a patient struggles with lack of satiety with typical portions, Ozempic may be suggested to help with earlier and longer-lasting feelings of fullness.
- 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.
Ozempic vs Contrave: The Final Verdict
Ozempic and Contrave 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, all patients are under the care of a Board Certified Doctor specialized 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 the 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.