Obesity is a complex, chronic disease that affects over 100 million 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 Wegovy® are both FDA-approved medications for chronic weight management in adults with a body mass index (BMI) of 30 kg/m2 or greater (obesity), or with a BMI of 27 kg/m2 or greater (overweight) with at least one weight-related medical problem, such as high blood pressure, high cholesterol, or type 2 diabetes. In this article, we will discuss the similarities and differences between Contrave vs. Wegovy for weight loss, why one medication may be chosen over another, and how much weight loss is typical in patients who take these medications.
What Are the Differences Between Contrave and Wegovy?
While both Contrave and Wegovy are FDA-approved for weight management, these medications have different mechanisms of action, dosing, weight loss efficacy, side effects, FDA-indications and cost.
Mechanisms of Action
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.
Wegovy, the brand name for semaglutide, is a GLP-1 receptor agonist which mimics gut hormones that our body naturally produces after meals. Like Contrave, Wegovy acts in the appetite control center of the brain to reduce appetite and in the reward center of the brain to reduce cravings. Wegovy also works in the gut to slow stomach emptying to produce earlier and longer-lasting feelings of satiety or fullness. Additionally, Wegovy acts at the pancreas and other sites in the body to enhance insulin sensitivity and improve blood sugar regulation.
Dosing
While dosing may vary based on what is deemed appropriate for a patient by their medical provider, typical dosing patterns for Contrave and Wegovy 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).
Wegovy, by contrast, comes in a pen and is injected subcutaneously, or under the skin, once weekly. Typically, Wegovy is started at 0.25 mg dosage weekly for 4 weeks. Then, the dose is increased every 4 weeks until the maximum dose of 2.4 mg weekly (Month 2: 0.5 mg weekly, Month 3: 1 mg weekly, Month 4: 1.7 mg weekly, Month 5 and beyond: 2.4 mg weekly).
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Weight Loss Results
In clinical trials, patients taking 2 Contrave tablets twice daily (32 mg Naltrexone/360 mg Bupropion total 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%.
In clinical trials, patients taking Wegovy 2.4mg 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.
Side Effects
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 these 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. Patients taking Contrave should notify their healthcare provider right away should they experience any side effects from the medication.
The most common Wegovy side effects are gastrointestinal symptoms, including nausea, vomiting, constipation, diarrhea, heartburn, and stomach pain. Headaches, tiredness, and dizziness can sometimes occur as well. Gallbladder disease, acute pancreatitis and other rare, more serious, side effects have been reported with this medication. Patients taking Wegovy should monitor for side effects and notify their healthcare provider immediately if they experience side effects while taking Wegovy.
FDA Indications
Both Contrave and Wegovy are 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.
In addition to its approval in adults, Wegovy has an additional FDA-indication for treating pediatric patients aged 12 years and older with a BMI at the 95th percentile or greater for age and sex (obesity).*
Cost and 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.
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.
With insurance coverage, Wegovy cost can range from $0 per month to much higher, depending on the individual insurance plan. Wegovy offers a savings card that takes $225 off of the monthly copay if Wegovy is covered by insurance and takes $500 off of the monthly cost if Wegovy is not covered by insurance. Unfortunately, even with the savings card, Wegovy cost is around $1,000 per month without insurance coverage for the medication.
A FORM medical provider can help patients navigate their Contrave & Wegovy Insurance coverage options to help patients find the most effective and affordable medication options available to them.
Treatment with Contrave vs Wegovy
Both Contrave and Wegovy can both be highly effective medications in helping patients to lose weight and maintain a healthy weight long-term. Because obesity is a chronic disease and complex in nature, scientific evidence points to the importance of long-term treatment with these medications. Weight loss medications are similar to blood pressure medications which are started to lower a person’s blood pressure and continued long-term to keep that blood pressure at healthy levels. Similarly, weight loss medications are prescribed to reduce elevated body weight and used long-term to promote healthy weight maintenance.
Choosing a weight loss medication is an individualized decision made by a patient and their healthcare provider based on a patient’s weight and health history, 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 struggles with lack of satiety with typical portions, Wegovy 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.
- If a patient has a diagnosis of Type 2 diabetes or other insulin resistance syndrome, a provider may suggest Wegovy as it can help to improve blood sugar regulation (although not FDA-approved for this use).
- 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).
Wegovy vs Contrave: The Final Verdict
Wegovy 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 provides an individualized nutrition plan, accountability, and support for long-term behavior change that promotes weight loss. If you are interested in learning more about FORM, schedule a call or send a message today for more information. You can also take our quiz to see if you are eligible to join FORM.
*The FORM program is only available to patients 18 and over.
Wegovy® is a registered trademark of Novo Nordisk A/S.
