Contrave vs. Semaglutide: Which Is Better for Supporting Weight Management?

What Is Contrave?

Contrave is an FDA-approved oral weight management medication combining two drugs:

• Bupropion, often used to treat depression and support smoking cessation.
  
• Naltrexone, commonly used to manage alcohol or opioid dependence.
  
  

Together, these medications act on the hypothalamus and reward centers in the brain to help reduce food cravings and support appetite control.

Typical Use: Oral extended-release tablet, taken twice daily alongside lifestyle changes.

Common Side Effects:

• Nausea
  
• Headache
  
• Constipation
  
• Insomnia
  
  

Black Box Warning: Contrave includes a warning related to the risk of suicidal thoughts associated with bupropion, particularly in individuals with a history of depression or mood disorders. Providers may recommend psychiatric screening before prescribing (Christou & Kiortsis, 2015).

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What Is Semaglutide?

Semaglutide is a GLP-1 receptor agonist that mimics a gut hormone involved in appetite and insulin regulation. FDA-approved forms include:

• Ozempic (type 2 diabetes)
  
• Wegovy (chronic weight management)
  
• Rybelsus (oral tablet for type 2 diabetes)
  
  

Semaglutide supports metabolic health by:

• Reducing hunger signals
  
• Delaying stomach emptying
  
• Promoting a sense of fullness
  
• Supporting improved insulin sensitivity
  
  

Note: Semaglutide may help regulate appetite and promote healthier eating patterns when used as part of a provider-supervised plan.

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Comparing Weight Outcomes

A 68-week clinical trial of Wegovy (semaglutide 2.4 mg weekly) showed an average weight loss of 14.9% in adults with overweight or obesity (Wen et al., 2024).

Clinical studies on Contrave showed average weight reductions between 4% and 8%, depending on adherence and baseline characteristics (Padwal, 2009).

These results were observed under trial conditions involving intensive lifestyle support. Real-world outcomes may vary and should be discussed with a provider.

Mechanism of Action

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Safety and Side Effects

Semaglutide:

• Nausea, constipation, or diarrhea (most common)
  
• Fatigue or dizziness
  
• Black box warning for thyroid C-cell tumors (seen in animal studies)
  
• Not for use in patients with personal or family history of medullary thyroid carcinoma
  
  

Contrave:

• Nausea, insomnia, dry mouth, or headache
  
• Risk of increased blood pressure or heart rate
  
• Black box warning for suicidal thoughts due to bupropion
  
• May interact with antidepressants, opioids, and seizure medications
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Administration and Convenience

Semaglutide:

• Injectable (once weekly) or oral tablet (daily)
  
• Requires refrigeration (for injectable forms)
  
  

Contrave:

• Oral tablet, taken twice daily
  
• Easier for those preferring non-injectable options
  
  

Both medications require gradual dose titration to reduce side effects and improve tolerability.

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Cost Comparison

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Note: Out-of-pocket costs vary by provider, location, and insurance plan. Eden providers can help explore affordability programs.

Summary: Pros and Cons

Semaglutide:

• Higher average weight reduction
  
• Weekly injection or daily oral option
  
• Supports glucose and appetite regulation
  
• Higher out-of-pocket cost
  
• Injectable form may deter some users
  
• GI-related side effects
  
  

Contrave:

• Oral tablet, no injections required
  
• Supports craving and appetite control
  
• Lower retail cost for many
  
• Black box psychiatric warning
  
• Modest weight loss compared to GLP-1s
  
• May require careful interaction management
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Which Medication Is Right for You?

Your provider may recommend one medication over another based on:

• Current medical conditions such as diabetes, depression, or liver function
  
• Medication tolerance and lifestyle preferences
  
• Past weight loss strategies
  
• Insurance coverage and cost accessibility
  
  

Eden providers evaluate your health history to help personalize a plan using FDA-approved GLP-1 medications when appropriate.

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Final Thoughts

Both Contrave and semaglutide offer clinically supported approaches to managing weight, but they work differently and suit different patient needs. Semaglutide may offer more significant weight outcomes, while Contrave may appeal to those seeking a pill-based option.

The best approach is one aligned with your goals and medical profile. Work with your provider to determine the safest and most effective path for you. Eden helps simplify this process by connecting you with licensed professionals who offer personalized, evidence-based care.

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Disclaimer

This content is for educational purposes only and does not constitute medical advice. Always speak with a qualified healthcare provider before starting or changing medications. Semaglutide and Contrave are FDA-approved for weight management under specific criteria. Use must follow a provider's clinical judgment and prescription. Eden connects users to licensed providers for personalized GLP-1 treatment. Eden is not a dispenser of any medication.

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