Contrave and Semaglutide: Understanding the Differences in Weight Management Approaches

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. It is the active ingredient in several FDA-approved medications, including::

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

In clinical studies and FDA-approved use, semaglutide has been shown to support 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

In a 68-week clinical trial using an FDA-approved dose of semaglutide (2.4 mg weekly), participants with overweight or obesity lost an average of 14.9% of their body weight under structured medical and lifestyle supervision (Wen et al., 2024). (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.

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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.

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Summary: Pros and Cons

Semaglutide:

• FDA-approved for type 2 diabetes and chronic weight management
• Weekly injection or daily oral option
  Acts on GLP-1 receptors involved in blood sugar and appetite regulation
• May have higher out-of-pocket cost
  
• Injectable form may deter some users
  
• GI-related side effects
  
  

Contrave:

• Oral tablet, no injections required
  
• FDA-approved for chronic weight management
  
• 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

Contrave and semaglutide are both FDA-approved options for weight management that work through different mechanisms and may be suited to different individuals. While semaglutide has been studied in trials with notable weight outcomes, Contrave may appeal to those who prefer an oral medication and are medically eligible.

The right approach depends on your health history, preferences, and provider guidance. Eden helps simplify the process by connecting you with licensed medical professionals who can evaluate your needs and determine whether a prescription is appropriate.

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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 to assess whether or not you are an eligible candidate for GLP-1 medications. Eden is not a dispenser of any medication.

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