How do Contrave and Wegovy compare for weight loss?

What are Contrave and Wegovy used for?

The Food and Drug Administration (FDA) has approved both drugs for weight management in adults with:

• a body mass index (BMI) of 30 or higher (obesity)
• a BMI of 27 or higher (overweight) plus at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol

Wegovy also has the following approved uses:

• Cardiovascular health: Wegovy is approved to reduce the risk of major heart-related events like heart attack or stroke in adults with known heart disease who have obesity or are overweight.
• Children: Wegovy can be used for weight loss in children ages 12 years and older with obesity.
• Liver health: Wegovy is approved to treat noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), a type of liver inflammation, in adults with liver scarring.

Contrave is not approved for use in children.

How do you take Contrave and Wegovy?

Both medications require a “titration” period, meaning you increase your dose slowly over several weeks to help your body adjust.

Contrave dosage

Contrave is an 8 mg/90 mg tablet. The standard schedule is:

• Week one: 1 tablet in the morning
• Week two: 1 tablet in the morning and one in the evening
• Week three: 2 tablets in the morning and one in the evening
• Week four and beyond: 2 tablets in the morning and two in the evening

You should swallow tablets whole and avoid taking Contrave with high fat meals, as this can increase the drug levels in your body and increase your risk of seizures.

Wegovy dosage

Wegovy injections are taken once a week. The dose starts at 0.25 mg and increases every 4 weeks until reaching a maintenance dose, usually 2.4 mg. A higher 7.2 mg dose is available if needed for some patients.

Wegovy tablets are taken once daily on an empty stomach. You should take them with no more than 4 ounces of plain water and wait at least 30 minutes before eating or taking other oral medications. The starting dose is 1.5 mg, which can increase to a maintenance dose of 25 mg.

Side effects of Contrave and Wegovy

Contrave and Wegovy are both used for weight management in certain adults. These drugs can cause some of the same mild side effects, as well as different ones, as the table below shows.

These side effects may be temporary, lasting a few days to weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Serious side effects

Serious side effects with Contrave and Wegovy are rare. They include:

Contrave

• increased blood pressure and heart rate
• seizures
• liver damage
• angle-closure glaucoma
• low blood sugar (hypoglycemia)
• manic episodes (mania)
• risk of opioid overdose
• risks associated with suddenly stopping opioids

Wegovy

• pancreatitis
• gallbladder problems, such as gallstones
• acute kidney failure due to dehydration
• diabetic retinopathy (diabetic eye disease)

If you have serious side effects while using Contrave or Wegovy, call your doctor immediately. If the side effects feel like a medical emergency, call 911 or your local emergency number right away.

Boxed warnings for Contrave and Wegovy

Contrave and Wegovy both carry a boxed warning, the FDA’s most serious safety warning.

Contrave: Suicidal thoughts and behaviors

Contrave contains bupropion, an antidepressant that can increase the risk of suicidal thoughts and actions, especially in children, teenagers, and young adults under age 25 years. While taking Contrave, you and your family should monitor for any sudden changes in mood or behavior.

If you have thoughts of suicide during treatment with Contrave, call 911 or your local emergency number. In the United States, you can call the Suicide and Crisis Lifeline at 988 or text HOME to the Crisis Text Line at 741741. You can also refer to this suicide prevention resource guide for ways to seek support.

Wegovy: Risk of thyroid C-cell tumors

In animal studies, the active ingredient in Wegovy caused thyroid cancer. It is unknown if it causes these tumors in humans. You should not use Wegovy if you or an immediate family member has ever had medullary thyroid carcinoma (MTC), or multiple endocrine neoplasia syndrome type 2 (MEN 2).

During treatment with Wegovy, let your doctor know if you have symptoms of thyroid tumors or cancer. Examples include a hoarse voice that doesn’t go away, a mass or lump in your neck, and shortness of breath.

Are Contrave and Wegovy equally effective?

Both drugs were found to be effective in clinical trials, but Wegovy may work faster for weight loss.

• Contrave: In a large 56-week trial, people taking Contrave lost an average of 5.4% of their body weight, compared to 1.3% for those on a placebo. If you have not lost at least 5% of your weight after 12 weeks on the full dose, your doctor may stop the treatment.
• Wegovy: In a 68-week trial, adults without diabetes taking Wegovy injections lost an average of 14.9% of their body weight, compared to 2.4% for those on a placebo.

How do costs compare?

How much Contrave or Wegovy costs depends on the treatment plan your doctor prescribes, your insurance plan, and your pharmacy.

You can visit Optum Perks for price estimates of Contrave and Wegovy. (Optum Perks is a sister site of Medical News Today.)

Precautions and safety

You should talk to your doctor about your full medical history before starting either medication.

You should not take Contrave if you:

• have uncontrolled high blood pressure
• have or have had seizures or an eating disorder like anorexia or bulimia
• are currently using opioid pain medications or are in opioid withdrawal
• take other medicines containing bupropion
• drink a lot of alcohol and suddenly stop
• have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days

You should use caution with Wegovy if you:

• have had problems with your pancreas or kidneys
• have type 2 diabetes and a history of diabetic retinopathy
• are taking insulin or other diabetes medications, as Wegovy can increase the risk of low blood sugar (hypoglycemia)

Pregnancy and breastfeeding

Neither drug is recommended during pregnancy, as weight loss offers no benefit to the fetus and may cause harm. If you become pregnant, you should stop taking these medications and inform your doctor.

For Wegovy, it is recommended to stop the drug at least 2 months before a planned pregnancy. Breastfeeding is not recommended while taking Wegovy tablets or Contrave.

Switching between Contrave and Wegovy 

It may be possible to switch between Contrave and Wegovy, but your doctor will decide based on your health needs. For example, if you use Wegovy for its heart health benefits, a switch to Contrave may not be appropriate.

Never stop or change your medication without your doctor’s guidance.

Summary

Contrave and Wegovy are prescribed for long-term weight management in adults with obesity or overweight and weight-related health conditions. Wegovy is also approved to help improve cardiovascular and liver health.

Talk with your doctor about which medication might be right for you. Each one carries a boxed warning and safety precautions that a doctor will assess carefully.