Contrave vs Alternatives: Which Weight Loss Medication Is Right for You?

Weight loss isn’t just about eating less and moving more. For many people, biology gets in the way. If you’ve tried diet and exercise but still can’t lose weight, you might be considering medication. One of the most commonly prescribed options is Contrave - a combination of naltrexone and bupropion. But is it the best choice for you? And what are the real alternatives out there in 2025?

What is Contrave, and how does it work?

Contrave is a once-daily tablet that combines two FDA-approved drugs: naltrexone and bupropion. Naltrexone was originally used to treat alcohol and opioid dependence. Bupropion is an antidepressant also sold as Wellbutrin. Together, they target brain pathways involved in hunger, cravings, and reward.

Unlike older weight loss drugs that simply suppress appetite, Contrave works by reducing food cravings and helping you feel satisfied with smaller portions. Clinical trials show people taking Contrave lost about 5% to 8% of their body weight over a year - when combined with diet and exercise. That’s not a miracle, but it’s meaningful for people with obesity or weight-related health risks like high blood pressure or type 2 diabetes.

It’s not for everyone. You can’t take Contrave if you have uncontrolled high blood pressure, a seizure disorder, or a history of eating disorders. It also carries a black box warning for increased risk of suicidal thoughts in people under 25. That’s why it’s only available by prescription and requires regular check-ins with your doctor.

Contrave vs Saxenda: GLP-1 agonists vs brain-targeted therapy

One of the biggest competitors to Contrave is Saxenda (liraglutide). Saxenda is a GLP-1 receptor agonist - the same class as Ozempic and Wegovy. It mimics a natural hormone that slows digestion and signals fullness to the brain.

Here’s how they stack up:

Saxenda works better on average, but you have to inject it. Contrave is easier to take - no needles, no refrigeration. If you’re squeamish about shots or prefer pills, Contrave wins on convenience. But if you’ve got severe obesity (BMI over 35) and need faster results, Saxenda’s stronger effect often makes it the first choice.

Contrave vs Wegovy: Why one is a game-changer

Wegovy (semaglutide) is the higher-dose version of Saxenda. It’s not just a competitor - it’s the new standard in weight loss meds. In 2025, Wegovy is the most effective prescription weight loss drug available in the UK.

People using Wegovy lost an average of 15% of their body weight in clinical trials. That’s more than double what most people lose on Contrave. It also improves blood sugar control, lowers blood pressure, and reduces the risk of heart disease in people with obesity.

The catch? Wegovy costs around £300-£400 per month in private clinics. NHS access is extremely limited - only approved for people with a BMI over 35 and a related condition like type 2 diabetes or sleep apnea. Contrave, while still expensive, is more widely available through private prescriptions.

Wegovy is also a once-weekly injection. That’s fewer injections than Saxenda, but still more than a daily pill. Some people prefer the simplicity of Contrave, even if the results are slower.

Contrave vs Orlistat: Old-school vs modern

Orlistat (sold as Xenical or Alli) is one of the oldest weight loss drugs still in use. It works by blocking fat absorption in your gut - about 30% of the fat you eat just passes through your system.

It’s available over-the-counter as Alli (lower dose) and by prescription as Xenical. But the side effects? They’re not pretty. Oily spotting, frequent bowel movements, gas with discharge - it’s messy and embarrassing. Most people can’t stick with it long-term.

Weight loss on Orlistat is modest: 3%-5% over a year. That’s less than Contrave. And unlike Contrave, it doesn’t touch cravings or brain signals. It just makes you avoid fatty foods - or deal with the consequences.

Orlistat is cheaper - around £40-£70 a month - and doesn’t require blood tests or mental health screenings. But if you’re looking for a sustainable solution, Contrave is a far better option for most people.

Contrave vs Phentermine: Stimulant vs non-stimulant

Phentermine is a stimulant appetite suppressant. It’s been around since the 1950s and is still prescribed as a short-term option (usually 12 weeks or less). It works fast - people often lose 5-10 pounds in the first month.

But it’s not a long-term fix. Tolerance builds quickly. Side effects include jitteriness, increased heart rate, high blood pressure, and insomnia. It’s also a controlled substance because of its potential for abuse.

Contrave doesn’t stimulate the nervous system. It doesn’t cause a rush or crash. That makes it safer for people with anxiety, heart conditions, or sleep issues. If you need a quick jumpstart and have no heart problems, phentermine might help. But for lasting results, Contrave is the more sustainable option.

Contrave vs Qsymia: Two pills, same goal

Qsymia combines phentermine and topiramate - a seizure and migraine drug that also reduces appetite. It’s another FDA-approved option, but not widely available in the UK due to cost and regulatory hurdles.

Weight loss with Qsymia averages 8%-10% - similar to Contrave. But side effects are more intense: tingling in hands and feet, dry mouth, memory issues, and birth defects if taken during pregnancy.

Contrave doesn’t carry the same pregnancy risks. It’s also less likely to cause cognitive side effects. If you’re considering Qsymia, ask your doctor if you’re a good candidate for Contrave first. It’s often a safer starting point.

Who should avoid Contrave?

Contrave isn’t right for everyone. You should not take it if:

• You have uncontrolled high blood pressure (over 140/90)
• You’ve had a seizure in the past
• You’re taking opioid painkillers or have opioid dependence
• You have an eating disorder like bulimia or anorexia
• You’re under 18 or over 75 (limited safety data)
• You’re taking MAO inhibitors or have used them in the last 14 days

Also, if you’re pregnant or planning to get pregnant, skip Contrave. It’s not recommended during pregnancy.

And don’t drink alcohol while on Contrave. It increases the risk of seizures.

What’s the bottom line?

Contrave is a solid, science-backed option for people who struggle with cravings and emotional eating. It’s not the most powerful weight loss drug on the market, but it’s one of the most balanced - effective without being extreme.

If you want:

• Strongest results → Go for Wegovy or Saxenda
• No needles → Contrave is your best bet
• Lowest cost → Orlistat, but expect messy side effects
• Quick start → Phentermine, but only short-term
• Safest for mental health → Contrave beats Qsymia and phentermine

Most people who start Contrave and stick with it for six months see real progress. But it’s not magic. You still need to eat better and move more. The medication helps you stick to those changes - it doesn’t replace them.

Frequently Asked Questions

Next steps if you’re considering Contrave

Start by talking to your GP or a weight management specialist. Bring your medical history, current medications, and any past attempts at weight loss. They’ll check your blood pressure, liver function, and mental health history before prescribing.

If Contrave isn’t right for you, ask about alternatives. Some clinics offer free consultations with weight loss specialists who can compare all options - including newer GLP-1 drugs, lifestyle programs, or even bariatric surgery if your BMI is high enough.

Remember: no pill replaces healthy habits. But the right medication can give you the edge you need to make those habits stick.