Contrave alternatives: What can I take instead?

In this article:

• Contrave alternatives
• Natural alternatives to Contrave
• How to switch to a Contrave alternative

In this article

• Contrave alternatives
• Natural alternatives to Contrave
• How to switch to a Contrave alternative

Contrave extended-release tablets are a brand-name prescription medication approved by the U.S. Food and Drug Administration (FDA) for weight management in adults who are overweight or obese. Contrave contains two medicines (naltrexone, an opioid antagonist, and bupropion, an antidepressant medicine) intended to be used along with a reduced-calorie diet and increased physical activity to help lose weight. Contrave is used in adults with an initial body mass index (BMI) of ≥30 or in adults with an initial BMI of ≥27 plus at least one weight-related risk factor such as Type 2 diabetes mellitus, high blood pressure, or high cholesterol. Contrave works to reduce food intake by targeting two areas of the brain to help control cravings and curb hunger. Contrave is available in an extended-release tablet that contains 8 mg of naltrexone and 90 mg of bupropion and is taken in a stepwise dosing schedule by mouth once and then twice daily with food.

Common side effects of Contrave include nausea, constipation, diarrhea, headache, vomiting, dizziness, trouble sleeping, and dry mouth. Less common serious side effects include seizures, increased blood pressure (hypertension) and heart rate, liver damage, increased pressure in the eye (glaucoma), and severe skin reactions.

Contrave has an FDA-mandated black box warning due to the risk of suicidal thoughts and behaviors associated with bupropion, the antidepressant ingredient. Those taking Contrave should be closely monitored for mood changes, suicidal thoughts, or unusual behavior, especially in the first few months of treatment or after dose changes. Contrave is not approved for use in children or adolescents under 18.

What can I take in place of Contrave?

There are other options available to manage weight loss if Contrave is not effective or there are concerns with side effects or interactions with other medicines. If Contrave is not right for you, there are other oral medications as well as injectable medicines that may help. It is important to consult with your healthcare professional to determine which weight-loss drug would be the best alternative to Contrave for you. The table below focuses on the most common alternatives to Contrave.

Other alternatives to Contrave

• Alli (orlistat OTC)
• Phendimetrazine
• Lomaira (phentermine)
• Ozempic (semaglutide) off-label
• Mounjaro (tirzepatide) off-label

Top 5 Contrave alternatives

The following are some of the most common prescription weight loss medication alternatives to Contrave.

1. Qsymia (phentermine/topiramate)

Qsymia is an oral medication approved by the FDA for weight loss in those ages 12 and older. It is a combination of phentermine and topiramate in an extended-release capsule. Phentermine is an appetite suppressant and topiramate is normally used for seizures and migraines, but it may also reduce binge eating. Qsymia is taken once daily in the morning with or without food and should not be taken in the evening due to the possibility of insomnia. 

The most common side effects of Qsymia are generally mild, such as dry mouth, constipation, and a tingling sensation in the skin, however, it is associated with potentially serious side effects, including birth defects, heart problems, and dependency. Due to the phentermine component, Qsymia is classified as a Schedule IV controlled substance.

2. Xenical (orlistat)

Xenical is an oral capsule whose active ingredient is orlistat. It is taken three times a day with each main meal containing fat. Xenical works by changing the amount of fat digestion in the GI tract through the inhibition of pancreatic lipases. In turn, this increases fecal fat excretion because fat is essentially not changed to a form that can be absorbed. Unlike other prescription-only weight-loss medicines, orlistat is available over-the-counter (OTC) under the brand name Alli.

Xenical may be used long-term, having demonstrated efficacy in weight loss for up to four years, and can have positive impacts on cardiovascular risk factors like diabetes, high blood pressure, and high cholesterol. Side effects of Xenical include fecal incontinence, flatus with discharge, and oily spotting. 

3. Tenuate (diethylpropion)

Tenuate is a sympathomimetic amine, similar to the amphetamine class of drugs, that decreases appetite and is used as a short-term treatment for obesity. It comes as a tablet given three times a day 30 minutes before meals or as an extended-release tablet given once a day before breakfast or one to two hours after breakfast.

Common side effects may include fast heartbeat, restlessness, dizziness, trouble sleeping, headache, dry mouth, or GI side effects such as nausea, vomiting, or diarrhea. Although less common, serious side effects include heart valve problems and increased blood pressure in the lungs. Tenuate is classified as a Schedule IV controlled substance.

4. Adipex-P (phentermine)

The active ingredient in Adipex-P is phentermine. Phentermine is indicated for short-term use as a weight loss treatment for adult patients. Phentermine, also in the sympathomimetic amine drug class, is thought to work by interacting with certain chemicals in the brain to reduce appetite. It is taken as a capsule or tablet once daily before breakfast or one to two hours after breakfast. Common side effects may include a fast heartbeat, restlessness or feeling uneasy, chest pain, dizziness, trouble sleeping, headache, dry mouth, or unpleasant taste. Although less common, severe side effects include heart valve problems and increased blood pressure in the lungs.

Phentermine is the oldest prescription weight-loss pill still available. It’s commonly prescribed even though there are newer options available because it is effective and comes in a much cheaper generic form. Phentermine is also available under the brand name Lomaira. Phentermine is classified as a Schedule IV controlled substance.

5. GLP-1 receptor agonists

Glucagon-like peptide-1 receptor agonists (GLP-1 agonists) are a class of medications used in the treatment of Type 2 diabetes as well as for chronic weight management in adults. GLP-1 agonists approved for weight management include Wegovy (semaglutide), Zepbound (tirzepatide), and Saxenda (liraglutide). GLP-1 agonists are FDA-approved to work for weight loss by decreasing appetite and delaying the emptying of food in the stomach. These three GLP-1 agonists are administered as subcutaneous injections given with or without food.  Saxenda is administered as an injection once daily, while Zepbound and Wegovy are given as once-weekly injections.

GLP-1 receptor agonists are considered safe and effective for long-term use in managing obesity. All GLP-1s may cause similar side effects, such as gastrointestinal problems like nausea, vomiting, constipation, diarrhea, indigestion, and stomach pain. Other side effects may include headaches and dizziness.

Natural alternatives to Contrave

It is important to note that all prescription weight loss medicines are recommended to be used as an adjunct to lifestyle changes, such as a reduced-calorie diet and regular exercise. Adherence to a healthy diet and exercise plan is a major contributor to losing unwanted weight and keeping it off. Behavior modification therapy is another component that can help make more permanent changes in one’s eating behavior. 

There are many OTC and natural weight-loss products and supplements that make claims of being effective, although they often lack rigorous clinical studies to back them up. Always seek medical advice from a healthcare professional before starting any weight-loss program or therapy, even if they’re available without a prescription.

How to switch to a Contrave alternative

Switching from Contrave to another weight-loss medication may be necessary due to a lack of efficacy, unwelcome side effects, allergic reactions, or the cost of therapy. When considering a switch to a Contrave alternative:

• If you decide to stop taking Contrave and switch to an alternative medicine, it is important to know that because Contrave isn’t expected to cause physical dependence, withdrawal symptoms aren’t likely to occur. However, naltrexone (one of the two active drugs in Contrave) may cause withdrawal symptoms in certain people who also take opioid drugs. It’s recommended to talk with your prescribing doctor or other healthcare professional before discontinuing Contrave.
• Check your prescription drug coverage formulary to see which Contrave alternatives your insurance provider covers. You can also search the SingleCare website or mobile app for free coupons. SingleCare customers can save up to 80% on prescription prices—what’s more, you can use SingleCare savings every time you fill your prescription.
• Consult your healthcare provider. Your healthcare provider is the only one who can determine which is the best option for you by considering your medical history, medical conditions, and medications you take that may potentially interact with weight-loss medications. You can also talk about dietary changes and exercise plans.
• If you change to an alternative medicine, review dosing instructions with your pharmacist or other healthcare professional and ask about any potential side effects. If you change to an injectable drug, be sure you understand how and when to use it, as well as how to store and dispose of it. 
• You should receive a patient information leaflet medication guide with your new prescription. If anything concerns you or if you have questions, consult your healthcare provider or pharmacist.