Contrave vs Ozempic: semaglutide, the drug in Ozempic and Wegovy, produces about two to three times the weight loss of Contrave in their main trials: 14.9% over 68 weeks for semaglutide 2.4 mg versus 5.4% over 56 weeks for Contrave.[2][1] Contrave is a twice-daily pill combining naltrexone and bupropion and carries a boxed warning about suicidal thoughts; Ozempic and Wegovy are weekly injections (Wegovy also comes as a pill) with a boxed warning about thyroid tumors in rodents.[1][4]
Note that Ozempic is approved for type 2 diabetes; for weight management, semaglutide is sold as Wegovy.[3][4] See our semaglutide profile.
Contrave vs Ozempic and Wegovy at a glance
| Contrave | Ozempic | Wegovy | |
|---|---|---|---|
| Ingredients | Naltrexone + bupropion[1] | Semaglutide[3] | Semaglutide[4] |
| Form | Tablets, 2 twice daily at full dose[1] | Weekly injection[3] | Weekly injection or daily pill[4] |
| Approved for | Weight management (adults)[1] | Type 2 diabetes[3] | Weight management, heart risk, MASH[4] |
| Main weight trial | −5.4% vs −1.3% (COR-I, 56 weeks)[1] | Not a weight-loss drug | −14.9% vs −2.4% (STEP 1, 68 weeks)[2] |
| In type 2 diabetes | −3.7% vs −1.7% (COR-Diabetes)[1] | — | −9.6% vs −3.4% (STEP 2)[6] |
| Boxed warning | Suicidal thoughts and behaviors[1] | Thyroid C-cell tumors[3] | Thyroid C-cell tumors[4] |
| Heart-outcome benefit | Not established[1] | Yes, in type 2 diabetes[3] | Yes (SELECT)[9] |
| Cash price (2026) | No more than $99/month via partner pharmacies[11] | $349/month most doses[13] | $349/month most doses[12] |
How they work
- Contrave pairs two older drugs. Bupropion is an antidepressant also used to help people quit smoking; naltrexone blocks opioid receptors and is used for alcohol and opioid dependence. Together they act on appetite and reward pathways in the brain.[1]
- Semaglutide copies GLP-1, a gut hormone that reduces appetite and slows stomach emptying.[4]
Weight loss compared
| Trial | Drug | Length | Average weight change | Placebo |
|---|---|---|---|---|
| COR-I | Contrave 32/360 mg | 56 weeks | −5.4%[1] | −1.3% |
| COR-BMOD (with intensive counseling) | Contrave | 56 weeks | −8.1%[1] | −4.9% |
| STEP 1 | Semaglutide 2.4 mg | 68 weeks | −14.9%[2] | −2.4% |
| STEP 2 (type 2 diabetes) | Semaglutide 2.4 mg | 68 weeks | −9.6%[6] | −3.4% |
In COR-I, 42% on Contrave lost at least 5% of their weight versus 17% on placebo; in STEP 1, 86.4% on semaglutide did, versus 31.5%.[1][2]
The Contrave label tells prescribers to evaluate the response after 12 weeks on the full dose and to stop if weight has not fallen by at least 5%.[1]
Side effects
Contrave (pooled trials, label):[1]
| Side effect | Contrave | Placebo |
|---|---|---|
| Nausea | 32.5% | 6.7% |
| Constipation | 19.2% | 7.2% |
| Headache | 17.6% | 10.4% |
| Vomiting | 10.7% | 2.9% |
| Dizziness | 9.9% | 3.4% |
| Insomnia | 9.2% | 5.9% |
| Dry mouth | 8.1% | 2.3% |
About 24% stopped Contrave because of side effects, versus 12% on placebo; nausea was the top reason.[1] Contrave can also raise blood pressure and heart rate, especially in the first three months, and can cause seizures in susceptible people.[1]
Semaglutide mainly causes nausea, diarrhea, vomiting and constipation; in STEP 1, 4.5% stopped because of stomach side effects versus 0.8% on placebo.[2]
A 2026 BMJ network meta-analysis found naltrexone-bupropion had the largest increase in fatigue of any weight-loss drug studied, and was among those most often stopped for side effects.[7]
The boxed warnings
- Contrave: because it contains bupropion, it carries the antidepressant class warning for suicidal thoughts and behaviors in children, teens and young adults, and all patients should be watched for mood changes. It is not approved for anyone under 18.[1] In the COR-I trial itself, depression and suicidality events were not more common than on placebo.[5]
- Ozempic and Wegovy: thyroid C-cell tumors in rodents; not for people with a personal or family history of medullary thyroid cancer or MEN 2.[3][4]
Who should not take Contrave
The label lists these contraindications: uncontrolled high blood pressure; seizure disorders; bulimia or anorexia; chronic opioid use or opioid withdrawal; other bupropion products; MAO inhibitors within 14 days; and abrupt stopping of alcohol, benzodiazepines, barbiturates or antiseizure drugs.[1] People who take opioid pain medicines regularly therefore usually cannot use Contrave, which can make semaglutide the more practical choice.
Heart and long-term outcomes
The Contrave label says its effect on heart disease and death has not been established.[1] Wegovy is approved to lower heart attack and stroke risk after SELECT, where events fell from 8.0% to 6.5%.[9] In a 2026 US health-record study of matched adults without diabetes, people starting semaglutide had lower death and kidney-event rates over two years than people starting naltrexone-bupropion, though the absolute differences were small (under 1 percentage point) and the study was observational.[10]
Can you take Contrave with Ozempic or Wegovy?
No trial has tested the combination, and neither label specifically addresses it.[1][4] The Contrave label rules out other bupropion products and advises against other naltrexone products.[1] Any combined use would be off-label and needs a clinician’s oversight, especially because both drugs can cause nausea and vomiting, which can lead to dehydration.
Who might prefer each
- Contrave may suit someone who prefers a pill, cannot take GLP-1 drugs (for example, because of a personal or family history of medullary thyroid cancer or MEN 2), or for whom cost is the main barrier. It is approved only for weight management in adults.[1]
- Wegovy suits people who want the largest average weight loss, have heart disease with excess weight, or take opioids regularly (which rules out Contrave).[4][1]
- Ozempic is the labeled option when type 2 diabetes is the main concern.[3]
Dosing compared
Contrave builds up over four weeks: one tablet in the morning in week 1, rising to two tablets twice daily from week 4. Tablets should not be cut, crushed or taken with a high-fat meal.[1] Wegovy starts at 0.25 mg weekly and rises every 4 weeks to 2.4 mg; Ozempic rises from 0.25 mg to as much as 2 mg.[4][3] A clinician sets the schedule.
Cost basics
- Contrave: in 2026 its maker advertised no more than $99 a month through its CurAccess partner-pharmacy program, and no more than $199 a month at retail pharmacies with its savings card if insurance does not cover it.[11] See our Contrave cost guide.
- Wegovy and Ozempic: NovoCare self-pay was $349 a month for most doses in October 2026 (Ozempic 2 mg: $499; Wegovy 7.2 mg: $399).[12][13]
Prices checked October 2026. They change often; confirm with the manufacturer or your plan. Compare semaglutide brands in Wegovy vs Ozempic, or see phentermine vs Ozempic for another older option.
