Which is better, Contrave or Qsymia? A Comprehensive Comparison

October 7, 2025 •

5 min read

In clinical trials, Qsymia has generally demonstrated greater average weight loss compared to Contrave, though both are effective prescription medications. Deciding which is better, Contrave or Qsymia, is not a simple question and depends heavily on individual health profiles, weight loss goals, and risk tolerance. This article breaks down the key differences to help inform the discussion with your healthcare provider.

Quick Summary

A comparison of the prescription weight-loss drugs Contrave and Qsymia, detailing their distinct mechanisms, clinical effectiveness, side effect profiles, and safety considerations. The right choice is highly personalized based on individual health needs, comorbidities, and tolerance for potential risks.

Key Points

Different Mechanisms: Qsymia suppresses appetite and promotes fullness using a stimulant and an anticonvulsant, while Contrave curbs cravings and affects the reward system using an antidepressant and an opioid antagonist.
Varied Efficacy: Qsymia generally leads to greater average weight loss (7-9%) over a year compared to Contrave (4-5%).
Distinct Side Effect Profiles: Qsymia commonly causes tingling and dry mouth, whereas Contrave's most frequent side effect is nausea.
Differing Safety Concerns: Qsymia has a high risk of birth defects and is contraindicated in pregnancy, while Contrave carries a black box warning for increased risk of suicidal thoughts.
Individualized Choice: The "better" option depends on individual patient factors like comorbidities, eating patterns (emotional vs. appetite-driven), and tolerance for specific side effects.
Cost Considerations: The cost of both drugs varies significantly with insurance, and patient assistance programs can impact the out-of-pocket expense.
Professional Guidance is Essential: A consultation with a healthcare provider is crucial to assess risks, benefits, and determine the safest and most effective medication for your specific needs.

Understanding the Mechanisms of Action

Contrave and Qsymia are both prescription medications approved by the FDA for chronic weight management in adults with a BMI of 30 or greater (obese), or a BMI of 27 or greater (overweight) with at least one weight-related comorbidity. However, their combination of ingredients and how they work in the brain differ significantly.

Contrave: Targeting Reward and Cravings

Contrave combines two active ingredients: naltrexone and bupropion.

Naltrexone: An opioid antagonist, primarily known for treating alcohol and opioid dependence. In Contrave, it is thought to reduce the reward or pleasure associated with eating, particularly in emotional or stress-related overeating.
Bupropion: An antidepressant and smoking cessation aid. It acts as a dopamine and norepinephrine reuptake inhibitor, which can help regulate mood and decrease appetite.

Qsymia: Focusing on Appetite and Satiety

Qsymia is a combination of phentermine and topiramate extended-release.

Phentermine: A sympathomimetic amine, or stimulant, that works primarily by suppressing appetite.
Topiramate: An anticonvulsant, or anti-seizure medication, that helps increase feelings of fullness (satiety) and may reduce food cravings.

Efficacy and Patient Results

In terms of raw weight loss numbers, Qsymia often shows a higher average percentage of total body weight reduction than Contrave in clinical trials.

Qsymia's Efficacy: Clinical studies demonstrated that patients taking Qsymia achieved an average weight loss of around 7% to 9% over a year.
Contrave's Efficacy: The data for Contrave shows a more modest average weight loss of about 4% to 5% over a year.

It is important to remember that these are average figures. Individual results can vary greatly depending on adherence to diet and exercise, starting weight, and other health factors.

Side Effect Profiles and Safety Warnings

Both drugs carry significant side effects and safety warnings, making a thorough discussion with a healthcare provider essential before starting treatment.

Common Side Effects

Qsymia:

Dry mouth
Tingling or "pins-and-needles" sensations in the hands and feet
Constipation
Insomnia
Changes in taste
Dizziness

Contrave:

Nausea (most common)
Headache
Constipation
Vomiting
Dizziness
Insomnia
Dry mouth

Serious Safety Risks

Pregnancy and Birth Defects (Qsymia): Qsymia is linked to a significant risk of birth defects (cleft lip/palate) if taken during pregnancy. As a result, it is only available through a restricted distribution program (REMS) and requires monthly pregnancy testing for women of reproductive potential.
Cardiovascular Risks (Qsymia): The stimulant phentermine can increase blood pressure and heart rate, making Qsymia contraindicated for patients with certain heart conditions or uncontrolled hypertension.
Suicidality and Psychiatric Issues (Contrave): Due to the bupropion component, Contrave carries a "black box" warning for increased risk of suicidal thoughts and behavior, particularly in adolescents and young adults.
Seizure Risk (Contrave): The bupropion in Contrave can increase the risk of seizures, especially if taken with a high-fat meal.
Opioid Interactions (Contrave): Naltrexone can block the effects of opioid medications and should not be taken with them, or during opioid withdrawal, due to the risk of precipitating acute opioid withdrawal symptoms.

Cost and Accessibility

Cost is a significant factor for many patients, and both medications can be expensive without insurance coverage.

Contrave: Without insurance, the retail cost can be high, but the manufacturer often offers patient assistance programs and discount cards to reduce the monthly cost, sometimes to $99 or less.
Qsymia: Retail prices without insurance can also be high, although the manufacturer offers a cash-pay program and savings card. Generic versions of its components may be cheaper, but Qsymia itself has no generic formulation.

Contrave vs. Qsymia Comparison Table


Feature	Contrave	Qsymia
Mechanism of Action	Combines naltrexone (opioid antagonist) and bupropion (antidepressant) to curb cravings and appetite.	Combines phentermine (stimulant) and topiramate (anticonvulsant) to suppress appetite and increase satiety.
Average Weight Loss	Approximately 4% to 5% of body weight over one year.	Approximately 7% to 9% of body weight over one year.
Common Side Effects	Nausea, headache, constipation, vomiting, dizziness, dry mouth.	Tingling, dry mouth, constipation, insomnia, altered taste.
Safety Warnings	Black box warning for suicidal thoughts; seizure risk; opioid interaction warnings.	Significant birth defect risk (REMS program); cardiovascular risks; metabolic acidosis.
Key Considerations	May be better for emotional eating and patients with certain cardiovascular concerns.	Potentially greater weight loss, but higher risk profile and special precautions for women of reproductive age.
Dosing Schedule	Dosing is gradually increased.	Once-daily dosing.
Controlled Substance	No.	Yes (Schedule IV).

Making an Informed Decision

Choosing the "better" medication is a complex decision that involves weighing several factors, including your medical history, weight loss goals, and potential side effect tolerance. There is no one-size-fits-all answer, and what works best for one person may not be the ideal choice for another.

Factors to consider with your doctor include:

Personal Health History: Do you have a history of heart conditions, seizures, or psychiatric issues? These can be significant contraindications.
Weight Loss Magnitude: Are your goals more ambitious (suggesting Qsymia) or are you looking for a more modest result (potentially Contrave)?
Eating Behaviors: Do you struggle with emotional eating and cravings (Contrave), or simply need more appetite suppression and satiety (Qsymia)?
Side Effect Sensitivity: Can you tolerate the common side effects of each drug? Contrave is known for initial nausea, while Qsymia can cause sensory changes and dry mouth.
Safety Requirements: For women of childbearing age, the strict REMS program and contraception requirements for Qsymia are a critical consideration.
Cost and Insurance Coverage: Your specific health insurance plan may cover one medication but not the other, or offer better discounts for one.

Conclusion

Both Contrave and Qsymia represent viable pharmacological options for chronic weight management, provided they are used alongside dietary changes and increased physical activity. While Qsymia typically shows greater weight loss results in clinical trials, it comes with a more restrictive risk profile, particularly regarding birth defects and cardiovascular effects. Contrave, while less potent in weight loss, may be a more suitable choice for individuals with certain health profiles, such as those sensitive to stimulants or dealing with emotional eating. The ultimate decision rests on a comprehensive evaluation of your unique medical situation with a qualified healthcare professional. They can help you navigate the benefits and risks of each drug to determine which is the most appropriate and safest option for your journey towards a healthier weight. For more detailed prescribing information, consult the FDA's drug database.

Frequently Asked Questions

No, you should never take Contrave and Qsymia together. These are both powerful prescription medications that affect your brain chemistry, and combining them could lead to dangerous interactions and increased side effects. You should only take one of these medications at a time, under the supervision of a healthcare provider.

Contrave may be a safer option if you have a history of cardiovascular concerns, as Qsymia contains a stimulant (phentermine) that can increase heart rate and blood pressure and is contraindicated for patients with certain heart conditions. However, your doctor will need to evaluate your specific cardiovascular health before making a recommendation.

Contrave may be more suitable for individuals who struggle with emotional eating or cravings due to stress because the naltrexone component helps modulate the brain's reward system. Qsymia primarily focuses on appetite suppression and satiety.

Nausea is a common side effect of Contrave, especially during the initial phase of treatment. The gradual dose titration schedule is designed to minimize this. If nausea is severe or persistent, your healthcare provider can discuss strategies to manage it or explore other treatment options.

Qsymia is only available through certified pharmacies participating in the Qsymia REMS (Risk Evaluation and Mitigation Strategy) program. This is due to the significant risk of birth defects if the medication is taken during pregnancy, and the REMS program ensures that patients are informed of this risk and comply with monthly pregnancy testing.

Contrave is taken as a tablet with dosing gradually increasing. Qsymia is a once-daily extended-release capsule.

No, neither Contrave nor Qsymia is currently available as a generic formulation. While the individual components may be available generically, the specific combination products are brand-name.