Contrave vs. Qsymia

See how Contrave and Qsymia compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both Contrave and Qsymia are oral prescription pills for chronic weight management, but they work through very different mechanisms and carry different safety warnings.

  • Contrave combines an opioid antagonist with an antidepressant and carries a boxed warning for suicidal thoughts, while Qsymia pairs a stimulant-like appetite suppressant with an anticonvulsant and requires REMS pharmacy enrollment.

  • Qsymia has a notably lower typical list price than Contrave, though both require step-wise dose increases over several weeks before reaching a full maintenance dose.

Contrave vs. Qsymia Drug Summary

Contrave

Contrave combines naltrexone, an opioid antagonist, with bupropion, an aminoketone antidepressant, to help reduce appetite and food cravings. It's FDA-approved for chronic weight management in adults with obesity, or overweight adults with a weight-related condition. It's taken as an oral extended-release tablet, with the dose raised over three weeks to a twice-daily maintenance dose.

Qsymia

Qsymia combines phentermine, a stimulant-like appetite suppressant, with topiramate, an anticonvulsant, to reduce hunger and increase fullness. It's FDA-approved for adults with obesity, overweight adults with a weight-related condition, and some adolescents 12 and older. It's taken as a once-daily capsule, with the dose raised gradually over about 16 weeks to reach full maintenance.

Contrave vs. Qsymia Side Effects

Contrave

Most common
nausea (up to 32.5%)
constipation (up to 19.2%)
headache (up to 17.6%)
vomiting (up to 10.7%)

Qsymia

Most common
paresthesia (up to 21%)
dry mouth (up to 19%)
constipation (up to 16%)
insomnia (up to 11%)

Contrave vs. Qsymia Dosage

Contrave

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 8 mg/90 mg once daily Week 1
Maximum dose 16 mg/180 mg twice daily Week 3
Dose changes 2 increases Every week

Qsymia

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 3.75 mg/23 mg once daily Days 1-14
Maximum dose 15 mg/92 mg once daily Week 17 onward
Dose changes 3 increases As tolerated

Contrave vs. Qsymia Indications

Contrave

Contrave is approved for adults with obesity, or who are overweight with a related condition like high blood pressure or type 2 diabetes, for use alongside diet and exercise. It is not approved for depression, smoking cessation, or use in children.

  • Adults with a BMI of 30 or higher (obesity)

  • Adults with a BMI of 27 or higher plus a weight-related condition

  • Used with reduced-calorie diet and increased physical activity

  • Not approved for major depressive disorder or smoking cessation

Qsymia

Qsymia is approved for adults with obesity, adults who are overweight with a related condition, and adolescents 12 and older with obesity, for use alongside diet and exercise. It is not approved for use in pregnancy, breastfeeding, or people with hyperthyroidism or glaucoma.

  • Adults with a BMI of 30 or higher (obesity)

  • Adults with a BMI of 27 or higher plus a weight-related condition

  • Adolescents 12 and older with obesity

  • Used with reduced-calorie diet and increased physical activity

Contrave vs. Qsymia Pros and Cons

Contrave

Contrave's opioid antagonist and antidepressant combination makes it a non-stimulant, non-controlled option for weight loss, but it carries a boxed warning for suicidal thoughts tied to its bupropion component. It can be filled at any standard pharmacy since it isn't subject to REMS restrictions.

Pros

  • Not a controlled substance, so no REMS enrollment needed

  • May help with cravings and mood-related eating patterns

  • Available at any standard retail pharmacy

Cons

  • Boxed warning for suicidal thoughts and behaviors

  • Contraindicated with any opioid or opiate use

  • Higher typical list price, roughly $750 to $840 per month without insurance

  • Not recommended with high-fat meals due to increased drug exposure

Qsymia

Qsymia pairs a stimulant-like appetite suppressant with an anticonvulsant, giving it strong appetite-suppressing effects, but it is a Schedule IV controlled substance dispensed only through certified REMS pharmacies. It also carries a specific risk of birth defects, requiring monthly pregnancy testing.

Pros

  • Approved for adolescents 12 and older with obesity

  • Lower typical list price, roughly $200 to $350 per month without insurance

  • Longer track record of use as separate agents before combination approval

Cons

  • Schedule IV controlled substance with abuse potential

  • Requires REMS enrollment and certified pharmacy dispensing

  • Not safe in pregnancy; requires monthly pregnancy testing

  • Risk of cognitive effects like memory and word-finding difficulty

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