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
Qsymia
Contrave vs. Qsymia Dosage
Contrave
Qsymia
| 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 |
| 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
| 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
| 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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