Contrave vs Wegovy: Which Weight Loss Medication Is Right for You?

Wegovy obliterates Contrave in raw weight loss numbers: 15% body weight reduction versus 5-8%, GLP-1 injection versus naltrexone/bupropion pills. But choosing a weight loss medication is never just about the scale. 

Contrave targets the brain’s reward system to reduce food cravings and emotional eating, while Wegovy mimics the gut hormone GLP-1 to suppress appetite and slow stomach emptying. One uses a single hormone pathway; the other uses dual CNS appetite suppression.

Both are FDA-approved for adults with a body mass index of 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure or high cholesterol. Wegovy is also approved for adolescents aged 12 and older.

TL;DR – Contrave vs Wegovy at a Glance

• Wegovy (semaglutide) and Contrave (naltrexone/bupropion) are both FDA-approved medications for chronic weight management, but they differ sharply in results, mechanism, and cost. 
• Wegovy produced an average weight loss of about 15% of body weight over 68 weeks in the landmark STEP 1 trial. 
• Contrave delivered roughly 5-8% body weight reduction over 56 weeks across COR clinical trials. 
• If your primary goal is more significant weight loss or you have established cardiovascular disease, Wegovy is typically the stronger option. 
• If you prefer pills over injections, struggle more with food cravings and emotional eating, or need a lower-cost starting point, Contrave may be the better fit. 
• Always consult your healthcare provider to determine which prescription medication aligns with your medical history, body mass index and weight loss goals..

Contrave vs Wegovy Mechanism Differences

Contrave combines two active ingredients that target brain pathways involved in hunger and reward. Bupropion in Contrave affects neurotransmitters (dopamine and norepinephrine) that regulate appetite and reward processing, while naltrexone – originally used to treat alcohol and opioid dependence – blocks opioid receptors in the brain’s reward system, helping to reduce food cravings. 

Together, they reduce emotional eating by targeting the brain’s reward system. Bupropion is also used as a smoking cessation aid and to treat depression, though Contrave is not approved for those uses.

Weight Loss Results – Wegovy 2-3x Superior

Clinical trials show a clear separation. In the STEP 1 trial (published in the New England Journal of Medicine), participants using Wegovy lost an average of 14.9% of their body weight over 68 weeks – approximately 35 lbs from a starting weight of 232 lbs. The STEP 5 trial confirmed this weight loss was maintained at 104 weeks.

Contrave’s COR trials showed more modest results. In the COR-II trial, participants lost about 6.4% of body weight at 56 weeks. The COR-BMOD trial, which added intensive behavioral modification, reached 9.3% – demonstrating that lifestyle changes significantly boost Contrave’s results. 

Dosing + Administration Burden

Wegovy is administered as a once-weekly injection using a pre-filled pen – roughly five minutes per week. Contrave is taken as an oral pill twice daily (two tablets each time at full dose). That translates to approximately 1,460 tablets versus 52 injections per year, making Wegovy far less burdensome in terms of daily pill management. Both medications require a gradual increase in dosage to minimize side effects and help the body adjust, but Wegovy’s titration schedule is longer (16-20 weeks versus 4 weeks for Contrave). For patients who prefer pills and dislike needles, Contrave has a clear advantage in delivery method. Note that an oral Wegovy pill was FDA-approved in December 2025, which may shift this dynamic for some patients.

Side Effects Comparison

Cost Comparison 2026

Contrave wins on affordability. Its list price ranges from roughly $500 to $740 per month without insurance, and Currax’s CurAccess program offers it for $99/month with free shipping. With insurance coverage and the Contrave savings card, patients may pay as little as $20 for a 30-day supply (GoodRx – Contrave).

Wegovy’s list price is approximately $1,349 per month for the injectable pen. However, Novo Nordisk’s NovoCare program offers $199/month for the first two months on starter doses (0.25 mg and 0.5 mg) for new patients through March 31, 2026, with subsequent months at $349/month for self-pay patients. With commercial insurance coverage, patients may pay as low as $25/month through the Wegovy Savings Offer (Wegovy cost & coverage).

Switching From Contrave to Wegovy: Protocol

Your healthcare provider will typically start you on the lowest Wegovy dose (0.25 mg) and follow the standard titration schedule regardless of your prior Contrave dose. Expect some nausea overlap during the first week as your body adjusts to the new mechanism.