Contrave vs Qsymia compared: how each combination pill works, label trial results, a network meta-analysis, side effects, warnings and cash prices checked October 6, 2026.
Fact-checked against FDA labels and official sources; not yet reviewed by a licensed clinician. This page is education, not medical advice. Talk to your doctor before starting, stopping or changing any treatment.
Key takeaways
- Contrave (naltrexone-bupropion) and Qsymia (phentermine-topiramate) are FDA-approved combination pills for chronic weight management; Qsymia is also approved for teens 12 and older.[2]
- In a network meta-analysis of 28 trials, 75% on phentermine-topiramate and 55% on naltrexone-bupropion lost at least 5% of their weight at one year, versus 23% on placebo.[5]
- Contrave has a boxed warning about suicidal thoughts and is not used with uncontrolled high blood pressure, seizures or chronic opioid use.[1]
- Qsymia is a Schedule IV controlled substance with a REMS program because it can cause birth defects; pregnancy tests are needed before and during treatment.[2]
- On 2026-10-06, Contrave's CurAccess program was $99 or less a month and Qsymia home delivery $74.99 for 30 days.[8]
The short answer
Contrave (naltrexone-bupropion) and Qsymia (phentermine-topiramate) are FDA-approved combination pills for chronic weight management in adults with obesity, or overweight with a weight-related condition; Qsymia is also approved for teens 12 and older. They work differently and have different side effects and safety rules. There is no head-to-head trial.
Scorecards
| Contrave (naltrexone/bupropion): how it works and its warningsFDA approved for weight managementPrescriptionPill | Qsymia (phentermine/topiramate): uses, risks and REMSFDA approved for weight managementPrescriptionPill | |
|---|---|---|
| Medical supervision | Required | Required |
No overall score and no winner: what matters depends on you. Hover a value for its definition.
Facts side by side
| Contrave (naltrexone/bupropion): how it works and its warningsFDA approved for weight managementPrescriptionPill | Qsymia (phentermine/topiramate): uses, risks and REMSFDA approved for weight managementPrescriptionPill | |
|---|---|---|
| Purpose | Reduce excess body weight and maintain weight reduction long term, with a reduced-calorie diet and increased physical activity | Reduce excess body weight and maintain weight reduction long term, with a reduced-calorie diet and increased physical activity; Reduce excess body weight and maintain weight reduction long term |
| Class or type | Opioid antagonist + aminoketone | Sympathomimetic amine |
| Regulatory status | FDA approved for weight managementPrescriptionPill | FDA approved for weight managementPrescriptionPill |
| Prescription required | Yes | Yes |
| How it works | Contrave (naltrexone/bupropion): how the combination works, who it is for, COR trial results, side effects, boxed warning, interactions and dated manufacturer prices. | Qsymia (phentermine/topiramate ER): who it is for, how it works, trial results in adults and teens, REMS and pregnancy testing, side effects, serious risks, generics and dated prices. |
| How it is done or taken | Pill (tablet) | Capsule |
| How often | Daily | Daily |
| Average outcomes in studies |
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| Main risks |
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| Cost (dated) | from 0 USD as low as, with private insurance that covers Contrave and the savings card (not for Medicaid beneficiaries) (checked October 6, 2026) | from 70 USD per month with a 90-day prescription (not available in all states) (checked October 6, 2026) |
| Official resources | dailymed.nlm.nih.gov | dailymed.nlm.nih.gov |
What the trials showed
- No head-to-head trial found; network meta-analysis (Khera 2016) 28 randomized trials, 29,018 people: at least 5% weight loss at 1 year in 75% with phentermine-topiramate, 55% with naltrexone-bupropion, 23% with placebo; excess loss vs placebo 8.8 kg vs 5.0 kg. Indirect comparison.[5]
Side effects compared
| Contrave (naltrexone/bupropion): how it works and its warningsFDA approved for weight managementPrescriptionPill | Qsymia (phentermine/topiramate): uses, risks and REMSFDA approved for weight managementPrescriptionPill | |
|---|---|---|
| From the label |
|
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Cost and coverage
| Option | Price | Amount | Basis | Checked on |
|---|---|---|---|---|
| Contrave (naltrexone/bupropion): how it works and its warnings | Self-pay / cash | 99 USD | per month or less, CurAccess home delivery (manufacturer program) | October 6, 2026 |
| Contrave (naltrexone/bupropion): how it works and its warnings | Self-pay / cash | 199 USD | 120 tablets at retail with the Contrave Savings Card, cash-paying patients | October 6, 2026 |
| Contrave (naltrexone/bupropion): how it works and its warnings | With savings program | 0 USD | as low as, with private insurance that covers Contrave and the savings card (not for Medicaid beneficiaries) | October 6, 2026 |
| Qsymia (phentermine/topiramate): uses, risks and REMS | Self-pay / cash | 74.99 USD | 30-day prescription, Qsymia home-delivery pharmacy, cash payers | October 6, 2026 |
| Qsymia (phentermine/topiramate): uses, risks and REMS | Self-pay / cash | 70 USD | per month with a 90-day prescription (not available in all states) | October 6, 2026 |
| Qsymia (phentermine/topiramate): uses, risks and REMS | With savings program | 75 USD | 30-day prescription at retail with the manufacturer discount | October 6, 2026 |
| Qsymia (phentermine/topiramate): uses, risks and REMS | Other | 85.42-92.72 USD | NADAC pharmacy acquisition cost, 30 generic capsules depending on strength (rates effective 2026-09-23) | October 6, 2026 |
Prices change often and depend on pharmacy, plan and location. Insurance can change what you pay. Every price shows the date we checked it.
Things people weigh up
- Average weight loss: in trial pooling, more people reached 5% loss with phentermine-topiramate; there is no head-to-head trial.
- Safety profile: Contrave has a boxed warning about suicidal thoughts and seizure and blood-pressure warnings; Qsymia carries birth-defect risk with monthly pregnancy tests and a REMS program.
- Conditions that rule one out: for example uncontrolled blood pressure, seizures, eating disorders or opioid use (Contrave); pregnancy, glaucoma or an overactive thyroid (Qsymia).
- Schedule: Contrave is taken twice a day at full dose; Qsymia once each morning.
- Controlled substance: Qsymia is Schedule IV; Contrave is not.
- Age: Qsymia is approved for teens 12 and older with obesity; Contrave is for adults only.
- Cost: both makers have cash programs under $100 a month (checked 2026-10-06); a generic exists for Qsymia only.
These are the differences people commonly consider, not a recommendation. A clinician can help you decide what fits you.
In short: Contrave (naltrexone and bupropion) and Qsymia (phentermine and topiramate) are both FDA-approved combination pills for chronic weight management in adults with obesity, or overweight with a weight-related condition; Qsymia is also approved for teens 12 and older with obesity. They work in different ways, have different side effects and safety rules, and are not GLP-1 medicines. There is no head-to-head trial; in a large analysis of trials, more people reached 5% weight loss on phentermine-topiramate than on naltrexone-bupropion. Qsymia is a controlled substance with a pregnancy-prevention program; Contrave carries a boxed warning about suicidal thoughts (labels checked on October 6, 2026).
These two pills are often discussed as options for people who prefer not to inject, cannot get a GLP-1 medicine or want a lower-cost prescription. This page compares the facts from the FDA labels and studies. Whether either is safe for you depends on your blood pressure, mood history, other medicines, pregnancy plans and more, which only a licensed clinician who evaluates you can judge.
Contrave vs Qsymia at a glance
- 55% vs 75%people reaching at least 5% weight loss at 1 year in a network meta-analysis (placebo 23%)JAMA 2016
- Twice daily vs once dailyContrave is 2 tablets twice a day at full dose; Qsymia is 1 capsule each morningFDA labels
- $99 vs $74.99manufacturer cash programs per month (Contrave CurAccess "or less"; Qsymia home delivery, 30 days)Currax; VIVUS
Checked on October 6, 2026
The basics side by side
| Contrave | Qsymia | |
|---|---|---|
| Ingredients | Naltrexone (an opioid blocker) plus bupropion (an antidepressant), extended release | Phentermine (an appetite suppressant) plus topiramate (an anti-seizure medicine), extended release |
| FDA approval | September 10, 2014 | July 17, 2012; teens 12+ added June 24, 2022 |
| Who it is approved for | Adults with obesity, or overweight with at least one weight-related condition | Adults with obesity, or overweight with at least one weight-related condition; teens 12 and older with obesity |
| How it is taken | Tablets; dose increases weekly over 4 weeks to 2 tablets in the morning and 2 in the evening | Capsule once each morning; starting dose for 14 days, then step-ups based on results |
| Controlled substance | No | Yes, Schedule IV (because of phentermine) |
| Boxed warning | Suicidal thoughts and behaviors (antidepressant class warning) | None; has a REMS program because of birth-defect risk |
| Check-in rule on the label | Stop if less than 5% weight loss after 12 weeks at the maintenance dose | Step up the dose if less than 3% after 12 weeks; stop (gradually) if less than 5% after 12 weeks at the top dose |
| Generic | None listed | Yes: generic phentermine-topiramate ER (Actavis, Dr. Reddy’s) |
| Maker on the label | Currax | VIVUS |
How each one works
Contrave combines two medicines that act on the brain’s appetite and reward systems. Bupropion is a weak inhibitor of dopamine and norepinephrine reuptake; naltrexone blocks opioid receptors. The label says the combination acts in the hypothalamus (appetite) and the mesolimbic reward system, and that the exact way it leads to weight loss is not fully understood.
Qsymia combines phentermine, which releases norepinephrine-type chemical messengers and lowers appetite, with topiramate, whose weight effect is, according to the label, not known. Phentermine on its own (first approved in 1959) is labeled only for short-term use of a few weeks; the extended-release combination in Qsymia is approved for chronic weight management. Learn more about this group on our appetite suppressants page.
What the trials showed
There is no trial that compared Contrave and Qsymia directly. Each was tested against placebo in one-year trials, all with diet and activity advice. In Contrave’s COR trials (4,536 people), about 45% to 46% stopped early; in Qsymia’s two main trials, 40% and 31% withdrew, so results are less certain than they look.
| Item | Medicine | Placebo |
|---|---|---|
| Contrave, COR-I | 5.4% | 1.3% |
| Contrave, COR-BMOD (with intensive behavior program) | 8.1% | 4.9% |
| Contrave, COR-Diabetes | 3.7% | 1.7% |
| Qsymia 15/92 mg, Study 1 (BMI 35+) | 10.9% | 1.6% |
| Qsymia 15/92 mg, Study 2 (with conditions) | 9.8% | 1.2% |
Separate trials, different populations and designs. Qsymia's mid dose (7.5/46 mg) led to -7.8% in Study 2.
Source: Contrave prescribing information (Table 6); Qsymia prescribing information (Table 10) (checked on October 6, 2026)
Comparing across trials. Network meta-analyses combine many trials to estimate how drugs compare. In one published in JAMA in 2016 (28 trials, 29,018 people), 75% of people taking phentermine-topiramate and 55% taking naltrexone-bupropion lost at least 5% of their weight at one year, compared with 23% on placebo. Extra weight lost beyond placebo was about 8.8 kg (19 lb) with phentermine-topiramate and 5.0 kg (11 lb) with naltrexone-bupropion. A 2024 Lancet analysis (132 trials) again ranked phentermine-topiramate among the most effective pills for weight. These analyses are useful but are not the same as a head-to-head trial, and both predate newer medicines.
| Item | Value |
|---|---|
| Phentermine-topiramate (Qsymia) | 75% |
| Naltrexone-bupropion (Contrave) | 55% |
| Placebo | 23% |
Median shares across trials; indirect comparison. Trial attrition was 30-45%.
Source: Khera R et al., JAMA 2016 (28 randomized trials, 29,018 people) (checked on October 6, 2026)
Teens: Qsymia was studied in 223 adolescents with obesity; BMI fell 7.1% at the top dose while it rose 3.3% on placebo over the trial. Contrave is not approved for anyone under 18. For context, GLP-1 medicines generally led to larger average losses in their trials; see injections vs pills.
Effects beyond the scale
| Measure (label trials, 1 year) | Contrave vs placebo | Qsymia vs placebo |
|---|---|---|
| Waist size | -6.2 cm vs -2.5 cm (COR-I) | -10.9 cm vs -3.1 cm (Study 1, top dose) |
| Blood sugar (HbA1c) in people with type 2 diabetes | -0.6 vs -0.1 points (COR-Diabetes) | -0.4 vs -0.1 points in the 388 Study 2 participants with type 2 diabetes (starting HbA1c 6.8%) |
| Heart rate and blood pressure | Blood-pressure-related side effects 6.3% vs 4.2%; the largest differences were in the first 12 weeks | Average heart rate about 1 to 2 beats per minute higher than placebo; a rise of more than 20 bpm at some visit in 19.6% at the top dose vs 11.9% |
Neither label claims a benefit on heart attacks or strokes: both say their effect on cardiovascular illness and death has not been established. That is one difference from some GLP-1 medicines, such as Wegovy, which has a heart-risk indication.
Side effects compared
The side-effect profiles are quite different, which is often what people and their clinicians weigh most.
| Item | 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% |
24% stopped Contrave because of side effects vs 12% on placebo; nausea was the leading reason (6.3%).
Source: Contrave prescribing information (DailyMed), adverse reactions table (checked on October 6, 2026)
| Item | Top dose (15 mg + 92 mg) | Mid dose (7.5 mg + 46 mg) | Placebo |
|---|---|---|---|
| Tingling (paresthesia) | 20% | 14% | 2% |
| Dry mouth | 19% | 14% | 3% |
| Constipation | 16% | 15% | 6% |
| Altered taste | 9% | 7% | 1% |
| Insomnia | 9% | 6% | 5% |
| Dizziness | 9% | 7% | 3% |
Mood and sleep problems and attention or memory effects were also more common than with placebo.
Source: Qsymia prescribing information (DailyMed), Table 1 (checked on October 6, 2026)
Serious risks and who should not take them
| Contrave | Qsymia | |
|---|---|---|
| Main warnings | Suicidal thoughts (boxed warning); seizures (about 0.1% in trials); raised blood pressure and heart rate; opioid overdose risk if opioids are used to overcome the blocker; liver injury; mania; angle-closure glaucoma | Birth defects (oral clefts) if taken in pregnancy; faster heart rate; mood and sleep effects and suicidal thoughts (anti-seizure class); thinking and memory problems; eye problems (acute myopia, glaucoma); metabolic acidosis; kidney stones; seizures if stopped suddenly; slower growth in teens |
| Do not use with (label contraindications, examples) | Uncontrolled high blood pressure; seizure disorder; anorexia or bulimia; chronic opioid use; other bupropion products; MAOI antidepressants within 14 days | Pregnancy; glaucoma; overactive thyroid; MAOI antidepressants within 14 days; allergy to its ingredients |
| Pregnancy | Not for use in pregnancy; stop if pregnant | Pregnancy test before starting and every month; effective birth control required; dispensed only by certified pharmacies (REMS) |
| Alcohol | Minimize or avoid (seizure risk) | May add to dizziness and drowsiness |
| Stopping | Follow the prescriber’s plan | Taper gradually (seizure risk if stopped suddenly) |
Interactions matter with both. Contrave interacts with opioids (including some cough and pain medicines), MAOIs, some antidepressants and heart medicines, and drugs that lower the seizure threshold. Qsymia interacts with MAOIs, alcohol and sedatives, some diuretics (low potassium), other carbonic-anhydrase inhibitors and birth-control pills (irregular bleeding). Bring a complete list of your medicines and supplements to your appointment.
Cost and coverage (checked on October 6, 2026)
- Contrave: CurAccess offers $99 or less a month with free delivery, processed as cash, and is open to people with or without insurance, including Medicare Part D, Medicaid and TRICARE enrollees paying cash. The savings card (private insurance) cannot be used by Medicaid beneficiaries. Contrave’s online service charges a $45 consult fee if it is prescribed.
- Qsymia: home delivery is $74.99 for a 30-day prescription ($70 a month on 90-day prescriptions where available); a GoodRx manufacturer discount of $75 for 30 days and a Costco member cash price of $65.99 are listed. The copay card is not available to California or Massachusetts residents. Qsymia’s telehealth consult is $65 and is not offered in every state. Generic phentermine-topiramate ER is also available; prices vary by pharmacy.
- Medicare: Medicare Part D is barred by law from covering drugs used for weight loss, and neither pill is on the temporary GLP-1 Bridge list. Some Medicaid programs cover weight-management drugs; many do not.
Read more on the costs hub and the insurance hub.
Other options to ask about
Other approved pills include orlistat (prescription and over the counter as Alli), the GLP-1 pills Wegovy pill and Foundayo, and short-term phentermine. All are listed on the weight-loss pills hub and the medications hub. Lifestyle foundations matter with any of them; start with how to lose weight, and if emotional eating is part of the picture, see emotional eating.
Compared with the items
Related guides
Weight-Loss Pills: prescription, over-the-counter and supplements, by evidenceWeight-loss pills by evidence: FDA-approved prescription pills (Wegovy pill, Foundayo, Qsymia, Contrave, orlistat, phentermine), Alli over…
Appetite Suppressants: prescription options vs supplement claimsAppetite suppressants compared from FDA labels: phentermine, Qsymia, Contrave and GLP-1s, plus supplement claims rated and…
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Questions to ask a professional
- Given my blood pressure, mood history and seizure risk, is either pill safe for me?
- Do any of my medicines, including pain medicines and antidepressants, interact with either one?
- If I could become pregnant, what birth control would I need with Qsymia?
- How will we judge at 12 weeks whether it is working?
- Would a GLP-1 medicine or orlistat be worth considering instead?
- What will it cost me with my insurance, a cash program or a generic?
Frequently asked questions
Which works better, Contrave or Qsymia?
No trial compared them directly. In a 2016 network meta-analysis, 75% of people on phentermine-topiramate and 55% on naltrexone-bupropion lost at least 5% of their weight at one year (placebo 23%). Side effects, safety rules and your health history matter as much as averages.
Are Contrave and Qsymia GLP-1 medicines?
No. Contrave combines naltrexone and bupropion; Qsymia combines phentermine and topiramate. They work through different brain pathways than GLP-1 medicines such as Wegovy or Zepbound.
Is Qsymia a controlled substance?
Yes. Qsymia is Schedule IV because it contains phentermine. Contrave is not a controlled substance.
Can I take Contrave if I take opioid pain medicine?
Contrave is contraindicated with chronic opioid use, and its naltrexone can block opioid pain relief and trigger withdrawal. The label has specific advice for planned opioid treatment; talk to your prescriber.
Why does Qsymia require pregnancy tests?
Topiramate can cause birth defects such as oral clefts. The label calls for a pregnancy test before starting and monthly, effective birth control, and dispensing through certified pharmacies under a REMS program.
What are the most common side effects?
Contrave: nausea (32.5%), constipation, headache, vomiting and dizziness. Qsymia: tingling, dry mouth, constipation, altered taste, insomnia and dizziness, with rates rising at higher doses.
How much do they cost?
On 2026-10-06, Contrave's CurAccess program was $99 or less a month and Qsymia home delivery $74.99 for 30 days ($70 a month on 90-day prescriptions where available). A generic of Qsymia exists; Contrave has no generic listed.
Does Medicare cover them?
Medicare Part D is barred by law from covering drugs used for weight loss, and neither pill is part of the temporary GLP-1 Bridge. Contrave's cash program is open to Medicare enrollees paying cash.
How long until I know if it is working?
Both labels use 12-week check-ins. Contrave: stop if less than 5% weight loss after 12 weeks at the maintenance dose. Qsymia: step up if less than 3% after 12 weeks, and stop gradually if less than 5% after 12 weeks at the top dose.
References
- CONTRAVE (naltrexone HCl and bupropion HCl) extended-release tablets: prescribing information. Nalpropion Pharmaceuticals, via DailyMed, 2025. (accessed October 6, 2026) Drug label
- QSYMIA (phentermine and topiramate) extended-release capsules: prescribing information. Vivus, via DailyMed, 2026. (accessed October 6, 2026) Drug label
- Drugs@FDA: Contrave, NDA 200063 (original approval 2014-09-10). U.S. Food and Drug Administration. (accessed October 6, 2026) Government page
- Drugs@FDA: Qsymia, NDA 022580 (original approval 2012-07-17). U.S. Food and Drug Administration. (accessed October 6, 2026) Government page
- Khera R, Murad MH, Chandar AK, et al.. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA, 2016. doi:10.1001/jama.2016.7602 · PMID 27299618 (accessed October 6, 2026) Meta-analysis
- Shi Q, Wang Y, Hao Q, et al.. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet, 2024. PMID 38582569 (accessed October 6, 2026) Meta-analysis
- Contrave savings and CurAccess pharmacy. Currax Pharmaceuticals. (accessed October 6, 2026) Other
- Qsymia pricing and home delivery. Vivus. (accessed October 6, 2026) Other
- What Medicare’s Temporary Program Covering GLP-1s for Obesity Means for Beneficiaries. KFF, 2026. (accessed October 6, 2026) Other
- Medicare GLP-1 Bridge: information for providers. Centers for Medicare and Medicaid Services. (accessed October 7, 2026) Government page
- 988 Suicide and Crisis Lifeline. 988 Lifeline. (accessed October 6, 2026) Other
Facts checked on October 6, 2026
Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.