Question 1

Is Qsymia more effective than Contrave?

Accepted Answer

Yes. At the highest approved dose, EQUIP reported about -10.9% mean body-weight loss at 56 weeks and CONQUER reported about -9.8%, versus about -6.1% at 56 weeks for Contrave in COR-I. That makes Qsymia roughly 1.5-2x more effective on average, though individual response varies. Neither approaches the -15% to -22% range seen with Wegovy or Zepbound.

Question 2

Which is cheaper, Contrave or Qsymia?

Accepted Answer

Contrave is typically about $99/mo via the Currax Direct savings card. Brand Qsymia runs about $100-$200/mo through the Qsymia Advantage program. However, generic phentermine-topiramate is now available and can drop to about $50/mo with GoodRx-style coupons, making the generic the cheapest of the three options.

Question 3

Which has worse side effects?

Accepted Answer

They differ. Contrave is more likely to cause nausea, headache, insomnia, and constipation, and it carries a boxed warning for suicidal thoughts in young adults from the bupropion component. Qsymia more often causes paresthesia (tingling in hands and feet), dry mouth, taste changes, and cognitive slowing, and it requires a REMS contraception program because topiramate increases the risk of oral clefts in pregnancy.

Question 4

Why does Qsymia require contraception but Contrave does not?

Accepted Answer

The topiramate component of Qsymia is associated with an increased risk of cleft lip and cleft palate when used in the first trimester. The FDA requires the Qsymia REMS program: a negative pregnancy test before starting, monthly pregnancy tests, and effective contraception while on the drug for anyone who can become pregnant. Contrave has no such program but is still contraindicated in pregnancy.

Question 5

Should I pick Contrave or Qsymia in 2026 if GLP-1s are not an option?

Accepted Answer

If your goal is the largest possible weight loss on an oral pill, Qsymia (especially the generic) wins. If cost matters most and you are not planning pregnancy, generic phentermine-topiramate is the cheapest effective option. Contrave is the better pick when craving-driven or reward-driven eating dominates, when you want to avoid the REMS contraception requirement, or when topiramate side effects (paresthesia, cognitive slowing) are a deal-breaker.

Question 6

Can I take Contrave or Qsymia with a GLP-1?

Accepted Answer

Off-label combinations of a GLP-1 plus Qsymia or Contrave are sometimes used by obesity-medicine specialists for patients who plateau on a GLP-1 alone, but neither combination is FDA-approved or studied in large randomized trials. The main concerns are stacking nausea (GLP-1 + bupropion or topiramate) and overlapping CNS effects. Do not combine without a clinician who manages obesity pharmacotherapy.

Field	Contrave	Qsymia
Mean weight loss (TBWL)	-6.1% at 56 weeks (COR-I, top dose)	-9.8% to -10.9% at 56 weeks (CONQUER and EQUIP, top dose)
Mechanism	Opioid antagonist (naltrexone) + dopamine/norepinephrine reuptake inhibitor (bupropion); damps reward-driven eating and cravings	Sympathomimetic appetite suppressant (phentermine) + GABA modulator / carbonic anhydrase inhibitor (topiramate); reduces appetite and increases satiety
Dosing	Oral tablets, 4-week titration to 2 tabs twice daily (32 mg naltrexone / 360 mg bupropion ER total)	Once-daily oral capsule, titrate from 3.75/23 mg to 15/92 mg over 2-4 weeks
Cash price (US, 2026)	About $99/mo via Currax Direct savings card; about $700/mo list	About $100-$200/mo via Qsymia Advantage; generic phentermine-topiramate from about $50/mo
FDA approval	September 2014, chronic weight management	July 2012, chronic weight management
Most common side effects	Nausea (about 32%), constipation (about 18%), headache (about 17%), insomnia, dizziness	Paresthesia (tingling), dry mouth, constipation, dysgeusia (taste change), insomnia, cognitive slowing
Boxed warning / REMS	Boxed warning for suicidal thoughts and behaviors in young adults (bupropion class)	REMS program required for teratogenicity (topiramate-associated oral clefts); negative pregnancy test plus contraception required in people who can become pregnant
Cardiovascular outcome data	No outcome trial; LIGHT was terminated early without showing CV benefit	No randomized CV outcome trial; phentermine is a sympathomimetic with cautions in uncontrolled hypertension
Age and BMI eligibility	Adults 18+ with BMI ≥30, or ≥27 with a weight-related comorbidity	Adults 12+ with BMI ≥30 (or ≥95th percentile in adolescents) and adults with BMI ≥27 plus a weight-related comorbidity
Who should avoid it	Uncontrolled hypertension, seizure disorder, eating disorders, chronic opioid use, MAOI within 14 days, pregnancy	Pregnancy or planning pregnancy, glaucoma, hyperthyroidism, MAOI within 14 days; caution with kidney stones and metabolic acidosis history

Contrave vs Qsymia (2026): Oral Second-Line Weight-Loss Pills Compared

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