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Ozempic vs Contrave: Off-Label GLP-1 vs FDA Weight-Loss Pill

Ozempic (semaglutide, Novo Nordisk) vs Contrave (naltrexone-bupropion, Currax Pharmaceuticals)

Last verified 2026-05-28

By Eli Marsden · Founding Editor
Editorially reviewed (not clinically reviewed) · How we verify contentLast reviewed

The verdict

Contrave is the FDA-approved chronic weight-management drug here; Ozempic is FDA-approved only for type 2 diabetes and cardiovascular risk reduction. Off-label Ozempic still beats Contrave on weight loss (roughly 10-15% TBWL on 1 mg versus ~6% with Contrave in COR-I), but the indicated semaglutide for weight loss is Wegovy. Contrave wins on price (~$99/mo cash) and oral route; Ozempic wins on glycemic and cardiovascular outcomes for diabetic patients.

Side-by-side comparison

FieldOzempicContrave
FDA-approved indicationType 2 diabetes (2017); CV risk reduction in T2D with CVDChronic weight management with BMI >=30 or >=27 + comorbidity (2014)
Drug class / mechanismGLP-1 receptor agonist (semaglutide)Opioid antagonist + aminoketone antidepressant (naltrexone 8 mg + bupropion 90 mg)
Route and dosingWeekly subcutaneous injection; 0.25 -> 0.5 -> 1 -> 2 mgOral tablet, twice daily; titrated to 32 mg/360 mg total daily dose over 4 weeks
Average weight loss at ~1 year (label dose)~10-15% TBWL off-label at 1-2 mg (Wegovy is the indicated semaglutide; STEP-1 ~14.9%)~6.1% body weight vs 1.3% placebo at 56 weeks (COR-I)
Cash price (US, 2026)~$599-$999/month brand list; NovoCare savings for T2D patients with coverage~$99/month via Currave/Currax direct-pay program
Cardiovascular outcomes26% reduction in major CV events in SUSTAIN-6 (T2D + high CV risk)No proven CV mortality benefit; LIGHT trial terminated early in 2015
Most common side effectsNausea ~15-20%, vomiting, constipation, diarrheaNausea ~30%, constipation, headache, insomnia, dry mouth
Boxed warnings / major safetyBoxed warning: thyroid C-cell tumors (rodent data); contraindicated with personal/family MTC or MEN 2Boxed warning: suicidal thoughts/behaviors in young adults (bupropion); seizure risk; contraindicated in uncontrolled hypertension, seizure disorder, eating disorders, chronic opioid use
Use for weight loss without diabetesOff-label only; Wegovy is the FDA-approved semaglutide for obesityOn-label for adults with BMI >=30, or BMI >=27 with weight-related comorbidity

Frequently asked questions

Is Ozempic FDA-approved for weight loss?

No. Ozempic is FDA-approved only for type 2 diabetes and to reduce cardiovascular risk in adults with T2D and established cardiovascular disease. The FDA-approved semaglutide for chronic weight management is Wegovy (semaglutide 2.4 mg weekly). Doctors do prescribe Ozempic off-label for weight loss, but it is not the labeled use.

Which one causes more weight loss, Ozempic or Contrave?

Off-label Ozempic typically produces about 10-15% total body weight loss at 1-2 mg weekly, based on semaglutide trials such as STEP-1 with the higher-dose Wegovy formulation. Contrave produced about 6.1% body weight loss versus 1.3% with placebo at 56 weeks in the COR-I phase 3 trial (PMID 20673995). On efficacy alone, semaglutide outperforms naltrexone-bupropion.

How much does each drug cost in 2026?

Contrave is roughly $99 per month through the manufacturer's direct-pay program. Ozempic's list price is about $999/month and cash prices typically run $599-$899/month; NovoCare savings can reduce out-of-pocket cost for patients with commercial insurance and a T2D diagnosis, but cash-pay patients seeking off-label weight loss usually pay full retail.

Is Contrave safer than Ozempic?

They have different risk profiles. Contrave carries a boxed warning for suicidal thoughts and behaviors in young adults (from bupropion), plus seizure risk and contraindications in uncontrolled hypertension, eating disorders, chronic opioid use, and seizure disorders. Ozempic carries a boxed warning for thyroid C-cell tumors (rodent data) and is contraindicated with personal or family history of medullary thyroid carcinoma or MEN 2. Talk to a prescriber about which warnings apply to you.

Can I take Ozempic and Contrave together?

There is no FDA-approved combination of semaglutide and naltrexone-bupropion, and the safety and efficacy of co-administration have not been established in randomized trials. Some specialty obesity clinics use them sequentially or as add-ons in specific cases. This is an off-label decision that should only be made with a clinician who can monitor blood pressure, mood, and gastrointestinal tolerability.

Which drug is better for someone with type 2 diabetes?

Ozempic. It is FDA-approved for type 2 diabetes, lowers HbA1c meaningfully, and reduced major adverse cardiovascular events by 26% in SUSTAIN-6 (PMID 27633186) in T2D patients at high cardiovascular risk. Contrave is not indicated for diabetes and has no proven cardiovascular mortality benefit (the LIGHT cardiovascular outcomes trial was terminated early in 2015).

References

  1. 1.Marso SP, Bain SC, Consoli A, et al.; SUSTAIN-6 Investigators Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes N Engl J Med 2016;375(19):1834-1844. 2016. PMID: 27633186.
  2. 2.Greenway FL, Fujioka K, Plodkowski RA, et al.; COR-I Study Group Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial Lancet 2010;376(9741):595-605. 2010. PMID: 20673995.
  3. 3.U.S. Food and Drug Administration Ozempic (semaglutide) Prescribing Information; Contrave (naltrexone HCl / bupropion HCl) Prescribing Information FDA Drug Labels. 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/209637s022lbl.pdf

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