Question 1

Is Wegovy more effective than Contrave?

Accepted Answer

Yes, by roughly 2-3x on weight loss. STEP-1 reported -14.9% mean body weight at 68 weeks on Wegovy vs about -6.1% at 56 weeks on Contrave in COR-I. Wegovy is also the only one of the two with a randomized cardiovascular outcome benefit (SELECT, MACE -20%).

Question 2

Which is cheaper, Wegovy or Contrave?

Accepted Answer

Contrave is much cheaper. With the Currax Direct savings card, eligible cash-pay patients can pay about $99/mo for Contrave. Wegovy via the NovoCare cash program is about $349/mo for the first two months and about $499/mo after — and list price is about $1,349/mo. Over a year that is roughly a $4,000-$5,000 difference.

Question 3

Which has worse side effects?

Accepted Answer

They differ. Wegovy is more likely to cause nausea (about 44% in STEP-1), vomiting, and diarrhea, mostly during dose escalation. Contrave is more likely to cause headache, insomnia, dizziness, and constipation, and it carries a boxed warning for suicidal thoughts and behaviors in young adults because of its bupropion component. Neither is clearly 'safer' — the right choice depends on your medical history.

Question 4

Can I switch from Contrave to Wegovy (or back)?

Accepted Answer

Yes, with a clinician's guidance. Most patients stop Contrave before starting Wegovy because the GI side effects of titrating onto a GLP-1 can stack with bupropion's nausea. Switching from Wegovy to Contrave usually means tapering Wegovy and starting Contrave's standard 4-week titration; expect some weight regain in the transition since Contrave alone produces less weight loss.

Question 5

Who should not take Wegovy or Contrave?

Accepted Answer

Avoid Wegovy if you have a personal or family history of medullary thyroid carcinoma, MEN 2, or a history of pancreatitis. Avoid Contrave if you have uncontrolled hypertension, a seizure disorder, an eating disorder, chronic opioid use, or have used an MAOI in the past 14 days. Neither is recommended in pregnancy.

Question 6

Does insurance cover Wegovy or Contrave?

Accepted Answer

Commercial coverage for both is inconsistent and usually requires prior authorization documenting BMI ≥30 (or ≥27 with a comorbidity) plus a documented lifestyle attempt. Medicare Part D does not cover either drug for weight loss alone, though Wegovy is covered for the SELECT cardiovascular indication when criteria are met. Medicaid coverage varies by state — only a minority cover GLP-1s for obesity, and Contrave coverage is similarly patchy.

Field	Wegovy	Contrave
Mean weight loss (TBWL)	-14.9% at 68 weeks (STEP-1)	-6.1% at 56 weeks (COR-I)
Mechanism	GLP-1 receptor agonist (appetite + satiety)	Opioid antagonist + dopamine/norepinephrine reuptake inhibitor (reward + craving pathway)
Dosing	Weekly subcutaneous injection, 16-week titration to 2.4 mg	Oral tablets, 4-week titration to 2 tabs twice daily (32 mg naltrexone / 360 mg bupropion total)
Cash price (US, 2026)	About $349/mo first 2 months then $499/mo via NovoCare; $1,349/mo list	About $99/mo via Currave Currax Direct savings card; about $700/mo list
FDA indication	Chronic weight management (2021); cardiovascular risk reduction in adults with CVD + overweight/obesity (2024)	Chronic weight management (2014)
Most common side effect	Nausea (about 44%), diarrhea, vomiting, constipation	Nausea (about 32%), constipation (about 19%), headache (about 18%), insomnia
Boxed warning	Thyroid C-cell tumors (rodent finding); contraindicated in MTC/MEN 2	Suicidal thoughts and behaviors in young adults (bupropion class warning)
Cardiovascular outcome data	SELECT: 20% relative reduction in MACE in adults with CVD + overweight/obesity without diabetes	No outcome trial; LIGHT was terminated early without showing CV benefit
Age and BMI eligibility	Adults and adolescents 12+ with BMI ≥30, or ≥27 with a weight-related comorbidity	Adults 18+ with BMI ≥30, or ≥27 with a weight-related comorbidity
Who should avoid it	Personal/family history of medullary thyroid cancer, MEN 2, history of pancreatitis	Uncontrolled hypertension, seizure disorder, eating disorders, chronic opioid use, MAOI use within 14 days

Wegovy vs Contrave (2026): Weight Loss, Cost, Side Effects

The verdict

Side-by-side comparison

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