Question 1

Which works better for weight loss, Contrave or Qsymia?

Accepted Answer

Contrave recorded -6.1% at 56 weeks (COR-I, top dose); Qsymia recorded -9.8% to -10.9% at 56 weeks (CONQUER and EQUIP, top dose). ⚠ These come from separate trials with different protocols and populations, so the gap between two numbers from two studies is weaker evidence than it looks. No head-to-head trial of this pair is on record here.

Question 2

Are Contrave and Qsymia the same drug?

Accepted Answer

No. Contrave is naltrexone-bupropion and Qsymia is phentermine-topiramate — different molecules, and they work differently: Opioid antagonist (naltrexone) + dopamine/norepinephrine reuptake inhibitor (bupropion); damps reward-driven eating and cravings against Sympathomimetic appetite suppressant (phentermine) + GABA modulator / carbonic anhydrase inhibitor (topiramate); reduces appetite and increases satiety. Results with one do not predict results with the other.

Question 3

Is Contrave or Qsymia cheaper?

Accepted Answer

On the manufacturers' own cash pricing: Contrave at About $99/mo via Currax Direct savings card; about $700/mo list, Qsymia at About $100-$200/mo via Qsymia Advantage; generic phentermine-topiramate from about $50/mo. ⚠ That is the list-price comparison, and it is not what most people pay. What you actually pay depends on whether your plan covers it, which formulary tier it sits in, and whether you have met your deductible — and for many people the honest comparison is between an insured copay and a cash-pay compounded alternative rather than between these two figures.

Question 4

Does either one have better cardiovascular evidence?

Accepted Answer

Neither has a clear edge. Contrave: No outcome trial; LIGHT was terminated early without showing CV benefit. Qsymia: No randomized CV outcome trial; phentermine is a sympathomimetic with cautions in uncontrolled hypertension. This matters more than it first appears — a drug with a completed outcomes trial has evidence about events that matter, not only about weight, and that is often what decides coverage.

Question 5

Which has worse side effects, Contrave or Qsymia?

Accepted Answer

The most common adverse event reported was Nausea (about 32%), constipation (about 18%), headache (about 17%), insomnia, dizziness for Contrave and Paresthesia (tingling), dry mouth, constipation, dysgeusia (taste change), insomnia, cognitive slowing for Qsymia. ⚠ Rates come from separate trial populations and are not a like-for-like comparison. In practice how fast the dose is escalated affects tolerability at least as much as which drug it is, which is one reason a slower titration is worth asking for.

Question 6

How is each one taken?

Accepted Answer

Contrave: Oral tablets, 4-week titration to 2 tabs twice daily (32 mg naltrexone / 360 mg bupropion ER total). Qsymia: Once-daily oral capsule, titrate from 3.75/23 mg to 15/92 mg over 2-4 weeks. Worth weighing honestly against your own habits — the best drug for you is partly the one you will still be taking in eight months, and a dosing routine that does not fit a life gets abandoned.

Question 7

Can I switch from Contrave to Qsymia?

Accepted Answer

Yes, with a prescriber. Expect to re-titrate from the bottom of the new drug's ladder rather than starting where you left off: these are different molecules and tolerance to one does not transfer to the other. Both the old drug's washout and the new drug's schedule apply.

Question 8

Which one should I ask for?

Accepted Answer

That is a prescriber's call, and anyone answering it from a table is guessing. What a page like this can do is tell you what the trials measured, what the manufacturers charge, and where the evidence is still missing, so the conversation starts from the record rather than from an advertisement.

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 not take it	Anyone with uncontrolled high blood pressure, a seizure disorder, an eating disorder, ongoing opioid use, an MAOI in the last two weeks, or who is pregnant	Anyone pregnant or planning to be, with glaucoma or an overactive thyroid, or an MAOI in the last two weeks. Caution with a history of kidney stones or acidosis

Contrave vs Qsymia: The Two Cheap Orals, Compared

The verdict

Side-by-side comparison

Frequently asked questions