Short answer: Both are for long-term weight management with diet and activity in adults with obesity, or overweight with a weight-related condition.12 Saxenda (liraglutide) is a daily injection stepped up to 3 mg and is also approved from age 12. Contrave is a tablet stepped up to 2 twice daily. Each carries a different boxed warning. Neither label reports a trial against the other.
| Saxenda | Contrave | |
|---|---|---|
| What it is | Liraglutide, a GLP-1 receptor agonist1 | Naltrexone and bupropion, extended-release2 |
| Who | Adults; children 12 and older with obesity and body weight over 60 kg1 | Adults2 |
| How taken | Injection under the skin once a day, any time1 | Tablets in the morning and evening; not with a high-fat meal2 |
| Dose steps | 0.6 mg in week 1, up 0.6 mg each week to 3 mg from week 51 | 1 tablet in week 1, up to 2 tablets twice daily from week 42 |
| Main 56-week trial | Study 1: −7.4% vs −3.0% on placebo; 62.3% vs 34.4% lost at least 5%1 | COR-I: −5.4% vs −1.3% on placebo; 42% vs 17% lost at least 5%2 |
| When adults stop | Under 4% weight loss at 16 weeks, or 3 mg not tolerated1 | Under 5% weight loss after 12 weeks on the full dose2 |
| Nausea | 39.3% vs 13.8% on placebo1 | 32.5% vs 6.7% on placebo2 |
| Stopped for side effects | 9.8% vs 4.3% on placebo1 | 24% vs 12% on placebo2 |
| Missed dose | Resume with the next daily dose; after more than 3 days, restart at 0.6 mg1 | Wait until the next scheduled dose2 |
| Boxed warning | WARNING: RISK OF THYROID C-CELL TUMORS1 | WARNING: SUICIDAL THOUGHTS AND BEHAVIORS2 |
Saxenda's Study 1 enrolled 3,731 adults without type 2 diabetes; average weight change at 56 weeks was −7.4% vs −3.0% on placebo. In Study 2, in adults with type 2 diabetes, it was −5.4% vs −1.7%.1 Contrave's COR-I trial showed −5.4% vs −1.3%; with intensive behavior therapy (COR-BMOD) −8.1% vs −4.9%; and in type 2 diabetes (COR-Diabetes) −3.7% vs −1.7%.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Saxenda's boxed warning is about thyroid C-cell tumors seen in rodents; it is not used with a personal or family history of medullary thyroid carcinoma or MEN 2. Other warnings include pancreatitis, gallstones (2.2% vs 0.8% on placebo), a faster resting heart rate and kidney injury from fluid loss.1 Contrave's boxed warning is about suicidal thoughts and behaviors, because it contains bupropion; other warnings include seizures, raised blood pressure and heart rate, and blocked opioid effects.2
Which, if either, fits is for your prescriber. More detail: Saxenda side effects, Contrave side effects, the Saxenda and Contrave dosing schedules, the Saxenda and Contrave missed-dose pages, the liraglutide and naltrexone-bupropion guides, and Wegovy vs Contrave: what do the labels show?.