Short answer: Wegovy is a GLP-1 drug taken as a weekly injection or daily tablet; Contrave is a twice-daily pill combining naltrexone and bupropion.12 In separate placebo-controlled trials, Wegovy 2.4 mg averaged −14.9% at 68 weeks and Contrave −5.4% at 56 weeks. They have never been tested head to head. Wegovy has a boxed thyroid tumor warning; Contrave's covers suicidal thoughts.
| Wegovy (semaglutide) | Contrave (naltrexone/bupropion) | |
|---|---|---|
| How it works | GLP-1 receptor agonist1 | Opioid antagonist + aminoketone antidepressant2 |
| Form | Weekly injection; also a once-daily tablet1 | Extended-release tablet, twice daily2 |
| Label dosing | Injection: 0.25 mg weekly, stepped up every 4 weeks to 1.7 or 2.4 mg; up to 7.2 mg. Tablet: stepped up every 30 days to 25 mg daily3 | 1 tablet daily in week 1, stepping up to 2 tablets twice daily from week 42 |
| Label trial (adults, no diabetes) | Study 2 (STEP 1), 68 weeks: −14.9% vs −2.4% on placebo1 | COR-I, 56 weeks: −5.4% vs −1.3% on placebo2 |
| Reached at least 5% loss | 83.5% vs 31.1% on placebo1 | 42% vs 17% on placebo2 |
| Label trial (with type 2 diabetes) | Study 3, 68 weeks: −9.6% vs −3.4%1 | COR-Diabetes, 56 weeks: −3.7% vs −1.7%2 |
| Nausea in trials | 44% vs 16% on placebo1 | 32.5% vs 6.7% on placebo2 |
| Boxed warning | Risk of thyroid C-cell tumors1 | Suicidal thoughts and behaviors2 |
| Other approved uses | Cardiovascular risk reduction; MASH with liver fibrosis; ages 12 and up (injection)1 | Weight management in adults only2 |
Not fairly. Wegovy's Study 2 ran 68 weeks in 1,961 adults without diabetes.1 Contrave's COR-I ran 56 weeks, and across Contrave's four trials 45% on placebo and 46% on Contrave left before week 56, mostly in the first 12 weeks.2 The groups, lengths and ways of handling missing data differ. No trial has put the two drugs side by side.
Wegovy is stepped up slowly to limit stomach side effects: the injection starts at 0.25 mg once a week and rises every 4 weeks.3 Contrave reaches its full dose in 3 weeks, and the label says to stop if you have not lost at least 5% of your weight after 12 weeks on that dose.2 Contrave should not be taken with a high-fat meal, which raises drug levels.2
More detail: Wegovy side effects, Contrave side effects, and the Wegovy and Contrave dosing schedules.
That is a decision for you and your prescriber. Other conditions (heart disease, seizures, depression, opioid use), whether you prefer a weekly shot or daily pills, and insurance coverage often decide it. For other pill options, see Contrave vs Qsymia: how do the two weight-loss pills compare?.