The increasing prevalence of obesity worldwide has led to a surge in the use of pharmaceutical treatments for weight loss. Prescription medications, often integrated with lifestyle modifications like dietary changes and exercise, are now a key part of many weight management plans. Ozempic and Contrave are two such medications that have gained significant traction due to their effectiveness.

Also Read: Natural Weight Loss Methods

Approved by the FDA in 2017 and 2014 respectively, Ozempic and Contrave have become mainstays in the battle against obesity. Though Ozempic was initially developed for type 2 diabetes and Contrave specifically for weight loss, both have proven successful in aiding patients to achieve substantial weight reduction.

Ozempic vs Contrave: An Overview

What is Ozempic?

Ozempic, with semaglutide as its active ingredient, regulates blood sugar. It enhances insulin release, slows gastric emptying, and reduces appetite. These actions help manage blood sugar and promote weight loss. The FDA approved Ozempic for type 2 diabetes, noting weight reduction benefits. Off-label, it effectively reduces body weight in non-diabetic obese individuals.

Also Read: Liraglutide vs Semaglutide for Weight Loss

The typical mode of administration for Ozempic is a once-weekly subcutaneous injection, making it a convenient option for many patients. The starting dose is usually 0.25 mg per week, gradually increasing to a maintenance dose of 0.5 mg to 1 mg based on glycemic response and tolerability. This progressive dosing schedule helps mitigate gastrointestinal side effects, which are common during the initial phase of treatment.

What is Contrave?

Contrave is a prescription medication for weight loss . It combines two drugs: bupropion and naltrexone. Bupropion treats depression and aids smoking cessation, while naltrexone helps with alcohol and opioid dependence. Together, they help reduce appetite and control cravings.

Also Read: How Contrave Works for Weight Loss

The primary use of Contrave, as approved by the FDA, is to help manage weight in adults with a body mass index (BMI) of 30 kg/m² or higher (obese), or 27 kg/m² or higher (overweight) in the presence of at least one weight-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia. It is intended for use in conjunction with a reduced-calorie diet and increased physical activity.

The mode of administration for Contrave is oral, and the typical dosage involves a titration method to minimize side effects. The recommended starting dose is one tablet in the morning for the first week, which allows patients to adjust to the medication.

Comparing Ozempic vs Contrave

How does Ozempic Work?

Ozempic (semaglutide) operates as a potent medication for weight loss by mimicking the actions of an endogenous hormone known as glucagon-like peptide-1 (GLP-1). GLP-1 is a key hormone involved in glucose metabolism and appetite regulation. By activating GLP-1 receptors, Ozempic enhances the release of insulin from the pancreas in response to elevated blood glucose levels, which is critical for patients with type 2 diabetes.

For weight loss, the mechanism extends beyond just improved insulin secretion. Ozempic slows gastric emptying—the rate at which food leaves the stomach and enters the small intestine. This delay in gastric emptying helps to prolong feelings of fullness after eating, reducing overall calorie intake.

Furthermore, GLP-1 receptor agonists like semaglutide influence areas in the brain that regulate appetite and satiety, leading to a decrease in hunger and an increased sensation of fullness. This dual action on both the gut and the brain makes Ozempic an effective agent for weight management.

In addition to its primary mechanisms, Ozempic offers several secondary benefits that contribute to weight loss and overall health improvement:

• Improved glycemic control

• Cardiovascular benefits

• Reduction in inflammation

• Improved fat metabolism

How does Contrave work?

Contrave is effective for weight loss primarily due to its two active components: bupropion and naltrexone. Each ingredient targets different mechanisms within the brain's pathways that influence body weight and appetite, focusing particularly on the brain’s reward system.

Bupropion is a well-known antidepressant and smoking cessation aid that functions as a reuptake inhibitor of dopamine and norepinephrine. By blocking their reuptake, bupropion increases the levels of these neurotransmitters in the brain, which are associated with heightened feelings of pleasure and satisfaction.

This increase can reduce the feelings of deprivation that often accompany dietary restrictions and can help manage the psychological component of hunger.

Naltrexone, on the other hand, is primarily used to manage alcohol and opioid dependence. It works as an opioid antagonist, blocking the opioid receptors in the brain. This blockade is thought to inhibit the feedback circuit that rewards eating behavior, particularly in response to high-calorie foods, which are often linked to addictive eating behaviors. By disrupting this reward pathway, naltrexone helps reduce cravings and the desire to overeat.

When used together in Contrave, bupropion and naltrexone create a synergistic effect that targets both the maintenance of higher dopamine and norepinephrine levels and the inhibition of the reward system linked to food intake. This dual action makes it easier for individuals to adhere to reduced-calorie diets and manage compulsive eating behaviors.

While the primary function of Ozempic (semaglutide) relates to glycemic control and reduced appetite through slowed gastric emptying, it also offers several secondary benefits that can support long-term weight management:

• Cardiovascular improvements

• Anti-inflammatory effects

• Improved lipid profiles

• Enhanced satiety

Ozempic vs Contrave Comparison Table

Contrave vs Ozempic: Which is More Effective for Weight Loss?

Contrave Weight Loss Results

Recent studies and clinical trials provide new insights into Contrave's (naltrexone/bupropion) effectiveness in weight management.

For instance, a 2021 clinical trial  evaluated Contrave's role in maintaining weight loss after a six-month intensive behavior modification program. This trial involved 89 participants with a BMI of ≥27 kg/m². They first underwent behavior modification, followed by Contrave treatment.

Results showed Contrave helped many participants maintain or lose more weight. Over half of the participants on Contrave sustained or further reduced their weight beyond initial loss achieved during behavior modification.

Another study  highlighted Contrave's general efficacy in weight loss among overweight or obese individuals. Participants experienced a significant weight reduction, averaging a 6.5% loss of baseline body weight over a year. This study emphasized Contrave’s role in reducing appetite and controlling cravings through its dual-action on the brain’s reward system.

In a crossover study , participants switching from placebo to Contrave continued to lose or maintain weight effectively, showcasing its potential for long-term weight management.

Side effects of Contrave

Common side effects associated with Ozempic (semaglutide) include:

• Nausea
• Constipation
• Headache
• Vomiting and Diarrhea
• Dizziness
• Dry Mouth
• Increased Blood Pressure and Heart Rate
• Insomnia

Ozempic Weight Loss Results

Ozempic’s active ingredient, semaglutide, is also used in higher doses under the brand name Wegovy for weight loss. The clinical trials for Wegovy provide a proxy for understanding the potential weight loss effects of semaglutide, even at the lower doses used in Ozempic. 

Wegovy's approval for weight management was based on a series of rigorous clinical trials known as the STEP (Semaglutide Treatment Effect in People with obesity) trials. These trials assessed the efficacy of once-weekly injections of semaglutide in promoting weight loss among adults with obesity or overweight with at least one weight-related comorbidity.

STEP 1 Trial : This 68-week, randomized, double-blind, placebo-controlled trial involved over 1,900 participants with a BMI of 30 or higher, or 27 or higher with at least one weight-related condition. The participants receiving Wegovy experienced a significant average weight reduction of about 14.9% of their initial body weight, compared to 2.4% in the placebo group.

STEP 2 Trial : Focused on individuals with type 2 diabetes, this trial showed that participants achieved an average weight loss of approximately 9.6% from baseline with Wegovy, compared to 3.4% with placebo, highlighting semaglutide's dual benefits for glycemic control and weight reduction.

STEP 3 Trial : This trial emphasized intensive behavioral therapy and dietary changes alongside Wegovy. Participants saw an average weight loss of 16% from baseline, demonstrating the enhanced effectiveness of combining medication with lifestyle modifications.

STEP 4 Trial : Participants who continued with Wegovy treatment maintained significant weight loss during the 68-week period, whereas those who switched to placebo regained weight, underlining the importance of continued therapy for sustaining weight loss.

Side effects of Ozempic

Common side effects associated with Ozempic (semaglutide) include:

• Nausea

• Vomiting

• Diarrhea

• Abdominal pain

• Constipation

• Indigesti

• Bloating

Ozempic vs Contrave: Safety Considerations

Safety Precautions for Ozempic

Ozempic (semaglutide), primarily used for type 2 diabetes management and off-label for weight loss, has several safety considerations:

1. Monitoring Thyroid Health:

   Due to the potential risk of thyroid C-cell tumors observed in animal studies, it's crucial to monitor any symptoms indicative of thyroid tumors, such as a lump in the neck, hoarseness, difficulty swallowing, or shortness of breath.

2. Avoidance in Certain Conditions:

   Patients with a personal or family history of medullary thyroid carcinoma (MTC) or those with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should not use Ozempic.

3. Gastrointestinal Monitoring:

   Given the common side effects like nausea, vomiting, and diarrhea, patients should stay hydrated. If symptoms are severe, consult a healthcare provider as these may lead to dehydration.

4. Hypoglycemia Risk: 

   When used with other diabetes medications that can cause low blood sugar, like insulin or sulfonylureas, monitor blood sugar levels closely and adjust dosages as necessary.

5. Diabetic Retinopathy: 

   Patients with a history of diabetic retinopathy should be monitored closely, as rapid changes in blood sugar levels can worsen this condition.

6. Pancreatitis:

   Be aware of severe abdominal pain as this could indicate pancreatitis. Immediate medical attention is necessary if this symptom occurs.

Safety Precautions for Contrave

Contrave, combining naltrexone and bupropion, is used for weight management and requires the following safety precautions:

1. Psychiatric Health Monitoring:

   Since Contrave includes bupropion, an antidepressant, it carries a risk of mood changes, including depression and suicidal thoughts. Patients should be monitored for any new or worsening mood symptoms.

2. Seizure Risk:

   Avoid Contrave in individuals with a history of seizures, as bupropion can lower the seizure threshold. Alert medical personnel about any sudden onset of seizures.

3. Avoidance with Opioid Use:

   Due to naltrexone’s opioid antagonistic properties, Contrave should not be used by individuals taking opioid medications, as it can precipitate withdrawal symptoms.

4. Substance Abuse History:

   Patients with a history of substance abuse should use Contrave cautiously, and under close supervision, due to the potential for misuse of the bupropion component.

5. Hypertension Monitoring:

   Contrave can raise blood pressure and heart rate; thus, patients with hypertension should have their blood pressure monitored regularly.

6. Allergic Reactions: 

   Watch for signs of allergic reactions such as rash, itching, or swelling, and seek immediate medical attention if these occur.

Ozempic vs Contrave: Cost and Insurance Coverage

The cost and insurance coverage of weight management medications can significantly impact their accessibility and affordability.

Ozempic Cost and Insurance Coverage in Canada

• Retail cost :

  Without insurance, Ozempic costs CAD 120-140 per pen, lasting about a month. Prices vary by pharmacy and region.

• Insurance coverage :

  Many private insurance plans in Canada cover Ozempic, reducing out-of-pocket costs. Coverage depends on the policy and purpose, like diabetes management versus weight loss.

• Provincial coverage :

  Provincial health plans, like Ontario's Drug Benefit Program, might cover Ozempic with special authorization, primarily for diabetes management.

• You can get a prescription for Ozempic in Canada  from Science & Humans

Contrave Cost and Insurance Coverage in Canada

• Retail cost :

  Contrave costs CAD 225-250 per month. Prices vary by pharmacy and region.

• Insurance coverage :

  Many private insurance plans in Canada cover Contrave if deemed medically necessary for obesity. Documentation of previous weight loss efforts may be required.

• Provincial coverage :

  Provincial plans like PharmaCare may cover Contrave with prior authorization and proof of medical necessity.

• You can get a prescription for Contrave in Canada from Science & Humans

Contrave vs Ozempic: When to Choose One Over the Other

When to Choose Contrave

Contrave (naltrexone HCI/bupropion HCI) is primarily designed for weight loss and is most suitable in the following scenarios:

• Targeting eating behaviors: Contrave helps control food cravings and appetite by targeting the brain's reward pathways, ideal for stress or emotional eating.
• Patients without diabetes:  Contrave is for weight loss in non-diabetic patients, not for those with type 2 diabetes.
• Previous success with Bupropion or Naltrexone: Patients who responded well to bupropion or naltrexone for other conditions may benefit from Contrave.

Comprehensive weight management program: Contrave is most effective when combined with diet, exercise, and a comprehensive weight management program.

When to Choose Ozempic

Ozempic (semaglutide) is initially approved for type 2 diabetes but also has significant benefits for weight loss, particularly suitable in the following cases:

• Patients with Type 2 Diabetes: Ozempic is ideal for overweight or obese individuals needing blood sugar management, improving glycemic control and promoting weight loss.
• Cardiovascular Benefits: Ozempic reduces cardiovascular risks, crucial for patients with obesity and related comorbidities like hypertension and high cholesterol.
• Less frequent dosing: Ozempic’s once-weekly injection is more convenient than Contrave’s daily oral administration.
• Higher weight loss expectations: Clinical trials show Ozempic often results in more significant weight loss than Contrave.

The choice between Contrave and Ozempic should be made based on individual medical needs, lifestyle considerations, and personal health goals. 

Why some people prefer Contrave over Ozempic

• Psychological eating challenges: Contrave is effective for those with behavioral eating issues, like stress-related snacking or non-hungry eating, due to its central nervous system activity that suppresses appetite and cravings.
• Suitability for non-diabetic patients: Contrave is focused solely on weight loss, ideal for individuals without diabetes.
• Preference for pill form: Contrave's oral tablet form may be preferable for those averse to injections.
• Contraindications with Ozempic: Individuals with certain medical histories or severe gastrointestinal reactions to GLP-1 agonists might opt for Contrave.

Why some people prefer Ozempic over Contrave

• Integrated diabetes management: Ozempic is beneficial for those needing to manage both blood sugar and body weight, providing dual benefits in one medication.
• Cardiovascular health benefits: Ozempic is shown to improve cardiovascular risk factors, which is crucial for patients with obesity-related heart issues.
• Convenience of Dosing: The once-weekly injection of Ozempic may be more convenient compared to the daily pills required by Contrave.
• Higher efficacy in weight reduction: Ozempic generally offers more significant weight loss, making it the preferred choice for those aiming for substantial weight reduction.
• Contraindications with Contrave: Patients sensitive to the psychiatric side effects of bupropion or those with contraindications for naltrexone, such as opioid use, might find Ozempic more appropriate.

Alternatives to Ozempic and Contrave

If you are looking for alternatives to Ozempic, you may try:

• Victoza (liraglutide) : Also a GLP-1 receptor agonist, used for type 2 diabetes and approved for weight loss under the brand name Saxenda . It helps control blood sugar levels and promotes satiety. You can get a prescription for Saxenda in Canada from Science & Humans.
• Trulicity (dulaglutide): Similar to Ozempic, it's a once-weekly injectable GLP-1 receptor agonist used to improve blood sugar control in adults with type 2 diabetes.
• Bydureon (exenatide extended-release): Another GLP-1 receptor agonist, administered weekly to improve glycemic control in adults with type 2 diabetes.
• Metformin: Often the first medication prescribed for type 2 diabetes, effective in lowering glucose production in the liver and improving the body's sensitivity to insulin.

On the other hand, Contrave (naltrexone HCI/bupropion HCI) alternatives include:

• Phentermine: A short-term use appetite suppressant that affects the central nervous system, commonly prescribed for weight loss.
• Qsymia (phentermine and topiramate extended-release): Combines an appetite suppressant with a medication that increases the feeling of being full. It is used for chronic weight management.
• Liraglutide (Saxenda): As mentioned above, while also a GLP-1 receptor agonist like Ozempic, it's approved specifically for weight loss.
• Orlistat (Xenical, Alli): A weight loss pill that blocks the absorption of dietary fats, suitable for weight loss in adults.

These alternatives offer different mechanisms of action and can be chosen based on individual health profiles, potential side effects, and specific medical needs.

Conclusion

Ozempic and Contrave are key medications for weight management, each with unique benefits. Ozempic suits those managing weight, blood sugar, and cardiovascular health. Contrave is ideal for those focusing on weight loss, especially with psychological eating issues. The choice depends on individual health needs and priorities.