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Contrave alternatives, including GLP-1 options

Six options when Contrave is not the right fit, from compounded semaglutide and tirzepatide, which are not FDA approved, to Foundayo, phentermine, Qsymia and the two generics. What each one is and how to choose.

Clinically reviewed
Medically reviewed by Harbor Health TeamMedical Content Team8 min read
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The top three

Prices are Harbor's monthly starting prices
Our pick
Compounded semaglutide vial

01  Compounded semaglutide

A weekly GLP-1 at one monthly price

$99a month, starting price

Compounded tirzepatide vial

02  Compounded tirzepatide

The dual-receptor molecule at one monthly price

$149a month, starting price

03  Foundayo, a daily GLP-1 pill

A GLP-1 for people who want a pill

11.1%mean loss at 17.2 mg vs 2.1% on placebo, 72 weeks

Compounded is not FDA approved. Compounded semaglutide and tirzepatide are not the brand products, and the FDA does not review compounded drugs for safety, effectiveness or quality before they are marketed.

Contrave alternatives at a glance

Contrave is naltrexone and bupropion in one extended-release tablet, approved by the FDA in 2014 to reduce excess weight and keep it off long term. It is not a GLP-1.

A Contrave alternative can be a GLP-1 shot or pill, another oral weight drug, or Contrave's two ingredients prescribed separately. Background on the combination is in this naltrexone & bupropion overview.

From each current FDA label on DailyMed: mean percent weight change on the top studied dose, in separate trials. Brand Wegovy averaged 14.9% at 68 weeks and brand Zepbound 20.9% at 72 weeks.
OptionDrug typeFDA status for weightHow it is takenLabel trial result
Contrave (reference)Opioid antagonist plus antidepressantApproved, long termTablets, twice a day at full dose5.4% vs 1.3% on placebo, 56 weeks
Compounded semaglutideGLP-1Not FDA approvedWeekly injectionNot studied in the brand trials
Compounded tirzepatideGIP and GLP-1Not FDA approvedWeekly injectionNot studied in the brand trials
Foundayo (orforglipron)GLP-1Approved, long termPill, once a day11.1% vs 2.1% on placebo, 72 weeks
PhentermineStimulant appetite suppressantApproved, a few weeks onlyTablet or capsuleA fraction of a pound a week over placebo
QsymiaPhentermine plus topiramate ERApproved, long termCapsule, each morning10.9% vs 1.6% on placebo, 56 weeks
Separate bupropion and naltrexoneThe same two molecules, as genericsNot approved for weightTwo separate prescriptionsNo weight result on either label

Prescription alternatives to Contrave compared

These Contrave alternatives start with GLP-1 medications, which work through a pathway Contrave does not touch, then the other oral drugs and Contrave's own ingredients.

Each figure below comes from a separate label trial with its own length and population, so none is a head-to-head result. Neither compounded option is FDA approved, and FDA has declared the semaglutide and tirzepatide shortages resolved, and the 2025 windows in which it did not act against compounders copying those drugs have ended.

Compounded semaglutide vial
01

Compounded semaglutide

Weekly GLP-1 injection, not FDA approved

$99a month, starting price

Compounded semaglutide contains semaglutide, the active ingredient in Wegovy and Ozempic, prepared by a licensed U.S. pharmacy. It is not FDA approved, and the Wegovy trials tested the brand product, not compounded semaglutide. Contrave vs Wegovy comes down to mechanism and scale. In separate label trials, Contrave averaged 5.4% weight loss vs 1.3% on placebo over 56 weeks, and Wegovy 2.4 mg averaged 14.9% vs 2.4% over 68 weeks. Contrave vs Ozempic is a different question, since Ozempic is approved only for type 2 diabetes and semaglutide's weight approval is Wegovy. Harbor compounded semaglutide starts at $99 a month, prescribed only after a board-certified physician reviews your health history and decides it is appropriate. Your clinician sets the dose.

Where it wins

  • A GLP-1, which Contrave is not
  • One injection a week instead of tablets twice a day
  • One monthly price as the dose goes up

What it costs you

  • Not FDA approved, and not reviewed by the FDA for safety, effectiveness or quality
  • Semaglutide labels rule out a personal or family history of medullary thyroid carcinoma (MTC) or MEN 2
  • An injection, so not for anyone set on a pill

A weekly GLP-1 at one monthly price

Compounded tirzepatide vial
02

Compounded tirzepatide

Weekly GIP and GLP-1 injection, not FDA approved

$149a month, starting price

Compounded tirzepatide contains tirzepatide, the molecule in Zepbound and Mounjaro, prepared by a licensed U.S. pharmacy. It is not FDA approved. The largest difference in label results here is Contrave vs Zepbound, from separate trials. On the Zepbound label, the 15 mg dose averaged 20.9% loss vs 3.1% on placebo over 72 weeks, against Contrave's 5.4% at 56 weeks. Both tested brand products, not compounded tirzepatide. Harbor compounded tirzepatide starts at $149 a month on the same terms: physician review first, then a dose your clinician sets.

Where it wins

  • Acts on GIP and GLP-1 receptors
  • One injection a week
  • One monthly price as the dose goes up

What it costs you

  • Not FDA approved
  • Costs more than compounded semaglutide
  • Tirzepatide labels rule out a personal or family history of MTC or MEN 2

The dual-receptor molecule at one monthly price

03

Foundayo, a daily GLP-1 pill

Orforglipron tablet, approved 2026

11.1%mean loss at 17.2 mg vs 2.1% on placebo, 72 weeks

Foundayo (orforglipron) is a once-daily GLP-1 pill, FDA approved on April 1, 2026, for long-term weight management in adults with obesity, or with overweight and at least one weight-related condition. Its 72-week label trial enrolled 3,127 adults. Treatment starts at 0.8 mg once a day and rises to a 17.2 mg maximum.

Where it wins

  • A pill, taken with or without food
  • A GLP-1, unlike Contrave
  • One tablet a day instead of four

What it costs you

  • Dose rises in steps at least 30 days apart
  • Not for people with a personal or family history of MTC or MEN 2
  • Brand cost and coverage vary

A GLP-1 for people who want a pill

04

Phentermine

Stimulant appetite suppressant, Schedule IV

$43median monthly list price (AWP), July 2025

Phentermine is a stimulant appetite suppressant and a Schedule IV controlled substance. Its label approves it only as a short-term adjunct, a few weeks, alongside diet, exercise and behavior change. Contrave vs phentermine is long term vs short term. Contrave is approved to maintain weight reduction, while the phentermine label puts the added loss over placebo in short-term trials at only a fraction of a pound a week. For the three pills side by side, see oral weight loss pills compared.

Where it wins

  • Lowest median list price on the ADA's 2026 cost table
  • A long-available generic
  • A tablet or capsule, no injections

What it costs you

  • Labeled for a few weeks, not long-term use
  • Schedule IV controlled substance
  • Ruled out by a history of heart disease or stroke, uncontrolled high blood pressure, an overactive thyroid, glaucoma, past drug misuse or pregnancy

A short course, not a long-term plan

05

Qsymia

Phentermine plus topiramate ER, Schedule IV

10.9%mean loss on 15 mg/92 mg vs 1.6% on placebo, 56 weeks

Qsymia pairs low-dose phentermine with extended-release topiramate. It is approved for long-term weight management in adults and in teens 12 and older with obesity. Qsymia vs Contrave on the labels: 10.9% vs 1.6% on placebo for Qsymia's top dose, and 5.4% vs 1.3% for Contrave, in separate 56-week trials. Treatment starts at 3.75 mg/23 mg for 14 days, then moves to 7.5 mg/46 mg.

Where it wins

  • Largest oral non-GLP-1 result here
  • One capsule each morning
  • Approved for ages 12 and up

What it costs you

  • Schedule IV, because it contains phentermine
  • Pregnancy testing before starting and monthly, and only certified pharmacies dispense it
  • Not for pregnancy, glaucoma, an overactive thyroid or MAOI use within 14 days

An oral option outside the GLP-1 class

06

Separate bupropion & naltrexone

Two generics, off-label for weight

Off-labelneither generic is FDA approved for weight

Generic naltrexone and generic bupropion are both FDA approved, for other uses: naltrexone for alcohol dependence and opioid blockade, and bupropion XL for depression and preventing seasonal affective disorder. Neither is approved for weight. Taking bupropion and naltrexone instead of Contrave means two prescriptions. Generic naltrexone tablets come as 50 mg, while Contrave's full dose is 32 mg of naltrexone and 360 mg of bupropion a day, split into two tablets twice daily. Eligibility checks carry over. Bupropion has the same boxed warning on suicidal thoughts and behaviors, and naltrexone rules out opioid pain medicines.

Where it wins

  • The same two molecules as Contrave
  • Both are long-available generics
  • Each drug has its own label and dosing

What it costs you

  • Off-label for weight
  • Generic strengths do not match Contrave's 8 mg/90 mg extended-release tablet
  • Contrave's weight trials tested the combination tablet, not separate generics

A prescriber's off-label call, not a direct swap

How to choose a Contrave alternative

The right alternative to Contrave depends on why you are looking. A clinician usually weighs four things.

  1. Results. The Contrave label says to stop if you have not lost at least 5% of your starting weight after 12 weeks on the maintenance dose. A GLP-1, with a different mechanism, is then a reasonable next conversation.
  2. Your history. Chronic opioid use, seizures, uncontrolled blood pressure and bulimia or anorexia rule Contrave out, and it is stopped in pregnancy. The alternatives have limits of their own.
  3. Your routine. Full-dose Contrave is two tablets twice a day. A GLP-1 can be one weekly injection or one daily pill.
  4. Your budget over a year. Long-term options run for months, so yearly cost matters more than the first fill.

The ADA's 2026 Standards of Care list a median average wholesale price of $750 a month at the maintenance dose, at July 2025 prices and before coverage or discounts. Savings programs and insurance change it, as Contrave cost & insurance coverage explains.

If you are paying cash for a GLP-1, Harbor offers compounded semaglutide from $99 a month and compounded tirzepatide from $149, prescribed only if a board-certified physician decides it is appropriate. Neither is FDA approved.

Who should not take these medicines

Contrave carries a boxed warning on suicidal thoughts and behaviors in young people taking antidepressants, is not approved for children, and is ruled out by uncontrolled high blood pressure, seizures, bulimia or anorexia, chronic opioid use and other bupropion products, and is stopped when a pregnancy is recognized. Every GLP-1 here is ruled out by a personal or family history of MTC or MEN 2. A clinician checks all of this before prescribing. For your own history, message your Harbor clinician.

Frequently asked questions

No. Contrave pairs naltrexone, an opioid antagonist, with bupropion, an antidepressant, and its label describes effects on the brain's appetite center and reward system. Neither ingredient is a GLP-1 receptor agonist.

On national list prices, a cheaper alternative to Contrave is generic phentermine, at a median $43 a month, or Qsymia at $238, against $750 for Contrave, per the ADA's 2026 table of July 2025 prices. Phentermine is labeled for only a few weeks. For a GLP-1 paid in cash, compounded semaglutide starts at $99 a month and is not FDA approved.

Yes, but it is a prescribing decision. Your clinician reviews why Contrave is stopping and every other medicine you take, as with any of these Contrave alternatives. On the brand labels, a GLP-1 starts at its lowest dose, and the prescriber sets each step. For the move in the other direction, see switching from a GLP-1 to Contrave.

Sources

  1. Contrave (naltrexone HCl and bupropion HCl) extended-release tablets label, DailyMed.
  2. Contrave NDA 200063 approval history, Drugs@FDA.
  3. Foundayo (orforglipron) tablets label, DailyMed.
  4. Foundayo NDA 220934 approval history, Drugs@FDA.
  5. FDA approves Foundayo (orforglipron), April 1, 2026.
  6. Phentermine hydrochloride tablets label, DailyMed.
  7. Qsymia (phentermine and topiramate ER) label, DailyMed.
  8. Qsymia NDA 022580 approval history, Drugs@FDA.
  9. Naltrexone hydrochloride tablets label, DailyMed.
  10. Bupropion hydrochloride extended-release tablets (XL) label, DailyMed.
  11. Wegovy (semaglutide) label, DailyMed.
  12. Zepbound (tirzepatide) label, DailyMed.
  13. Ozempic (semaglutide) injection label, DailyMed.
  14. American Diabetes Association. Standards of Care in Diabetes 2026, Section 8, Table 8.2. Diabetes Care. 2026.
  15. FDA's concerns with unapproved GLP-1 drugs used for weight loss.
  16. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize.

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