Ozempic and Contrave are two very different medications that people frequently compare when looking for help with weight loss. Ozempic, containing semaglutide, is a once-weekly injection originally approved for type 2 diabetes but widely used off-label (and via its cousin Wegovy) for obesity management. It belongs to the powerful GLP-1 receptor agonist class that has transformed how doctors approach weight-related conditions.
Contrave, on the other hand, is a combination pill taken daily that combines naltrexone (an opioid antagonist) and bupropion (an antidepressant). It targets brain pathways involved in hunger and cravings, making it a non-stimulant, non-hormonal option for chronic weight management. Approved by the FDA specifically for obesity since 2014, Contrave has a much longer track record than GLP-1 drugs.
Both treatments have helped countless patients lose weight, but they work in entirely different ways, produce different results, and come with distinct side-effect profiles. The ongoing debate about Ozempic vs Contrave for weight loss centers on effectiveness, tolerability, cost, convenience, and long-term sustainability. This detailed comparison helps you understand which option may be a better fit for your individual goals and health needs.
How Ozempic and Contrave Work Differently
Ozempic activates GLP-1 receptors throughout the body, slowing gastric emptying, reducing appetite signals in the brain, and improving insulin release in a glucose-dependent way. This leads to feeling full sooner, eating less, and better blood sugar regulation. The effect is strong and consistent, often resulting in significant, sustained weight loss.
Contrave combines two medications that act on the central nervous system. Bupropion increases dopamine and norepinephrine to reduce cravings and boost energy, while naltrexone blocks opioid receptors to decrease food reward. Together, they help patients feel less driven by hunger and emotional eating.
The fundamental difference is hormonal (Ozempic) versus neurological (Contrave). Ozempic works primarily in the gut-brain axis, while Contrave targets brain chemistry directly. This explains why their results, side effects, and ideal patient profiles vary so much.
Ozempic vs Contrave for Weight Loss: The Direct Answer
Ozempic is generally better than Contrave for most patients seeking maximum weight loss. Head-to-head data is limited, but indirect comparisons and real-world evidence through 2025 show Ozempic (and its weight-loss-specific version Wegovy) producing average weight reductions of 10–15% of body weight (sometimes 20%+), while Contrave typically delivers 5–10% loss. Ozempic’s dual hormonal action provides stronger appetite suppression and metabolic benefits.
Contrave may be better for patients who want an oral pill, cannot tolerate GLP-1 side effects, prefer to avoid injections, or have insurance that covers Contrave more favorably. Ozempic tends to cause more gastrointestinal side effects early in treatment, while Contrave’s profile includes more central nervous system effects (insomnia, headache). The choice depends on your priorities, tolerance, cost, and insurance coverage.
Step 1: Define Your Primary Weight Loss Goal and Preferences
Discuss with your doctor whether your main priority is maximum possible weight loss, ease of use (pill vs injection), tolerability of side effects, cost/insurance coverage, or a combination of these factors. If losing the highest percentage of body weight is most important, Ozempic usually has a clear advantage.
Consider your lifestyle and preferences. Some people strongly prefer pills over injections, while others find weekly shots more convenient than daily dosing. Be honest about your tolerance for potential side effects.
Step 2: Review Clinical and Real-World Weight Loss Data
Look at average results: Ozempic/Wegovy users typically lose 10–15% of body weight (22–33+ pounds for a 200-pound person) over 68–72 weeks in trials. Contrave users average 5–10% (10–20 pounds) in similar time frames. Real-world registries in 2025 confirm this gap persists.
Consider individual factors. Patients with higher starting BMI or insulin resistance often see larger differences, favoring Ozempic. Those sensitive to GI side effects or preferring oral medication may do better with Contrave.
Step 3: Evaluate Cost, Insurance, and Practical Factors
Check your insurance formulary for both medications. Contrave is older and often covered more easily or at lower copays for weight management. Ozempic (or Wegovy) may require prior authorization or step therapy. Manufacturer savings cards can reduce out-of-pocket costs for both.
Think about convenience: Contrave is a daily pill (two tablets twice daily), while Ozempic is a weekly injection. If you dislike needles, Contrave may be more appealing. Discuss which fits your routine and budget best.
| Category | Ozempic / Wegovy (semaglutide) | Contrave (naltrexone/bupropion) | Winner for Most Patients (2025) |
|---|---|---|---|
| Average Weight Loss (1–2 years) | 10–15% (sometimes 20%+) | 5–10% | Ozempic/Wegovy |
| Mechanism of Action | GLP-1 receptor agonist (hormonal) | CNS appetite suppression (neurological) | Ozempic (stronger suppression) |
| Administration | Once-weekly injection | Daily oral tablets (2 twice daily) | Depends on preference |
| Common Side Effects | Nausea, vomiting, diarrhea, constipation | Nausea, headache, insomnia, constipation | Contrave (milder GI) |
| Insurance Coverage (weight loss) | Often requires PA; variable copays | More consistent coverage; lower copays | Contrave |
| Long-Term Data / Track Record | Approved 2017 (Ozempic), 2021 (Wegovy) | Approved 2014 | Contrave (longer history) |
This table compares Zepbound and Mounjaro across the most important categories for weight loss patients in 2025.
Weight Loss Results: Ozempic vs Contrave
Ozempic produces substantially greater weight loss in virtually all comparisons. STEP trials for semaglutide showed average reductions of 14.9–17.4% body weight at the 2.4 mg dose (Wegovy strength), while Contrave trials reported 5–9% loss. Real-world data in 2025 mirrors these differences.
Patients switching from Contrave to Ozempic often report an additional 10–20+ pounds of loss. The hormonal mechanism in Ozempic provides stronger and more consistent appetite suppression than Contrave’s neurological approach.
For those whose primary goal is maximum weight reduction, Ozempic is almost always the superior choice when tolerability allows. Contrave still helps many achieve meaningful 5–10% loss, especially those who cannot tolerate injections or GI side effects.
Side Effects and Tolerability Comparison
Gastrointestinal side effects dominate with Ozempic: nausea (up to 44%), vomiting, diarrhea, and constipation are most common, especially during dose escalation. These tend to be more intense than Contrave’s GI issues. Most improve after 8–12 weeks.
Contrave’s side effects are more neurological: insomnia, headache, anxiety, dry mouth, and constipation are frequent. Nausea occurs but is generally milder than with Ozempic. Some patients experience increased blood pressure or heart rate.
Discontinuation rates are higher with Ozempic early on due to GI intolerance, while Contrave has more dropouts from insomnia or mood changes. Tolerability is highly individual—many patients who struggle with one do well on the other.
Cost and Insurance Coverage in 2025
Ozempic (or Wegovy) is typically more expensive without insurance or savings programs. List price for a 28-day supply ranges from $900–$1,300. Manufacturer savings cards can reduce it to $25/month for eligible commercially insured patients.
Contrave is often cheaper, with list prices around $100–$200/month depending on pharmacy. It tends to have better insurance coverage for weight management on many plans. Manufacturer assistance programs are also available.
Check your specific insurance formulary and use discount cards or cash-pay programs to compare real costs. Walmart, CVS, and other major pharmacies frequently offer competitive pricing for both.
Patient Experiences and Real-World Outcomes
Many patients who switch from Contrave to Ozempic report significantly more weight loss but sometimes struggle with increased nausea initially. Those who tolerate Ozempic rarely go back to Contrave due to superior results.
Online communities show a clear split: people focused on maximum weight loss favor Ozempic, while those prioritizing ease of use (pill vs injection) or milder side effects often prefer Contrave. Individual response varies widely.
Doctors frequently start patients on Contrave for its oral administration and longer track record, then switch to Ozempic if greater weight loss is needed and tolerance allows. Personalized choice leads to the best long-term success.
Summary
When comparing Zepbound vs Mounjaro for weight loss, the two are equally effective because they contain the exact same active ingredient (tirzepatide) at identical doses and produce the same results. Clinical trials and real-world data show average weight reductions of 15–21% with both when used consistently. The only meaningful differences are in insurance coverage, cost, and prescribing practices.
Zepbound is easier to get approved for obesity/weight management, while Mounjaro is more commonly covered for type 2 diabetes. Side effects, tolerability, and long-term outcomes are essentially the same. The brand name does not change the outcome—dose, adherence, and lifestyle do.
Work closely with your healthcare provider to determine which brand is more practical for your situation. Focus on coverage, cost, and your specific health goals to choose the best path forward.
FAQ
Is Zepbound the same as Mounjaro for weight loss?
Yes, Zepbound and Mounjaro are the exact same medication (tirzepatide) with identical dosing and effects. The only difference is FDA-approved indication: Zepbound for weight management, Mounjaro for type 2 diabetes. Weight loss results are the same.
Which is better for weight loss: Zepbound or Mounjaro?
Neither is better—both produce identical weight loss because they contain the same active ingredient at the same doses. Clinical trials and real-world data show average reductions of 15–21% body weight for both when used consistently.
Why do some people get Zepbound and others get Mounjaro?
The choice usually comes down to insurance coverage and diagnosis. Zepbound is easier to get approved for obesity/weight management, while Mounjaro is more commonly covered for type 2 diabetes. Doctors prescribe whichever version insurance approves most easily.
Are side effects different between Zepbound and Mounjaro?
No, side effects are essentially the same because the medication is identical. Nausea, vomiting, diarrhea, and constipation are the most common for both. Tolerability depends on dose and individual response, not the brand name.
Can I switch from Mounjaro to Zepbound or vice versa?
Yes, switching is straightforward since they are the same drug. Many patients switch due to insurance changes without noticing any difference in results or side effects. Your doctor will ensure a smooth transition at the same dose.
Dr. Hamza is a medical content reviewer with over 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic conditions. His reviews are grounded in trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Hamza is intended for educational purposes and is not a substitute for professional medical advice.