Zepbound vs. Contrave for Weight loss: Important Differences and Potential Risks.

Key takeaways

Tirzepatide (Zepbound) and naltrexone / bupropion (Contrave) are both medications used to help with weight loss in adults. However, they belong to different medication classes and have distinct mechanisms of action. Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, administered as a weekly subcutaneous injection. It's also approved for treating moderate-to-severe sleep apnea. In contrast, Contrave combines an opioid antagonist (naltrexone) and a dopamine and norepinephrine reuptake inhibitor (bupropion) and is taken orally as tablets twice daily. While both medications can cause nausea, tirzepatide may lead to side effects like diarrhea and injection site reactions, whereas Contrave can cause headaches and insomnia. Tirzepatide has potential interactions with diabetes medications, warfarin (Jantoven, Coumadin), and birth control pills, while Contrave should not be taken with opioids or certain other medications due to the risk of opioid withdrawal, seizures, and other serious side effects. Both medications are only available in brand-name forms.

Zepbound

(tirzepatide)

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Contrave

(naltrexone / bupropion)

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Summary for Zepbound

Prescription only

Zepbound (tirzepatide) is an injectable medication that's used along with diet and exercise. It helps with weight loss in adults who meet criteria for weight management therapy. It's also approved to treat moderate-to-severe sleep apnea. This medication belongs to the drug class called GIP and GLP-1 agonists. The dosage is 1 injection under the skin once a week. Common side effects include nausea, diarrhea, and injection site reactions. Zepbound (tirzepatide) is only available as a brand-name medication.

Indications for Zepbound

In addition to a balanced diet and exercise plan:

Weight loss and long-term weight management in adults considered obese or overweight with at least one weight-related condition (e.g., high blood pressure, Type 2 diabetes)
Moderate-to-severe obstructive sleep apnea (OSA) in adults considered obese

Pros and Cons for Zepbound

Pros

Taken once a week
Can take with or without food
Has different forms for some people to choose from (vials, single-dose injectable pens, multi-dose KwikPens)

Cons

Must inject under the skin
Can cause bothersome side effects, like nausea, diarrhea, and stomach pain
Can't use with other tirzepatide products (Mounjaro) or with other GLP-1 agonists

Common Side Effects for Zepbound

Nausea (25-29%)
Diarrhea (19-23%)
Constipation (11-17%)
Vomiting (8-13%)
Stomach pain (9-10%)
Indigestion (9-10%)

Warnings for Zepbound

Risk of thyroid cancer
Stomach problems
Kidney damage
Gallbladder problems
Inflammation of the pancreas (pancreatitis)
Allergic reactions
Low blood sugar (hypoglycemia)
Eye problems in people with Type 2 diabetes (diabetic retinopathy)
Lung problems during general anesthesia or deep sedation
Don't share Zepound KwikPens with anyone

Summary for Contrave

Prescription only

Contrave is a combination medication that helps with weight loss for certain adults. It's taken along with a balanced diet and exercise plan. Contrave is a tablet with two active ingredients that help regulate your appetite. They are naltrexone (an opioid antagonist) and bupropion (a dopamine and norepinephrine reuptake inhibitor). Your dosage will slowly increase over the first 3 weeks. Then, you take the maintenance dose of two tablets by mouth twice a day. Some side effects are nausea, constipation, and headache. But it can also have serious risks, like unusual changes in behavior. Contrave is brand name only; there isn't a generic version available yet.

Indications for Contrave

Long-term weight management in certain adults
- Adults with a body mass index (BMI) of 30 kg/m2 or greater
- Adults with a BMI of 27 kg/m2 or greater and a weight-related condition (e.g., high blood pressure, Type 2 diabetes, high cholesterol)

Pros and Cons for Contrave

Pros

Comes as a tablet that you take by mouth
Might start to notice results in as early as 4 weeks (when taken along with a balanced diet and regular exercise)

Cons

Must take twice a day (after the dose ramp-up at the beginning)
Might raise your risk of unusual behavior and thoughts of self-harm
Interacts with a lot of medications

Common Side Effects for Contrave

Nausea (33%)
Constipation (19%)
Headache (18%)
Vomiting (11%)
Dizziness (10%)
Trouble sleeping (9%)
Dry mouth (8%)
Diarrhea (7%)

Warnings for Contrave

Risk of suicidal thoughts and behavior
Possible changes in thoughts, behavior, and mood
Seizures
Don't take Contrave with opioid medications
Higher blood pressure and faster heart rate
Liver problems
Mania (extreme enthusiasm or excitement)
Worsening of glaucoma in certain people
Potential risk of low blood sugar in people taking certain medications for Type 2 diabetes