Contrave, Wegovy, and 4 Other Phentermine Alternatives for Weight Loss
Key takeaways:
Phentermine (Adipex-P, Lomaria) is an oral weight-loss medication. But it’s only approved for short-term use and may not be the right fit for everyone.
Oral phentermine alternatives include topiramate, Qsymia (phentermine / topiramate), and Contrave (naltrexone / bupropion). Orlistat (Alli, Xenical) is available by prescription as well as over the counter for weight loss.
Two injectable phentermine alternatives are Wegovy (semaglutide) and Zepbound (tirzepatide). These seem to be the most effective phentermine alternatives for most people. Your healthcare team can help you choose the right weight-loss medication based on your overall health, other medications, and insurance coverage.
Phentermine (Adipex-P, Lomaira) is an affordable and effective oral weight-loss medication for some people. But it isn’t the best choice for everyone.
Phentermine is a stimulant that helps reduce your appetite. However, it’s only approved for short-term use and may not be a safe option if you have a history of heart problems. It’s also a controlled substance, so phentermine may not be ideal for those with a history of substance misuse. And it may just not work for some people.
If you’re looking for phentermine alternatives for weight loss, we’ve got you covered. Let’s take a look at six options to help you find the best fit for your needs. Keep in mind that all weight-loss medications should be combined with regular exercise and a reduced-calorie diet for best results.
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1. Topiramate
Topiramate (Topamax) is an oral medication that’s FDA approved to treat seizures and migraines. But it’s also commonly prescribed off-label for weight loss.
Topiramate seems to reduce your appetite and help you feel full sooner. It may also help lower the levels of leptin in your body. Leptin is a hormone that tells your body to store fat.
Clinical studies found that after 24 weeks, people taking topiramate lost around 5% of their body weight. Weight loss typically begins within 1 month (4 weeks) of starting topiramate. And for some people, weight loss seems to continue with long-term use, even after 1 year of treatment.
Other than weight loss, the most common topiramate side effects are skin tingling or numbness, drowsiness, and trouble with memory or concentration. You should also avoid alcohol while taking topiramate. And talk to your healthcare team about any interactions with your other medications.
How to save: Topiramate is available as a lower-cost generic. GoodRx can help you save on the average retail price. You can get a month’s supply of generic topiramate for as little as $1.80 at certain pharmacies with a free GoodRx discount.
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2. Qsymia
Qsymia is an oral weight-loss medication that combines two ingredients: phentermine and topiramate ER. Topiramate ER is an extended-release version of topiramate. Qsymia is a once-daily oral capsule that’s approved for adults and children ages 12 and older.
Qsymia is considered one of the most effective oral weight-loss medications. In clinical studies, 70% of people on the highest Qsymia dosage lost at least 5% of their body weight after 56 weeks. And close to half of those taking Qsymia lost at least 10% of their body weight. It typically takes about 8 to 12 weeks to notice weight loss with Qsymia. And it seems safe for long-term weight management.
Common Qsymia side effects include skin tingling or numbness, dry mouth, and constipation. It also has several interactions to be aware of before taking it, including alcohol.
Since Qsymia can cause serious birth defects, you’re required to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program while taking it. This requires monthly pregnancy tests and the consistent use of birth control while taking Qsymia.
How to save: Qsymia is only available as a brand-name medication. If you have commercial insurance, Qsymia’s price is as low as $70 per month with a copay card from the manufacturer. If you’re uninsured or underinsured, you may be eligible for Qsymia’s patient assistance program, which offers the medication for $98 per month.
Good to know: Because it contains phentermine, Qsymia is a controlled substance. So it isn’t recommended if you have a history of substance misuse. And if phentermine or topiramate aren’t safe options for you, Qsymia won’t be either.
3. Contrave
Contrave (naltrexone / bupropion) is also a combination medication that’s approved for weight loss. It’s an oral tablet you’ll take twice a day once you reach your target dosage, and it’s safe to take it long term. Contrave is currently only approved for adults.
The two ingredients in Contrave are naltrexone and bupropion. Naltrexone blocks the rewarding effects of substances such as opioids and alcohol. Bupropion is an antidepressant that’s also used to help people quit smoking.
We don’t know exactly how combining these medications works for weight loss. But we do know that Contrave works on the brain’s appetite and reward centers. This may help reduce food cravings and lower your appetite. So Contrave may be especially useful for emotional eating. In studies, about 40% of adults lost at least 5% of their body weight after taking Contrave for 1 year. And around 20% of adults lost at least 10% of their body weight. It takes about 4 weeks to notice weight loss from Contrave.
The most common Contrave side effects are nausea, constipation, and headache. Contrave isn’t recommended if you have a history of seizures. And you should avoid alcohol while taking it. Have your healthcare team review your medication list for any possible interactions with Contrave.
How to save: Contrave is only available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $20 per month for Contrave using a savings card from the manufacturer. If you’re uninsured or underinsured, you may be eligible for Contrave’s patient assistance program, which provides a month of medication for $99 or less.
4. Orlistat
Orlistat (Xenical) is an older medication that may also be a phentermine alternative. It’s an oral capsule you take three times a day with meals. Prescription orlistat is approved for adults and adolescents ages 12 and older.
Orlistat works directly in your digestive system to prevent your body from absorbing fats in your diet. In studies, over half of adults taking orlistat lost at least 5% of their body weight after 1 year.
Keep in mind that Alli, the over-the-counter (OTC) version of orlistat, is a lower dosage than the prescription version. So the weight loss results won’t be the same. And Alli is only approved for adults.
Side effects can be an issue when taking orlistat. They include loose stools, oily stools, and gas with oily spotting. A low-fat diet can help reduce the chance of side effects. But they’re still unpleasant for some people. Orlistat can also affect the way you absorb your other medications. So be sure to review your medication list with your healthcare team before taking it.
How to save: Prescription orlistat is available as both a brand-name and generic medication. GoodRx can help lower your cost with a free discount. If your prescriber writes a prescription for OTC Alli, a month’s supply may cost as little as $52.90 with a GoodRx discount. Manufacturer coupons are also available for Alli.
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5. Wegovy
Wegovy (semaglutide) is an injectable, once-weekly weight-loss medication. It’s approved for adults and adolescents ages 12 and older. And it seems safe for long-term use.
Wegovy is a glucagon-like peptide-1 (GLP-1) agonist. It slows down the movement of food through your gut. It also reduces cravings, lowers your appetite, and helps you feel full. Wegovy also lowers the risk of heart problems in adults with heart disease who are considered overweight or obese.
Wegovy seems to be more effective than phentermine and other oral phentermine alternatives. Studies show that people lose an average of 15% of their body weight after 16 months of Wegovy. Most people start noticing weight loss after about 4 weeks of using Wegovy.
Common Wegovy side effects include nausea, vomiting, and diarrhea. More serious side effects include an increased risk of pancreatitis, certain thyroid tumors, and stomach paralysis.
Since Wegovy requires an injection, you may also experience skin irritation, bruising, or other injection-site reactions. Wegovy can also change the way you absorb your other oral medications. So be sure to review your medication list with your healthcare team for any interactions before starting it.
How to save: Wegovy is only available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $0 for Wegovy using a savings card from the manufacturer. Discounts are also available if you’re uninsured or underinsured.
Good to know: Compounded and research-grade versions of semaglutide are not the same as FDA-approved products such as Wegovy or Ozempic. Unapproved semaglutide products don’t have the verified safety and effectiveness data that approved products do, which may put you at risk.
6. Zepbound
Zepbound (tirzepatide) is another injectable phentermine alternative. Like Wegovy, it’s injected once weekly, but it’s only approved for adults at this time.
Zepbound mimics the actions of two hormones in the body: GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). Its effects are similar to Wegovy, but Zepbound’s dual action seems to lead to more weight loss.
In clinical studies, 80% to 90% of people taking the highest Zepbound dosage lost 5% or more of their starting body weight. And the average weight loss was around 20% of starting body weight. Most people begin to notice weight loss about 4 weeks after starting it. And Zepbound seems safe for long-term use.
Zepbound’s side effects are similar to Wegovy’s. Nausea, diarrhea, and heartburn are common. Injection site reactions are also possible. And as with all weight-loss medications, your healthcare team should review your medication list for any interactions with Zepbound before you start it.
How to save: Zepbound is only available as a brand-name medication. If you have commercial insurance, you could pay as little as $25 per month for Zepbound with a copay card from the manufacturer.
The bottom line
Phentermine (Adipex-P, Lomaira) is an effective weight-loss medication for some people. But if you’re unable to take phentermine or it doesn’t work for you, there are alternative weight-loss medications available.
Oral phentermine alternatives include topiramate, Qsymia (phentermine / topiramate ER), and Contrave (naltrexone / bupropion). Orlistat (Xenical, Alli) is also available as a prescription or over-the-counter option.
Wegovy and Zepbound are once-weekly injectable phentermine alternatives. They’re more effective than oral weight-loss medications. But they have other risks and side effects to consider. Your healthcare team can help you choose a phentermine alternative based on your other health conditions, medication list, and insurance coverage.
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References
Ben-Menachem, E., et al. (2012). Predictors of weight loss in adults with topiramate-treated epilepsy. Obesity Research.
Eli Lilly and Company. (2024). Zepbound- tirzepatide injection, solution [package insert]. DailyMed.
H2-Pharma LLC. (2023). Xenical- orlistat capsule [package insert].
Haleon US Holdings LLC. (2023). Alli- orlistat capsule [package insert]. DailyMed.
Kramer, C. K., et al. (2011). Efficacy and safety of topiramate on weight loss: A meta-analysis of randomized controlled trials. Obesity Reviews.
Nalpropion Pharmaceuticals LLC. (2024). Contrave extended-release- naltrexone hydrochloride and bupropion hydrochloride tablet, extended release [package insert].
National Heart, Lung, and Blood Institute. (n.d.). Low-calorie, lower fat alternative foods.
Physicians Total Care, Inc. (2012). Topamax- topiramate tablet, coated [package insert]. DailyMed.
U.S. Food and Drug Administration. (2024). FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight.
Vivus LLC. (n.d.). Risk Evaluation and Mitigation Strategy (REMS).
Vivus LLC. (2023). Qsymia- phentermine and topiramate capsule, extended release [package insert]. DailyMed.
Wajid, I., et al. (2023). Topiramate (topamax): Evolving role in weight reduction management: A narrative review. Life.
