Among the various prescription weight loss medications on the market today, Mounjaro and other GLP-1 agonists are gaining more and more popularity for their weight loss effects and have been prescribed in the off-label management of obesity. However, there are still FDA-approved weight loss medications that have been on the market for a while, like Contrave, a combination of Bupropion and Naltrexone. In this blog post, we will compare these two medications to each other and provide information to assist you in picking which medication is best for you.
Mounjaro is a new medication that belongs to the GLP-1 agonist family of anti-diabetic medications. It has been gaining popularity for its off-label use for weight loss and obesity. It is a GLP-1, GIP, and glucagon triple agonist that works by targeting multiple hormones that regulate appetite and metabolism. Mounjaro has shown promising results in clinical trials, with patients experiencing significant weight loss in over a year combined with exercise and diet (1).
Mounjaro is administered once a week via a subcutaneous injection. The duration of therapy depends on the patient’s goals, but the most significant effects were studied over a 72-week (~1.4 years) period.
The most common side effects of Mounjaro reported in clinical trials include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. However, these side effects were mild to moderate and usually resolved within a few days.
Contrave is a prescription weight loss medication that combines two drugs: naltrexone and bupropion. Naltrexone is an opioid antagonist that can help reduce food cravings, while bupropion is an antidepressant that can also help suppress appetite and increase metabolism. Together, these drugs can help people lose weight by reducing their calorie intake and increasing their energy expenditure. Though one of the components of Contrave is an antidepressant, Contrave is not indicated for use for depression, and there is no current evidence that Contrave benefits pre-existing depression.
Contrave is typically prescribed for people with a body mass index (BMI) of 30 or higher or for those with a BMI of 27 or higher and at least one weight-related condition such as high blood pressure, diabetes, or high cholesterol. However, it is essential to note that Contrave should be used in conjunction with a healthy diet and regular exercise for best results, and is not a magic solution for weight loss. The COR-BMOD trial published in 2015 looked at the weight loss effects of Contrave in addition to intensive lifestyle modifications (1). The modifications that they used in this study included a calorie restriction diet (1200-2000 kcal/day, depending on weight) and exercising for about 180 minutes per week. Based on this trial, you should model your lifestyle modifications to see the best results.
Contrave can have side effects, including nausea, constipation, headache, dizziness, and dry mouth. It should only be taken under the supervision of a healthcare professional and is not recommended for pregnant or breastfeeding women.
Here are some critical differences between Mounjaro and Contrave when used for weight loss that you should consider before starting either of these medications
Both medications have shown great promise when managing obesity and assisting people with weight loss. It should always be noted that the best results are seen in combination with dieting and regular exercise.
One of the most important studies for Mounjaro was the SURMOUNT-1 trial published in 2022. This trial was a large clinical trial with over 2500 participants that looked at how effective Mounjaro (tirzepatide) was at managing obesity (2). Mounjaro was given at different doses for a period of 72 weeks to groups of non-diabetic participants who were struggling with obesity. The participants also did a calorie restriction diet (500 kcal/day), did 150 minutes of exercise per week, and had regularly scheduled with a dietician.
They found that after 72 weeks, each group that was taking Mounjaro showed significant weight loss compared to the placebo group. Each treatment group experienced a 15-20% change in weight from the start of the trial, with higher doses showing a more remarkable change. This showed us that the use of Mounjaro in combination with diet and exercise is very effective at treating obesity.
For Contrave, it was the COR-1 trial that showed Contrave’s benefits for obesity and weight management. This was a large trial published in 2010 that looked at the weight loss effects of Contrave in overweight and obese patients. Participants were given oral Contrave for a period of 52 weeks, along with a calorie-restricted diet and regular exercise. The results showed that after the 52-week period, almost have the participants taking Contrave saw at least a 5% reduction in weight. After this trial, multiple clinical trials followed that further showed the benefits of Contrave for weight loss.
When comparing the two studies, there is a higher percentage of people achieving at least 5% weight loss after the trial period for people taking Mounjaro (85% for Mounjaro vs. 48% for Contrave). However, Mounjaro was studied for a much more extended time period than Contrave. Though Mounjaro appears to be more effective, Contrave may be more convenient for patients who do not wish to use injectable medications. Since Contrave contains naltrexone and bupropion, it may have benefits for people who wish to quit smoking and/or are struggling with depression. It should be noted that Contrave is not currently FDA-approved for managing depression or smoking cessation.
The dosage and administration of Contrave and Mounjaro are very different. Mounjaro is a once-weekly injection that starts at a low dose of 2.5mg and can gradually increase over time.
Contrave is given as two tablets taken twice a day in the morning and evening. The titration period takes about three weeks before the recommended dosage is reached. It is dosed at 8 mg/90mg and cannot exceed a maximum dose of 32 mg/360 mg per day (there are two doses together because it is a combination of two medications).
The most common side effects of Mounjaro are nausea (25%), vomiting (8%), diarrhea (18%), and stomach aches (5%). These are often mild to moderate in severity and are dependent on the dose. They are also often transient and disappear over time. Mounjaro should be avoided if you have a history of pancreatitis, gallbladder disease, diabetic retinopathy, history of medullary thyroid cancer or a family history of Multiple Endocrine Neoplasia Cancer Syndrome Type 2 (MEN-2). Mounjaro should also be avoided if you have had low blood sugar (hypoglycemia) episodes or are currently taking insulin.
Side effects of Contrave include nausea, constipation, vomiting, headache, dizziness, and dry mouth. Contrave is not approved for treating depression and can potentially increase thoughts of suicide. Contrave is contraindicated for the following conditions or situations:
Unfortunately, Mounjaro can be very expensive, depending on your insurance. The average cost for a month's supply of Mounjaro can range from $900-$1000. Depending on your insurance plan, you may also be eligible for the Mounjaro Savings Card, which can allow you to pay as little as $25 per month for Mounjaro. There are also compound forms of Mounjaro that you can get at a lower monthly price. If you would like to know more about compound options for Mounjaro, check out our website at Mochi Health.
Though not as expensive, Contrave can still be pricy depending on what a particular insurance plan covers. The average cost for a 30-day supply of Contrave is around $515. There is a Contrave Savings Card that you may be eligible for depending on your insurance plan. The amount covered depends on the plan, but you could save more than out-of-pocket. If your insurance plan does not cover Contrave, you can pay up to $99 or less with free shipping with the CurxAccess Program. Click the provided link to see how to apply for the CurxAccess program. Contrave is currently FDA-approved for the management of obesity, so call your insurance provider to see if they can assist with costs or to see if it is covered by your insurance plan.
If you would like to learn more about GLP-1 medications or want to see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!
Dr. Constantine Joseph Pella, MD
Boston University Medical Center