Approximately 42 percent of adults in the United States struggle with obesity. Obesity is a complex, chronic disease that can place individuals at risk for weight-related conditions such as type 2 diabetes, high blood pressure, and high cholesterol. Many people who struggle with their weight have tried to lose weight several times in their lives, and most struggle to keep weight off long-term because of biological and hormonal shifts which promote weight regain. Research shows that utilizing medications to help with weight loss can improve the long-term success rate for weight loss and improve or reverse weight-related chronic conditions. Contrave® and Mounjaro™ are both medications that can be used for long-term treatment of obesity. In this article, we will discuss the similarities and differences between Contrave vs. Mounjaro including potential benefits, adverse effects of each medication, and availability and cost.

What are the differences between contrave and mounjaro?

While both Contrave and Mounjaro are used for weight management, these medications have different FDA-indications, mechanisms of action, weight loss results, side effects, dosages, cost, and availability.

Approved for different uses

Contrave (bupropion/naltrexone) is FDA-approved for chronic weight management in adults with a body mass index (BMI) of 30 kg/m2 or greater (obesity), or with a BMI of 27 kg/m2 or greater (overweight) with at least one weight-related medical problem, such as high blood pressure, high cholesterol, or type 2 diabetes. Mounjaro (tirzepatide), by contrast, is currently only FDA-approved for the treatment of type 2 diabetes. However, tirzepatide has been studied in patients with overweight and obesity without type 2 diabetes and has been shown to be safe and effective in this population. Therefore, tirzepatide is currently going through the FDA-approval process and may receive an approval as a weight loss treatment option in the future.

Mechanism of action

Contrave is a combination medication of naltrexone plus bupropion. Bupropion is a medication used as an antidepressant and for assistance with smoking cessation while naltrexone is used for alcohol and opioid use disorder. These medications work together primarily in the reward center of the brain to reduce food cravings and pleasure-based eating. They also act in the appetite control center in the brain to reduce overall appetite.

Mounjaro (tirzepatide) is a GLP-1 and GIP dual-receptor agonist which mimics gut hormones that our body naturally produces after eating. Like Contrave, Mounjaro reduces both appetite and cravings by acting on the appetite control center and reward center of the brain, respectively. Mounjaro also works in the stomach to slow gastric emptying, resulting in earlier and longer-lasting feelings of fullness. Additionally, Mounjaro acts at the pancreas and other sites in the body to improve insulin sensitivity and blood sugar regulation.

Weight loss results

Contrave (bupropion/naltrexone) clinical trials in patients with overweight or obesity showed an average loss of 8.1% of their total body weight over 56 weeks on the maximum dose of Contrave, 2 tablets twice daily (total daily dose of 32 mg naltrexone and 360 mg bupropion daily), when paired with healthy lifestyle changes. Participants receiving a placebo plus healthy lifestyle intervention in the study lost an average of 4.9% total body weight in the same period of time.

Mounjaro (tirzepatide) clinical trials that included patients with overweight or obesity, but without type 2 diabetes, showed an average weight loss of 20.9% over 72 weeks for patients on the maximum(15 mg) weekly dose plus healthy lifestyle changes. Study participants receiving placebo plus healthy lifestyle interventions lost an average of 3.1% total body weight in the same period of time.

Side effects

The most common side effects of Contrave include constipation, headache, nausea, vomiting, dizziness, trouble sleeping, dry mouth, and diarrhea. To reduce the risk of experiencing these side effects, Contrave is started at a low dose which is increased slowly over time. Contrave can sometimes cause an increase in blood pressure and heart rate, so blood pressure and pulse should be monitored closely while on Contrave and the medication should not be started unless blood pressure is well controlled. Contrave may also cause mood changes and, very rarely, patients taking Contrave may experience suicidal thoughts. Because of this, mood should be monitored closely while on Contrave. Patients taking Contrave should notify their healthcare provider right away if they experience any concerning side effects from the medication. Common side effects of Mounjaro include nausea, vomiting, decreased appetite, constipation, diarrhea, heartburn, and stomach pain. Like Contrave, Mounjaro is also started at a low dose which is increased slowly to reduce the risk of side effects. In rare cases, kidney disease may worsen while on Mounjaro, so patients are encouraged to stay well hydrated while on Mounjaro to avoid dehydration and protect their kidneys. Rarely, severe abdominal problems such as pancreatitis or gallstone disease have been seen with Mounjaro so patients are advised to seek medical attention right away if severe stomach pain that does not go away occurs while taking Mounjaro. Patients taking Mounjaro should notify a healthcare professional immediately if they experience concerning side effects while taking the medication.

Different dosing

Contrave comes in a tablet and is taken orally. Each tablet contains 8 mg of naltrexone and 90 mg of bupropion. Contrave is usually started at 1 tablet each morning for the first week and then increased each week by 1 tablet daily until the full dose of 2 tablets twice daily is reached by week 4 (Week 2: 1 tablet twice daily, Week 3: 2 tablets in the morning and 1 tablet in the evening, Week 4 and beyond: 2 tablets twice daily).Mounjaro comes in a pre-filled pen and is injected under the skin of the abdomen, thigh, or upper arm once weekly. Typically, Mounjaro is started at 2.5 mg weekly. The dose is typically increased by 2.5 mg every 4 weeks until the maximum dose of 15 mg weekly (Month 2: 5 mg weekly, Month 3: 7.5 mg weekly, Month 4: 10 mg weekly, Month 5: 12.5 mg weekly, Month 6 and on: 15 mg weekly).

Cost, coverage and availability

While some insurance companies cover Contrave for weight loss, many do not cover any anti-obesity medications. However, Contrave has an access program that provides the medication for $99 or less per month via a mail-order pharmacy, even without any insurance coverage for the medication (including coverage through Medicare and other government agencies). With insurance coverage, many patients may pay less. Contrave is currently available nationally without any shortage or availability issues.

Mounjaro is currently covered by many insurance companies for the treatment of type 2 diabetes, however, a prior authorization is often needed. Most insurance companies do not cover Mounjaro off-label for weight loss in people without diabetes at this time. For patients with insurance coverage for Mounjaro, there is a manufacturer coupon which can bring the cost down to as little as $25 for a 1-month or 3-month supply. For those without insurance coverage for Mounjaro, there are no current coupons and the out-of-pocket cost can be high, over $1000 per month at most pharmacies. There are ongoing shortages of some doses of Mounjaro due to the medication supply being unable to keep up with the high demand for this medication.

Treatment with Contrave and Mounjaro

Contrave and Mounjaro are both effective medications in helping patients to reduce weight and maintain weight loss long-term. Studies indicate that long-term treatment with weight loss medications in addition to healthy lifestyle changes is more effective in treating the disease of obesity than lifestyle changes alone for most people. While typically only one medication is started at a time, Contrave and Mounjaro can safely be used together if needed for enhanced weight control if additional weight loss benefit is needed.

The decision of which medication to use for weight loss should be an individualized decision made by a patient and a healthcare professional based on a patient's medical history, weight history, preferences, insurance coverage for medication, and other factors. There are some instances in which a patient and their healthcare provider may choose one of these medications over another. These include but are not limited to:

• If a patient has a diagnosis of type 2 diabetes or insulin resistance, a provider may suggest Mounjaro because it is FDA-approved for treating type 2 diabetes and can help to significantly improve blood sugar regulation and reduce hemoglobin a1c levels.

• If a patient struggles with inadequately controlled depression or experiences reduced libido on another antidepressant medication, Contrave may be considered as this includes an antidepressant component, bupropion, which can help improve depression symptoms and can help to reduce sexual side effects experienced on some other antidepressant medications. It should be noted that Contrave is not FDA-approved for this use.

• If a patient struggles with portion control and does not feel satisfied on typical meal sizes, Mounjaro may be suggested to help patients feel satiated on smaller portions.

• If a patient does not have insurance coverage for Mounjaro and the out-of-pocket price is cost-prohibitive, Contrave may be considered as a more cost-effective option.

If you’re interested in looking into other weight loss medication options, take a look at our comparison between Contrave and Wegovy.

Contrave or Mounjaro: The final verdict

Contrave and Mounjaro have both been shown to be effective medications for long-term weight reduction which can result in improvements in other weight-related health conditions. Deciding which weight loss medication is right for each individual depends on a number of factors and should be a personalized decision made by a patient and their healthcare provider. At FORM, all patients are under the care of a Board Certified Obesity Medicine Doctor who will complete a comprehensive medical evaluation and work with each patient to determine which medication and treatment plan is best for them. Throughout the program, patients participate in frequent visits with their Doctor and Registered Dietitian, who provide an individualized nutrition plan, accountability, and support for long-term behavior change that will help you reach your weight loss goals.

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Contrave® is a registered trademark of Currax Pharmaceutical LLC

Mounjaro™ and its delivery device base are registered trademarks owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

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Disclaimer: The content made available on The Form Health Medical Weight Loss Blog represents the views and opinions of the authors and not those of other entities, such as the manufacturers of products mentioned therein. 

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