Contrave Vs. Qsymia: Drug Comparison

Contrave^® (naltrexone hydrochloride and bupropion hydrochloride) is a prescription medication used for weight management in adults, combining two active ingredients: naltrexone, which affects the brain's reward system, and bupropion, which influences appetite and cravings. It works by targeting the hypothalamus to reduce hunger and the mesolimbic reward system (a pathway in the brain that plays a key role in regulating feelings of pleasure, motivation, and reinforcement) to curb food cravings. Contrave is FDA-approved for chronic weight management. Common side effects include nausea, constipation, headache, and insomnia, while drug interactions can occur with MAO inhibitors, opioid pain medications, and drugs that lower the seizure threshold. Contrave carries a boxed warning for an increased risk of suicidal thoughts and behaviors, particularly in young adults, due to its bupropion component.

Qsymia^® (phentermine and topiramate) is a prescription medication used for chronic weight management in adults with obesity or overweight with at least one weight-related condition, such as hypertension, type 2 diabetes, or high cholesterol. It combines two active ingredients: phentermine, an appetite suppressant, and topiramate, which induces a feeling of fullness and reduces appetite. Qsymia is intended to be used alongside a reduced-calorie diet and increased physical activity. Common side effects include dry mouth, constipation, and tingling sensations in the hands and feet. It should be used with caution due to potential risks such as mood changes, increased heart rate, and birth defects if taken during pregnancy.

Naltrexone: opioid antagonist

Bupropion: aminoketone antidepressant

Phentermine: sympathomimetic amine anorectic

Topiramate: anticonvulsant

Contrave (naltrexone hydrochloride and bupropion hydrochloride) is indicated:

• As an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:

  • 30 kg/m² or greater (obese)

  • 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia)

Qsymia (phentermine and topiramate) is indicated:

• As an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in:

  • Adults with an initial body mass index (BMI) of:

    • 30 kg/m² or greater (obese) or

    • 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia

  • Pediatric patients aged 12 years and older with BMI in the 95th percentile or greater standardized for age and sex

• Typically taken orally twice daily

• Comes as 8 mg/90 mg extended-release tablets

• Typically taken orally once daily

• Comes in 3.75 mg/23 mg, 7.5 mg/46 mg, 11.25 mg/69 mg, and 15 mg/92 mg extended-release capsules

Most common adverse reactions (greater than or equal to 5%):

• Nausea

• Constipation

• Headache

• Vomiting

• Dizziness

• Insomnia

• Dry mouth

• Diarrhea

Most common adverse reactions in adults (incidence ≥5% and at least 1.5 times placebo) are:

• Tingling sensation

• Dizziness

• Altered taste

• Insomnia

• Constipation

• Dry mouth

Most common adverse reactions in pediatric patients aged 12 years and older (incidence ≥4% and greater than placebo) are:

• Depression

• Dizziness

• Joint pain

• Fever

• Influenza

• Ligament sprain

• Uncontrolled hypertension

• Seizure disorders, anorexia nervosa or bulimia, or undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs

• Use of other bupropion-containing products

• Chronic opioid use

• During or within 14 days of taking monoamine oxidase inhibitors (MAOI)

• Known allergy to any of the ingredients in Contrave

• Drug interactions: MAOIs, antidepressants (e.g., selective serotonin reuptake inhibitors and many tricyclics), antipsychotics (e.g., haloperidol, risperidone, and thioridazine), beta-blockers (e.g., metoprolol), type 1C antiarrhythmics (e.g., propafenone and flecainide), digoxin, CYP2B6 inhibitors (e.g., ticlopidine or clopidogrel), CYP2B6 inducers (e.g., ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital, and phenytoin), drugs that lower seizure threshold, dopaminergic drugs (levodopa and amantadine)

• Pregnancy

• Glaucoma

• Hyperthyroidism

• Taking or within 14 days of stopping monoamine oxidase inhibitors

• Known hypersensitivity to any component of Qsymia or idiosyncrasy to sympathomimetic amines

• Drug interactions: Oral contraceptives, central nervous system (CNS) depressants including alcohol, non-potassium sparing diuretics

• Suicidal behavior and ideation

• Neuropsychiatric adverse events during smoking cessation

• Risk of seizure may be minimized by adhering to the recommended dosing schedule and avoiding coadministration with high-fat meal

• Increase in blood pressure and heart rate

• Liver toxicity

• Angle-closure glaucoma

• Use of antidiabetic medications: Weight loss may cause hypoglycemia

• Pregnancy: Weight loss during pregnancy may cause fetal harm. Discontinue when a pregnancy is recognized

• Embryo-fetal toxicity: Can cause fetal harm

• Increase in heart rate

• Suicidal behavior and ideation

• Risk of ophthalmologic adverse reactions

• Mood and sleep disorders

• Cognitive impairment: May cause disturbances in attention or memory, or speech/language problems

• Slowing of linear growth

• Metabolic acidosis

• Decrease in renal function

• Serious skin reactions

• Breastfeeding: Breastfeeding not recommended

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for major depressive disorder and other psychiatric disorders. Monitor for worsening and emergence of suicidal thoughts and behaviors.

Contrave has not been studied in pediatric patients.

*This information is from the label for brand name Contrave^®. See the Full Prescribing Information for more complete information. Naltrexone and bupropion, the active ingredients in Contrave, may also be the active ingredients in other medications, and this information may not be accurate for all medications that include the active ingredients naltrexone and bupropion.

*This information is from the label for brand name Qsymia^®. See the Full Prescribing Information for more complete information.