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Qsymia vs Contrave
Introduction
For patients seeking weight management assistance, certain pharmaceutical aids that affect the brain's response to hunger and fullness can help when used in conjunction with diet and exercise. Qsymia and Contrave are two such drugs prescribed for this purpose. Both impact different mechanisms within the body but share a common goal of helping manage weight.
Qsymia is a combination medication containing phentermine (an appetite suppressant) and topiramate (a drug used for seizures or migraine headaches). These compounds work together, contributing to weight loss by reducing hunger pangs and increasing feelings of satiety.
Contrave, on the other hand, is composed of naltrexone (usually used in treating alcohol or opioid dependence) and bupropion (an antidepressant also useful as a smoking cessation aid). It works by affecting two areas of your brain — the hunger center and the reward system — to reduce appetite and help control cravings.
Qsymia vs Contrave Side By Side
| Attribute | Qsymia | Contrave |
|---|---|---|
| Brand Name | Qsymia | Contrave |
| Contraindications | Cannot be taken with monoamine oxidase inhibitors (MAOIs), not suitable for individuals with a history of eating disorders such as anorexia or bulimia nervosa. | Cannot be taken with monoamine oxidase inhibitors (MAOIs), not suitable for individuals with a history of eating disorders such as anorexia or bulimia nervosa. |
| Cost | $200 for a 30-day supply (3.75 mg/23 mg) | $250 for a 30-day supply (8mg/90mg) |
| Generic Name | Phentermine/Topiramate | Naltrexone/Bupropion |
| Most Serious Side Effect | Mood changes like depression and anxiety, allergic reactions, irregular heartbeat causing fainting spells. | Suicidal thoughts or actions, seizures, severe allergic reactions. |
| Severe Drug Interactions | Adverse interactions with other drugs or underlying health conditions, particularly with heart disease or stroke history. | Should not be used in combination with other forms of bupropion due to increased risk of seizures; potential interactions with drugs that affect CYP2D6 enzyme. |
| Typical Dose | Starts at one capsule of 3.75 mg/23 mg per day for 14 days, then possibly increased to one capsule of 7.5 mg/46 mg per day. | Starts with one tablet once daily for a week, increasing to two tablets twice daily (morning and evening) by the fourth week. |
What is Qsymia?
Qsymia and Contrave are both prescription weight-loss medications that marked a significant development in the fight against obesity. Qsymia, first approved by the FDA in 2012, is a combination of phentermine (an appetite suppressant) and topiramate (a drug used for seizures or migraine headaches). It works by reducing hunger and making you feel full sooner, effectively decreasing calorie intake. On the other hand, Contrave combines bupropion (an antidepressant) with naltrexone (an opioid antagonist), which was first approved by the FDA in 2014. This dual-action medication targets two areas of your brain —the hunger center and reward system— to lessen hunger pangs while also helping to control cravings. Both medications have different side effects due to their different active ingredients; however it's worth noting that neither should be taken without consulting with a healthcare provider as they may interact adversely with other drugs or underlying health conditions.
What conditions is Qsymia approved to treat?
Qsymia is approved for the treatment of different conditions related to excessive body weight:
- Chronic weight management in adults with a BMI of 30 kg/m² or greater (obese), or
- Adults with a BMI of 27 kg/m² or greater (overweight) who have at least one weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol.
It's important to note that it should be used together with a reduced-calorie diet and increased physical activity.
How does Qsymia help with these illnesses?
Qsymia aids in weight management by suppressing appetite and increasing feelings of fullness. It accomplishes this by combining two active ingredients: phentermine, which decreases appetite, and topiramate, which increases the feeling of being full after eating a small amount. Both of these elements work together to reduce food intake and promote weight loss. This can be particularly beneficial for individuals struggling with obesity or those who need to lose weight due to medical concerns such as high blood pressure or diabetes.
Contrave, on the other hand, also helps manage overweight and obesity issues but operates slightly differently. Contrave combines naltrexone—an opioid antagonist—and bupropion—a dopamine/norepinephrine reuptake inhibitor—which together help curb hunger cravings and control overeating habits frequently associated with emotional triggers.
While both medications aid in weight loss efforts when used alongside proper dieting and exercise regimens, they use different mechanisms within the brain's reward system related to eating behaviors. Therefore their suitability will depend on an individual's specific needs as assessed by a healthcare professional.
What is Contrave?
Contrave is a brand name for the combination of bupropion and naltrexone, which are an NDRI (norepinephrine-dopamine reuptake inhibitor) and an opioid antagonist respectively. This means Contrave combines two mechanisms: increasing levels of norepinephrine and dopamine in the brain by reducing their reabsorption, much like Wellbutrin does, while also blocking opiate receptors to curb cravings. Approved by the FDA in 2014 as a weight management medication, Contrave shares its NDRI component with antidepressants but it's not considered one itself due to its unique pairing with naltrexone. The lack of action on serotonin differentiates its side-effect profile from SSRIs such as Prozac; specifically, it doesn't cause sedation nor is it likely to cause weight gain or sexual dysfunction - common SSRI side effects. Instead, its dual-action approach may be beneficial for patients struggling with obesity who have not responded well to other weight loss medications such as Qsymia.
What conditions is Contrave approved to treat?
Contrave is an FDA-approved medication used for chronic weight management. It's specifically designed to help adults who are either overweight (with a BMI over 27) and have at least one weight-related medical issue, or people who are obese (BMI of 30 or higher). The conditions that Contrave can be associated with treatment include:
- Weight loss in conjunction with diet and exercise
- Management of weight-related health complications such as high blood pressure, type 2 diabetes, or high cholesterol.
How does Contrave help with these illnesses?
Contrave is a weight loss medication that works by affecting two key areas of the brain involved in regulating hunger and reward. In particular, it impacts the hypothalamus (which controls appetite) and the mesolimbic dopamine circuit (which manages reward). Contrave combines naltrexone, which is usually used to treat alcohol and opioid dependence, with bupropion, an antidepressant. The combination helps reduce food cravings as well as control portions when eating. This differs from Qsymia which uses a blend of phentermine (an appetite suppressant) and topiramate (an anticonvulsant), leading to weight loss via reducing hunger and increasing feelings of fullness. Since Contrave also addresses issues related to reward systems besides controlling appetite like typical weight-loss medications such as Qsymia, it may be prescribed when patients do not respond well or are looking for a comprehensive approach towards their weight management.
How effective are both Qsymia and Contrave?
Both phentermine/topiramate (Qsymia) and naltrexone/bupropion (Contrave) have been established as effective medications in the management of obesity, and they were approved by the FDA within a year of each other. Since they act on different neurotransmitters and pathways involved in appetite regulation, they may be prescribed under different circumstances depending on patient's individual needs.
The effectiveness of Qsymia and Contrave in managing weight loss was directly studied; both drugs exhibited significant efficacy in reducing body weight compared to placebo. In head-to-head comparisons, Qsymia appears to produce slightly more weight loss than Contrave but individual responses can vary significantly.
A 2012 review showed that Qsymia is effective at promoting weight loss starting from the first few weeks of treatment, with side effects including dry mouth, constipation, tingling sensation or altered taste sensation. The same study reports that it is well-tolerated overall but should be used carefully in patients with heart disease or stroke history.
A 2014 meta-analysis indicated that Contrave seems to be more effective than placebo at promoting weight loss over one year period. Similar to Qsymia, it also has its own set of side effects such as nausea,vomiting,constipation,dizziness,and dry mouth among others . Nonetheless,it can provide an additional option for those who did not respond adequately to lifestyle modification or other medication therapies.
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At what dose is Qsymia typically prescribed?
For managing weight, Qsymia dosages typically start at one capsule of 3.75 mg/23 mg (phentermine/topiramate) per day for 14 days. After this initial period, if the patient tolerates the medication well, the dosage can be increased to one capsule of 7.5 mg/46 mg per day. If after an additional twelve weeks there is not a sufficient response (generally defined as a five percent decrease in body weight), then the dosage may be further increased up to a maximum daily dose of one capsule of 15mg/92mg.
Similarly with Contrave, patients generally start by taking one tablet (8mg naltrexone/90mg bupropion) once daily for a week. The dose is then gradually escalated over four weeks to reach the maintenance dose of two tablets taken twice daily. If no significant reduction in body weight has been seen after sixteen weeks on this maintenance dose—typically measured as at least five percent reduction in body weight—the drug should likely be discontinued.
At what dose is Contrave typically prescribed?
Contrave treatment usually begins with one tablet taken once each day for a week. In the second week, this is increased to one tablet twice daily, taken in the morning and evening. From the third week onwards, two tablets are taken in the morning and one in the evening. By the fourth week, if tolerated well, it moves up to its maximum dose of two tablets taken twice daily (morning and evening). This dosage may be adjusted based on your response to Contrave after several weeks. It's important to note that all doses should be spaced out evenly throughout your day with a gap of around 8 hours between each dose.
What are the most common side effects for Qsymia?
Possible side effects of Qsymia include:
- Numbness or tingling in the hands, feet, or face
- Dizziness
- Changes in taste
- Insomnia (difficulty sleeping)
- Constipation
- Dry mouth
While Contrave could potentially cause:
- Nausea/vomiting
- Constipation
- Headaches/migraines
- Dizziness
- Insomnia (difficulty falling asleep and staying asleep)
-Sweating excessively
-Dry mouth -Increased blood pressure/heart rate
-Rash
-Decreased appetite
It's important to remember that these medications should only be used under a healthcare provider's supervision due to potential health risks associated with their use. If you experience any of these symptoms while on either medication, consult your doctor immediately.
Are there any potential serious side effects for Qsymia?
While Contrave and Qsymia are both used for weight loss, they can cause different side effects. For example, some users of Contrave have reported:
- Suicidal thoughts or actions
- Signs of allergic reactions such as skin rashes, itching or hives; swelling of the face, lips, tongue or other parts of the body; shortness of breath, wheezing or difficulty breathing
- Changes in vision including blurred vision and seeing halos around lights
- Increased heart rate leading to chest pain or discomfort
- Lower sodium levels manifesting as headaches, difficulties concentrating, memory problems and confusion
- Severe reactions involving stiff muscles and high fever with sweating
For those taking Qsymia:
- Mood changes like depression and anxiety may increase significantly.
- Allergic reactions might include swelling on various parts of the body (face/throat), difficulty breathing accompanied by hives, severe skin issues ranging from red/purple skin rash to blistering/peeling.
- It could lead to irregular heartbeat causing fainting spells due to sudden dizziness.
If you experience any worrisome symptoms while taking either medication contact your doctor right away.
What are the most common side effects for Contrave?
Contrave, like any other medication, can cause a range of side effects. These can include:
- Dry mouth and sore throat
- Ringing in the ears or changes in hearing
- Nausea, vomiting, stomach pain and constipation - this may result from the medicine's appetite-suppressant effect
- Insomnia or unusual sleep patterns
- Anxiety or nervous feelings as well as potential tremors
- Increased heart rate could be experienced by some patients
- Some individuals might experience confusion, agitation and even hostility while undergoing treatment with Contrave
- Skin reactions such as rash are possible but rare
- Although intended for weight loss purposes, abrupt alterations in weight should still be monitored carefully
- Changes in urination frequency could occur due to its diuretic properties.
Headache and dizziness are common complaints
Muscle or joint pain may also occur on occasion.
It is important to note that not everyone will experience these side effects and they often subside after your body adjusts to the medicine. However if you do suffer from persistent discomfort it's essential to consult your doctor promptly.
Are there any potential serious side effects for Contrave?
While Contrave is generally well-tolerated, some individuals may experience adverse reactions to the medication. Serious side effects associated with Contrave include:
- Signs of an allergic reaction or severe skin reaction: rashes, itching, hives, fever, swollen glands, difficulty breathing
- An increase in suicidal thoughts or behavior; this is especially prevalent in younger adults and children.
- Convulsions or seizures
- Unusual changes in mood or behavior such as agitation, irritability and depression
- Vision problems including blurred vision and tunnel vision. In rare cases you might also experience eye pain or swelling.
- Rapid heartbeat (tachycardia) which could be indicative of potentially serious heart-related issues.
If any of these symptoms are experienced while taking Contrave it's crucial to stop using the medication immediately and consult a healthcare professional for further advice.
Contraindications for Qsymia and Contrave?
Both Qsymia and Contrave, much like other weight-loss medications, may have serious side effects. If you notice rapid heartbeat, suicidal thoughts or behaviors, eye problems (like glaucoma), difficulty concentrating or confusion after taking these drugs, please seek immediate medical attention.
Neither Qsymia nor Contrave can be taken if you are currently using monoamine oxidase inhibitors (MAOIs) for depression. Always inform your physician about any medications you are taking; MAOIs need around two weeks to clear from the system to prevent hazardous interactions with either of these weight loss pills. Furthermore, both medicines should not be used by individuals who have a history of eating disorders such as anorexia or bulimia nervosa due to risk exacerbating the disorder.
How much do Qsymia and Contrave cost?
For the brand name versions of these drugs:
- The price for a 30-day supply of Qsymia (3.75 mg/23 mg) averages around $200, which works out to approximately $6-$13 per day, depending on your dose.
- The cost for a 30-day supply of Contrave (8mg/90mg) is about $250, which translates to roughly $8-$16 per day.
Thus, if you are in the higher dosage range for Qsymia (i.e., 15 mg/92 mg or higher), then brand-name Contrave may be less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
Currently there are no generic versions available either for Qsymia or Contrave, so costs remain fairly steady:
- Qsymia continues to retail at an approximate daily expense ranging from as low as $6/day up to about $13/day depending upon the dosage selected.
- Similarly, the cost associated with daily intake of Contrave largely falls within an estimated range starting from nearly $8/day and can reach up to about $16/day based on required dosages.
Popularity of Qsymia and Contrave
Qsymia, a combination of phentermine and topiramate, was estimated to have been prescribed to about 600,000 people in the US in 2020. Qsymia accounted for approximately 13% of weight-loss drug prescriptions in the US. It appears to be one of the most commonly used 'combination therapy' medications (not classified as a monotherapy or single active ingredient medication). The prevalence of Qsymia has been generally increasing since its approval by FDA back in 2012.
Contrave, including brand versions such as naltrexone-bupropion SR combo, was prescribed to around 500,000 people in the USA during same year. In terms of prescription volume within weight loss drugs category, Contrave accounts for nearly 11%. The overall trend shows that Contrave usage has remained steady over recent years since its launch date back in late 2014.
Conclusion
Both Qsymia (a combination of phentermine and topiramate) and Contrave (a combination of naltrexone and bupropion) have established records in managing obesity, supported by numerous clinical studies indicating that they contribute to significant weight loss compared to placebo. In some cases, these drugs may be used together under careful medical supervision, although they are generally not recommended for combined use due to their differing mechanisms of action: Qsymia works primarily on the central nervous system to suppress appetite and enhance satiety, while Contrave acts on the reward center in the brain to help control cravings.
Qsymia is typically considered an initial treatment option because it has been shown in trials to result in greater weight loss than Contrave. However, Contrave might be a better choice for patients who struggle with food cravings or binge eating because it specifically targets pathways involved in reward-driven eating behavior.
Both medications are available only through prescription due its potential side effects. Neither should be seen as a magic bullet; lifestyle changes including diet adjustments and increased physical activity remain fundamental parts of any weight management plan.
The side effect profiles vary between these two drugs but both can cause nausea, constipation, headache among others. With Qsymia having additional risks such as palpitations due its stimulant component (phentermine), while Contrave could increase risk for seizures due its anti-depressant component (bupropion). Patients must closely monitor their health when starting treatment with either drug.
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Refrences
- Caixas, A., Albert, L., Capel, I., & Rigla, M. (2014, September). Naltrexone sustained-release/bupropion sustained-release for the management of obesity: review of the data to date. Drug Design, Development and Therapy. Informa UK Limited.http://doi.org/10.2147/dddt.s55587
- Mercer, S. L. (2011, September 21). ACS Chemical Neuroscience Molecule Spotlight on Contrave. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/cn200076y
- Narayanaswami, V., & Dwoskin, L. P. (2017, February). Obesity: Current and potential pharmacotherapeutics and targets. Pharmacology & Therapeutics. Elsevier BV.http://doi.org/10.1016/j.pharmthera.2016.10.015