Contrave vs Qsymia comes down to different drugs: Contrave combines naltrexone and bupropion, Qsymia combines phentermine and topiramate. Phentermine alone and orlistat complete the approved oral list. Compounded oral GLP-1 therapy at telos rx is a separate route.
Most articles about weight loss pills compare two and stop, leaving out mechanism, legal status, duration of use, and who each one rules out. Here are the four side by side, from their FDA labels.
The Approved Oral Options
Contrave is an extended-release tablet of 8 mg naltrexone hydrochloride with 90 mg bupropion hydrochloride, approved in 2014 and marketed by Currax Pharmaceuticals. Qsymia is an extended-release capsule of phentermine with topiramate, approved in 2012. Phentermine alone is a sympathomimetic amine anorectic, meaning an appetite suppressant. Orlistat is the outlier: it does not act on the brain, and sells as prescription Xenical 120 mg and as the non-prescription weight loss aid alli at 60 mg.
The Head-to-Head Comparison
Every entry comes from the current FDA labels.
| Contrave | Qsymia | Phentermine alone | Orlistat | |
|---|---|---|---|---|
| Active ingredients | Naltrexone HCl 8 mg, bupropion HCl 90 mg, ER | Phentermine and topiramate, extended-release | Phentermine hydrochloride | Orlistat |
| How it works | Opioid antagonist plus a dopamine and norepinephrine reuptake inhibitor, acting on appetite and reward | Appetite suppression from phentermine, with topiramate | Appetite suppression via a sympathomimetic amine | Blocks gut lipases; some dietary fat is not absorbed |
| Approved population | Adults with obesity, or overweight plus one weight-related condition | Adults and patients aged 12+ with obesity; adults with overweight plus one condition | BMI of 30 or above, or 27 or above with other risk factors | Obesity management, weight loss and maintenance |
| Controlled substance | No DEA schedule on the label | Yes, Schedule IV (CIV) | Yes, Schedule IV (CIV) | No |
| Duration of use per label | Long-term; response assessed at 12 weeks | Long-term weight reduction and maintenance | Short-term only, per the label | Long-term, alongside a reduced-calorie diet |
| Boxed warning | Yes, for suicidal thoughts and behaviors | None; REMS for embryo-fetal toxicity | No | No |
| Notable contraindications | Uncontrolled hypertension, seizure disorder, bulimia or anorexia nervosa, chronic opioid use, recent MAOI use | Pregnancy, glaucoma, hyperthyroidism, recent MAOI use | Cardiovascular disease, hyperthyroidism, glaucoma, drug abuse history, recent MAOI use | Pregnancy, chronic malabsorption syndrome, cholestasis |
| Common side effects on label | Nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, diarrhea | Paraesthesia, dizziness, altered taste, insomnia, constipation, dry mouth | Raised heart rate and blood pressure, insomnia | GI effects from unabsorbed fat |
Mechanism Is the Real Dividing Line
Three act on the brain, one acts in the gut. Contrave's label says naltrexone and bupropion affect two brain areas involved in food intake, the hypothalamus and the mesolimbic dopamine circuit, and that the exact effects behind weight loss are not fully understood.
Qsymia and phentermine work through appetite suppression. Orlistat binds gastric and pancreatic lipases so some dietary triglycerides are never absorbed, which is why its side effect profile is so distinctive.
None of these four is a GLP-1 medication. The confusion is common, and is cleared up in Is Contrave a GLP-1? and What Is Contrave?.
Controlled Substance Status Changes the Practical Experience
Qsymia and phentermine are Schedule IV controlled substances, printed as CIV on their labels, which affects refills and prescribing rules month to month. Contrave's label carries no DEA schedule designation, and notes that in studies of up to 56 weeks there was no evidence of euphoric intoxication, physical dependence, diversion or abuse. Orlistat is not scheduled either. That is a practical difference, not a claim about which works better.
Duration of Use Separates Phentermine From the Rest
This is the point most comparisons miss. The phentermine label indicates it as a short-term adjunct, described as a few weeks, and states that tolerance to the appetite-suppressing effect usually develops in that time, at which point it should be discontinued.
Contrave, Qsymia and orlistat are framed around long-term maintenance instead. Contrave's label escalates over four weeks to two tablets twice daily, then adds a checkpoint: if a patient has not lost at least 5 percent of baseline body weight after 12 weeks at that dose, it should be stopped. That is label fact, not dosing guidance, and nobody should start or stop these except on a prescriber's instruction. Detail sits in Contrave dosing, and one-to-one guides in phentermine vs semaglutide and semaglutide vs phentermine.
If you are exploring oral options, there is a different mechanism worth knowing about. telos rx offers a compounded oral GLP-1, which is not Contrave, not Qsymia, and not FDA-approved, prescribed only after review by a licensed provider.
See the oral GLP-1 optionSafety: Where Each One Rules People Out
Contrave carries a boxed warning for suicidal thoughts and behaviors. It contains bupropion, the same active ingredient as antidepressants including Wellbutrin, and antidepressants increased the risk of suicidal thinking and behavior in children, adolescents and young adults in short-term trials. The Contrave label instructs that patients of all ages be monitored closely for emerging suicidal thoughts, and states Contrave is not approved for paediatric patients. More in Contrave vs Wellbutrin and Contrave side effects and the boxed warning.
Qsymia's label has no boxed warning but carries a Risk Evaluation and Mitigation Strategy for embryo-fetal toxicity, with a negative pregnancy test recommended before starting and monthly after. Its warnings also cover acute myopia and secondary angle closure glaucoma, effects on attention and memory, metabolic acidosis, and slowed linear growth in younger patients.
Phentermine's cardiovascular profile matters most for people with heart disease or uncontrolled blood pressure. Orlistat's risks are absorption-related: reduced uptake of fat-soluble vitamins, and interactions with cyclosporine and levothyroxine.
What the Evidence Base Looks Like
Contrave's approval rests on four 56-week placebo-controlled trials, the COR programme: COR-I, COR-II, COR-BMOD and COR-Diabetes, enrolling 4,536 randomised patients. In COR-I, mean change in body weight was 5.4 percent below baseline on Contrave versus 1.3 percent on placebo, and 42 percent of that group reached at least a 5 percent reduction versus 17 percent.
No head-to-head trial comparing these four pills is cited here, because the trials ran separately, in different populations, under different protocols. The same applies to GLP-1 comparisons: a Contrave figure and a semaglutide or tirzepatide figure are not a contest. More in Does Contrave work? and Contrave cost with and without insurance.
Where the Oral GLP-1 Fits
GLP-1 receptor agonists are a fifth mechanism, and none of the four pills belongs to that class. They act on receptors involved in appetite and gastric emptying, explained in how GLP-1 medications work and oral vs injectable.
telos rx offers compounded oral semaglutide and tirzepatide, held under the tongue for about 60 to 90 seconds then swallowed, with ondansetron in each dose. Here is the regulatory asymmetry, stated plainly. Contrave, Qsymia, phentermine and orlistat are FDA-approved. The compounded oral GLP-1 offered by telos rx is not FDA-approved. Compounded preparations are made under federal compounding regulations against a prescription for an individual patient, and on regulatory status that is a real point in favour of the approved pills. Sublingual absorption is also lower than a subcutaneous injection, and the provider sets the dose accordingly.
telos rx is LegitScript-certified and works online-first and asynchronously: you complete a written intake and a licensed provider reviews it in writing. Everything is subject to medical approval by a licensed provider, and approval is never guaranteed. Eligibility generally starts at a BMI of 30 or higher, or 27 or higher with a weight-related condition. As of publication, plans start from $9 a day on the prepaid three-month plan, including the online visit, expedited shipping and ondansetron. Service covers all 50 states through licensed US compounding pharmacies, with formulation varying by state.
Frequently Asked Questions
Which is better, Contrave or Qsymia?
No trial has compared them head to head, so neither is better in general. Qsymia is a Schedule IV controlled substance approved down to age 12. Contrave is not scheduled, but carries a boxed warning for suicidal thoughts and behaviors and is not approved for paediatric use. A prescriber weighs your history against both labels.
Is Contrave a controlled substance?
The Contrave label carries no DEA schedule designation, unlike Qsymia and phentermine, both marked CIV for Schedule IV. The label notes that in trials of up to 56 weeks there was no evidence of euphoric intoxication, physical dependence, diversion or abuse, and that naltrexone does not lead to dependence.
How long can you take phentermine?
The phentermine label indicates it only as a short-term adjunct, described as a few weeks, within a programme of exercise, behavioural change and calorie restriction. It also states that tolerance to the appetite-suppressing effect usually develops in that period, and phentermine should be discontinued if it does. Contrave, Qsymia and orlistat are framed for longer-term use.
Are any weight loss pills available without a prescription?
One is. Orlistat is sold at 60 mg as alli, an FDA-approved non-prescription weight loss aid for overweight adults aged 18 and older, alongside prescription Xenical at 120 mg. Contrave, Qsymia and phentermine are prescription-only, and compounded oral GLP-1 preparations need a prescription too. Nothing here should be sourced outside a licensed pharmacy.
Is Contrave a GLP-1 like Wegovy or Ozempic?
No. Contrave contains naltrexone and bupropion and does not act on GLP-1 receptors at all. Its label describes effects on the hypothalamus and the mesolimbic dopamine circuit instead. GLP-1 receptor agonists such as semaglutide are a separate drug class with a separate mechanism, which is why the two are not interchangeable.
Does telos rx prescribe Contrave or Qsymia?
No. telos rx does not sell, prescribe or supply Contrave, Qsymia, phentermine or orlistat. This article is educational. What telos rx does offer is compounded oral semaglutide and tirzepatide, which are not FDA-approved and are prescribed only after a licensed provider reviews a written intake, with approval not guaranteed.
TelosRX is LegitScript-certified. Compounded medications are not FDA-approved and are prepared under federal compounding regulations. Approval is subject to evaluation by a licensed provider; approval is not guaranteed. Individual results vary. TelosRX operates as an online-first, asynchronous telehealth service.
All four pills come from a prescriber who knows your history, and telos rx supplies none of them. If a different mechanism is what you want to look at, the compounded oral GLP-1 route is on the telos rx oral GLP-1 page, and evaluation starts here: start an online visit for oral GLP-1. These preparations are not FDA-approved, and approval is not guaranteed.