Skip to content

Compare

Contrave vs Xenical

Quick read · 5 min

Last reviewed: September 2026Based on 2 clinical trialsEvery claim linked to source

Contrave (naltrexone / bupropion ER, twice-daily tablet) and Xenical (orlistat, capsule, three times daily with meals) are both approved for weight loss in the United States. No head-to-head trial has compared these two drugs. The figures below come from separate trials, each with its own participants, length and comparison group.

At a glance

Contrave and Xenical compared on form, trial results, cost and reported side effects
 ContraveXenical
FormTwice-daily tablet3x daily with meals
How oftenTwice-daily oral tablet — no injectionThree capsules daily, taken with each fat-containing meal
Weight loss in trialsUp to 9.3% — COR-BMOD (56 weeks)Up to 8.5% — Sjostrom 1-year RCT (52 weeks)
FDA approved20141999
Made byCurrax PharmaceuticalsRoche (Xenical) / GSK (Alli OTC)
How it worksBupropion activates appetite-suppressing nerve cells in the brain's hunger control centre (the hypothalamus).Blocks pancreatic lipase enzymes in the small intestine, preventing approximately 30% of dietary fat from being broken down and absorbed.
Monthly cost, self-pay$100–$400/mo$40–$400/moover-the-counter strength; prescription runs to $400
Most reported reactionNausea 33% (COR-I)Oily/fatty stools (steatorrhoea) 27% (XENDOS)

Every figure in this table is read from the same trial and label records used everywhere else on this site.

Weight loss in each drug's main trial

No head-to-head trial has compared these two drugs.

Contrave(naltrexone / bupropion ER)9.3%

COR-BMOD (56 weeks)

Xenical(orlistat)8.5%

Sjostrom 1-year RCT (52 weeks)

In clinical trials, participants taking naltrexone / bupropion ER lost on average up to 9.3% of their starting body weight, and participants taking orlistat lost on average up to 8.5%. Those numbers come from two different studies: COR-BMOD enrolled adults with obesity, with intensive behaviour therapy over 56 weeks against placebo + intensive behaviour therapy, while Sjostrom 1-year RCT enrolled 743 adults with obesity over 1 year (52 weeks) against placebo. Who took part, how long each trial ran and what each drug was measured against all move the percentage, so the two figures are not a measured difference between the drugs.

Monthly cost, self-pay

The bar spans the range in each drug's price record — lowest listed price to highest.

Contrave$100–$400/mo

~$100–$400/month (brand). Generic available in some markets.

Xenical$40–$400/mo

over-the-counter strength; prescription runs to $400

Prescription Xenical ~$200–$400/month; over-the-counter Alli (60mg) ~$40–$60/month.

Self-pay prices are what the manufacturer or the pharmacy lists, not what most people end up paying. Contrave: $100–$400/month. Xenical: $40–$400/month. Insurance, dose and pharmacy all change both figures.

Side effects reported in the trials

COR-I and XENDOS did not report the same reactions, so there is no shared row to line up. Each drug's own reported rates are listed below.

Contrave
  • Nausea33%
  • Constipation19%
  • Headache18%
  • Vomiting11%
  • Dizziness10%
  • Dry mouth8%

From COR-I

Xenical
  • Oily/fatty stools (steatorrhoea)27%
  • Faecal urgency22%
  • Oily spotting on underwear27%
  • Faecal incontinence8%
  • Abdominal pain/discomfort14%

From XENDOS

A rate is the share of trial participants who reported that reaction, not a prediction for any one person.

How they differ in practice

How you take it

  • Contrave — Oral extended-release tablet, twice daily
  • Xenical — Oral capsule 120 mg, three times daily with meals (prescription). Also available OTC as Alli at 60 mg.

Dose build-up

  • Contrave — titrated to 32/360 mg/day over 4 weeks

Where a drug is not listed here, its prescribing information sets out its own dose steps.

How soon it acts

  • Contrave — Appetite and craving changes typically within 4–8 weeks; significant weight loss by 16–24 weeks
  • Xenical — Weight effects begin from the first week (related to calorie malabsorption), but significant loss takes 8–12 weeks

Heart and metabolic findings

  • Contrave — The LIGHT cardiovascular outcomes trial was terminated early due to a protocol violation and did not provide a definitive answer on CV outcomes.
  • Xenical — In the 4-year XENDOS trial, orlistat reduced progression from prediabetes to type 2 diabetes by 37% compared to placebo plus lifestyle changes.

As stated in each drug’s trial record — not a claim about which drug protects the heart more.

Other findings recorded

  • Contrave — May help specifically with emotional eating and food cravings; bupropion's antidepressant effect may be beneficial if low mood contributes to overeating
  • Xenical — 37% reduction in progression to type 2 diabetes (XENDOS, 4 years); only approved obesity drug with a 4-year safety dataset

If you stop taking it

  • Contrave — Weight regain after stopping is expected.
  • Xenical — Weight is typically regained after stopping.

Common questions

Written and maintained by one person · Built with agentic AI tools · Every number checked against the cited trial · Not medical advice

How this site is built →

Next step most people take

Compare all options
Every approved drug side by side, plus the other head-to-head pages
Contrave in full
Contrave — results, side effects, cost and how it is taken
Xenical in full
Xenical & Alli — results, side effects, cost and how it is taken
Take the option finder quiz
Answer a few questions and see which options fit your situation

Built with agentic AI tools and not a substitute for medical advice

Last reviewed:

Medical disclaimer: This website is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any treatment.