Saxenda vs Contrave vs Xenical

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Currently (as of 2022), Health Canada has approved only three medications for long-term use specifically for weight loss and obesity:

1. Saxenda
2. Contrave
3. Xenical

Although there are many other drugs used off-label for weight loss, these three drugs are the most common in Canada, so let’s compare these three drugs, to hopefully help shed some light onto which ones might be helpful for your situation.

Comparisons

I have much more detailed articles on each of these drugs, so check them out if you need more in-depth information. But allow me to briefly introduce each one.

Saxenda, which is the drug liraglutide, is an appetite suppressant. Approved in Canada in 2015, it’s one of the newer, and more heavily marketed weight loss drugs on the market.

Contrave, which is a combination drug of both Bupropion and Naltrexone, is also an appetite suppressant. Approved in Canada in 2018, it is one of the newest weight loss drugs we have.

Xenical, which is the drug orlistat, is a fat blocker, preventing your body from properly absorbing fat. Approved in Canada in 1999, it is one of our oldest and most commonly used weight loss drugs.

I’m going to compare the following 4 characteristics I believe are important for each drug:

1. side effects
2. cost and availability
3. ease of use
4. effectiveness

I’ll be generalizing a bit to help contrast the drugs better.

Also remember that these are just my opinions and experiences with seeing these drugs being used in many patients, and may not actually reflect what you will experience with each drug.

So with that out of the way let’s get into it.

Side effects

1. Xenical – moderate side effects, but manageable
2. Saxenda – moderate/strong nausea, difficult to manage
3. Contrave – moderate/strong side effects, difficult to manage

Although Xenical may cause you to poop yourself from time to time, many patients seem to be able to deal with it, and continue on the medication without too much difficulty.

For example, by taking a soluble fiber supplement, lowering their fat intake, and scheduling meals around washroom breaks, it’s possible to manage these side effects pretty well.

If you’re unfortunate enough to experience side effects like nausea from Saxenda or Contrave on the other hand, you might end up having to discontinue the medication, since many people do end up stopping the drugs due to the side effects.

Additionally, nothing they seem to do makes those symptoms go away. Changing their diet, pepto bismol, ibuprofen, nothing seems to work well for those side effects.

So all the drugs possibly come with some significant side effects.

However, in terms of overall patient tolerability, I’m going to rank Xenical as generally being the most tolerable.

Between Saxenda and Contrave, I’d slightly give Saxenda better tolerability, but not by much.

It’s mainly because the worst side effects I’ve noticed in Saxenda seem to be mostly limited to nausea, while I’ve seen bad side effects from Contrave ranging from nausea, to headaches, to dizziness, to feeling just… awful in general.

Cost and Availability

1. Xenical – cheapest and easiest to obtain, generics available including non-prescription options
2. Contrave – moderately expensive, no generics however alternatives are possible, prescription only
3. Saxenda – very expensive, no generics and very few alternatives, prescription only

Saxenda can cost up to a few thousand dollars per month. Contrave can cost a few hundred dollars per month.

Xenical can cost one to a few hundred dollars per month, depending on how often you use it, but orlistat, which is the drug that Xenical is made of, is available over the counter under the trade name Alli, which is only available in the US unfortunately. Alli is usually less than $100 per month.

So of all the three drugs, only orlistat can be obtained without a prescription legally. Keep in mind that Alli is a lower dose than Xenical, so although they use the same drug, Xenical will be more effective.

Contrave is a combination of bupropion and naltrexone, and many patients use bupropion off-label to help with weight loss. While Contrave is expected to be more effective than bupropion, many of my patients report that bupropion works pretty well as far cheaper alternatives go.

Saxenda only has Victoza as an alternative, and both drugs are currently owned by the same company, hence no generic alternatives exist. However, a recent development may see generic Victoza on the market in 2024.

Ranking them in terms of cost and availability, Xenical, or orlistat, will generally be the cheapest and easiest to get.

Saxenda will likely be the most expensive to get, especially through insurance.

Ease of use

1. Contrave – easy to use, pills taken daily
2. Saxenda – a little more complex to use, self-injection daily
3. Xenical – most difficult to use properly, requires adherence to a low-fat diet

Xenical is not super easy to use properly. You’ll need to take it correctly with meals and follow the proper low fat diet. If you don’t use it properly, Xenical is not going to work well for you.

Saxenda can only be given by injection, and even though it’s an auto-injector that makes it somewhat easier, you’ll still need to learn proper and clean injection techniques.

So I’m going to rank Contrave as the easiest to use, since it’s just a pill taken like 2 times a day, whereas Xenical is likely the most difficult to use properly.

Effectiveness for weight loss

1. Saxenda – generally most effective
2. Contrave – can be quite effective for some people
3. Xenical – can be effective, but often used incorrectly, rendering it ineffective

Of course, an important measure of any weight loss tool is, how much weight can you lose on it?

Here’s the problem though, it really depends.

Comparing the amount of weight lost in research studies is not the same as in real life.

Research studies are a best case scenario, under extremely controlled and similar conditions.

Real life is messy, and full of inconsistencies.

For example, Contrave can be very hit or miss, and may be more effective in people with cravings and emotional eaters, while Saxenda may be more useful in prediabetics or people with blood sugar issues.

So their effectiveness really depends on your specific situation, and I strongly recommend you check out the videos we have, detailing each specific medication in our channel, before determining how effective it may be for you.

That being said, if you really want to hear what the research says, Saxenda appears to be the most effective, with the largest proportion of people maintaining at least a 5-10% weight loss after 1 year. Contrave is second, followed by Xenical at third. Take a look at the description down below for the specific studies.

From my experience, comparing the three drugs in terms of short-term weight loss, Xenical will likely be the least effective if you don’t implement a proper weight loss diet.

The other two will often work at least temporarily, even if you don’t implement much of a dietary plan, since Saxenda and Contrave directly suppress your eating habits, while Xenical makes the diet you’re supposed to be following, more effective.

Long-term weight loss however, seems to depend more on whether the patient was able to implement a successful weight loss diet or not.

I’ve seen weight rebound from Saxenda and Contrave, once it stopped working or patients stopped taking it, which basically cancelled out any initial short-term weight loss.

So the way I look at it, is that all three medications will help make your weight loss diet more effective.

But if you don’t have a good weight loss diet, Xenical will let you know right away, basically by not working. And while the other two may initially work for a little while, even if you don’t have a good weight loss diet, it’ll likely stop working once your body gets used to the drug or you stop taking it.

So if long-term weight loss is your goal, the differences in the effectiveness of these three drugs are less important if you have a good overall weight loss plan in place.

Final rankings

Overall, it’s clear to see that each of these medications have their potential strengths and weaknesses.

Plugging them into a tier list, I’ll give Xenical a B.

Although it’s not the most effective, it helps to balance the need to build a good weight loss diet and protocol, with the reliance of using a weight loss medication.

Long-term weight loss most strongly depends on how consistently a patient is following their weight loss diet and lifestyle, not really how consistently they’re taking their weight loss medication.

I actually kinda like the fact that Xenical is not super effective, since it prevents patients from relying too heavily on the medication, which could end up becoming a crutch later on, and lead to strong weight regain when they discontinue it.

In fact, weight rebound may potentially be worse for patients discontinuing more effective weight loss drugs due to their over-reliance on it.

Contrave, I’ll give a C.

Because although it can be quite effective, many people experience side effects strong and bothersome enough that they stop using it anyways.

Also I’ve seen too many people become dependent on them and regain the weight once they’ve stopped.

Saxenda, I’ll also give a C.

Although most patients tend to find this option the most effective in the short-term, it’s very expensive. And weight rebound can be quite strong for some people discontinuing the drug.

But at the end of the day, it should be you and your doctor who makes the decision whether or not to try one of these medications.

Feel free to remove characteristics you don’t believe are important to you, or focus on characteristics you believe are very important. Then tally up a new ranking yourself.

Learn more about

• Saxenda (liraglutide)
• Contrave (naltrexone-bupropion)
• Xenical (orlistat)
• 5 Things To Know Before Starting Weight Loss Medication
• Other weight loss medications

See also

• 
  Bupropion vs Contrave vs Naltrexone
  Contrave is a synergistic combination of buproprion and naltrexone, which can be replicated to some degree using the generics individually.
• 
  New Obesity Drugs in 2024
  New obesity drugs target more than just GLP-1 and do much more than suppress appetite for a more nuanced approach to weight loss.
• 
  Mounjaro: Who Loses the Most Weight?
  White or Asian younger women who use metformin and have lower sugar and lipid levels tend to experience more weight loss with Mounjaro.
• 
  How does Oforglipron compare?
  Orforglipron, Semaglutide, and Danuglipron are oral GLP-1 agonists that are all similar enough that cost may end up being the winning factor.
• 
  Retatrutide vs Wegovy vs Mounjaro
  Eli Lilly’s retatrutide has shown stronger weight loss effects than others we’ve seen so far. However, it may have additional heart risks.