Medication Alternatives
Non-GLP-1 Weight Loss Medications (2026): Contrave, Qsymia and the Alternatives
Educational reference • Last reviewed August 5, 2026
Executive Summary
Almost every weight-loss provider on the internet now sells the same two molecules. That is fine if a GLP-1 suits you and you can pay for it — and useless if you have a contraindication, cannot tolerate the gastrointestinal effects, have been declined, or simply cannot make the numbers work.
There are four other FDA-approved oral options, two of them with manufacturer-run telehealth programs that cost a fraction of a GLP-1 subscription. They produce less weight loss on average and carry their own distinct risks. This guide covers what each one is, what it costs, who prescribes it, and what you are trading away.
Section 1: The Options
Contrave (naltrexone HCl / bupropion HCl)
What it is: A combination of two drugs that have each been on the market over 30 years, believed to act on the hypothalamus to reduce hunger and on the mesolimbic reward system to control cravings.
Results: Across three 56-week studies, 46% of patients lost 5% or more of body weight versus 23% on placebo.
Cost: $99/month with free shipping through the manufacturer's CurAccess program.
Where to get it: UpScript delivers the manufacturer program; PlushCare, MEDvidi, and other telehealth practices also prescribe it.
Caution: Carries a boxed warning regarding suicidal thoughts and behaviors. Not for people with uncontrolled hypertension, seizure disorders, eating disorders, or those using opioids.
Qsymia (phentermine / topiramate extended-release)
What it is: A fixed-dose combination of an appetite suppressant and an anticonvulsant, approved for chronic weight management.
Results: Generally produces more weight loss than Contrave and less than GLP-1 medications, depending on dose.
Cost: $65 flat telehealth visit fee through ChooseQ, the manufacturer's designated partner, with medication billed separately.
Where to get it: ChooseQ is the official route; Klarity Health and MEDvidi also facilitate prescriptions.
Caution: Can cause birth defects — effective pregnancy prevention is required. Requires blood testing for metabolic acidosis before and during treatment, and must be tapered rather than stopped abruptly.
Phentermine (Adipex-P, Lomaira)
What it is: A stimulant appetite suppressant, the oldest and cheapest option here, approved for short-term use.
Results: Effective for short-term weight loss; not indicated for the long-term chronic management GLP-1s are approved for.
Cost: Typically the cheapest option, often available as an inexpensive generic.
Where to get it: Availability varies sharply by provider. Hello Alpha, for example, publishes an explicit policy of not prescribing phentermine or Qsymia.
Caution: A controlled substance in the U.S. with cardiovascular considerations, and approved for short-term use rather than ongoing therapy.
Xenical (orlistat) and Alli
What it is: A lipase inhibitor that blocks absorption of some dietary fat. Alli is the over-the-counter version; Xenical is the prescription strength.
Results: Modest weight loss relative to the other options, and heavily dependent on dietary fat intake.
Cost: Generally inexpensive, and Alli is available without a prescription.
Where to get it: PlushCare and MEDvidi both list orlistat products among their weight-management options.
Caution: Gastrointestinal effects from fat malabsorption are the defining downside and are directly proportional to how much fat you eat.
Section 2: Providers That Prescribe Them
Most GLP-1 telehealth platforms will not touch these medications. These will.
| # | Provider | Rating | Published cost | Why it ranks here |
|---|---|---|---|---|
| 1 | UpScriptBest for Contrave | 8.3 | $99/mo Contrave | Runs the manufacturer's CurAccess program at $99/month with free shipping. No consultation fee in most cases, full refund if you are not prescribed, FSA/HSA accepted. |
| 2 | ChooseQBest for Qsymia | 8 | $65/visit | The manufacturer's designated telehealth partner. Flat $65 visit fee, choose your own state-licensed provider, multiple fulfillment options. |
| 3 | PlushCareBroadest formulary | 8.9 | $129/visit or copay | Prescribes Contrave and Xenical alongside GLP-1s, bills insurance, and handles prior authorizations. The best option if you want a clinician weighing all the choices. |
| 4 | MEDvidiNo membership | 8.2 | Consultation pricing from about $105; no membership fee | Covers orlistat (Xenical, Alli) and Qsymia alongside GLP-1s with no membership fee and same-day appointments available. |
| 5 | Klarity HealthMarketplace option | 7.4 | Varies by provider; transparent pricing shown before booking | Facilitates Qsymia prescriptions through licensed providers with an intake-then-virtual-visit flow. |
Prices are what each provider published as of the review date and change frequently. Confirm current pricing on the provider's own site before enrolling.
Section 3: How They Compare to GLP-1s
Where non-GLP-1s win
Cost. $99/month for Contrave against $299–$1,599 for brand-name GLP-1s.
Oral administration. No needles, no refrigeration, no cold-chain shipping.
Availability. No shortages, no compounding controversy, no supply anxiety.
Eligibility. Options for people with GLP-1 contraindications.
Track record. These drugs have been in use far longer.
Where GLP-1s win
Weight loss. 15% to 21% average versus meaningfully less for the alternatives.
Cardiometabolic benefits. Documented effects beyond weight in several trials.
Additional indications. Zepbound is approved for obstructive sleep apnea in adults with obesity.
Dosing convenience. Once weekly for the injectables versus twice daily for Contrave.
Provider availability. Nearly every telehealth platform offers them.
Section 4: Safety Considerations
- !Contrave has a boxed warning regarding suicidal thoughts and behaviors. It is also not approved to treat depression or for smoking cessation, despite containing bupropion.
- !Qsymia can cause birth defects. Effective pregnancy prevention is required, and you should stop immediately and contact your provider if you become pregnant.
- !Qsymia requires blood monitoring for metabolic acidosis before and during treatment, and must be tapered rather than stopped abruptly.
- !Phentermine is a controlled substance approved for short-term use, with cardiovascular considerations. Some providers decline to prescribe it at all.
- !State restrictions apply. Contrave is not available through UpScript in Florida, and Florida separately requires re-evaluation two to four weeks after a weight-loss prescription is written.
None of this is a reason to avoid these medications — it is a reason to have the conversation with a clinician who knows your history rather than picking from a menu. See our eligibility guide for how clinical and insurance criteria interact.
Frequently Asked Questions
What are the alternatives if I cannot take a GLP-1?
The main FDA-approved oral options are Contrave (naltrexone/bupropion), Qsymia (phentermine/topiramate), phentermine on its own for short-term use, and Xenical or Alli (orlistat). All produce less average weight loss than semaglutide or tirzepatide, but they are considerably cheaper, taken by mouth, and appropriate for some people who cannot use a GLP-1.
How much does Contrave cost?
$99 per month with free shipping through the manufacturer's CurAccess program, delivered by UpScript. If your insurance covers Contrave through a pharmacy it may cost less than that.
How much does Qsymia cost?
ChooseQ, the manufacturer's designated telehealth partner, charges a flat $65 telehealth visit fee, with medication billed separately depending on the fulfillment option you choose and your insurance. Manufacturer savings programs may also apply.
How much weight will I lose on a non-GLP-1 medication?
Less, on average. Contrave's trials showed 46% of patients losing 5% or more of body weight versus 23% on placebo across three 56-week studies. GLP-1 trials typically report 15% to 21% average loss. That said, a medication you can afford and tolerate beats one you cannot.
Are these medications safer than GLP-1s?
Not necessarily — just differently risky. Contrave carries a boxed warning regarding suicidal thoughts and behaviors. Qsymia can cause birth defects and metabolic acidosis and requires blood monitoring. Phentermine is a stimulant with cardiovascular considerations. Each has its own contraindication list that a clinician needs to work through with you.