What Is Mysimba and How Is It Used?
Mysimba (marketed as Contrave in the US) is a prescription weight loss medication approved for adults with obesity or overweight with comorbidities. It contains two active substances: naltrexone (8 mg) and bupropion (90 mg) in an extended-release tablet. Mysimba experiences vary considerably between individuals, but clinical studies show an average weight loss of 5-10% after one year of use. The medication is approved by the EMA (European Medicines Agency) for patients with a BMI of 30 or higher, or a BMI of 27 or higher combined with weight-related conditions such as type 2 diabetes or hypertension.
Mysimba works differently from GLP-1 medications like Ozempic or Wegovy. While those medications target hunger signals through the gut, Mysimba focuses on the reward system in the brain. This makes it an interesting alternative for people who do not qualify for injectable medication or prefer not to use it.
Want to know which weight loss medication suits you best? Check how it works at Go Leaner for a personal consultation with a registered physician.
How Does Mysimba Work for Weight Loss?
Mysimba combines two substances that each target a different mechanism in the brain:
Synergistic Effect of Naltrexone and Bupropion
The combination works synergistically. Bupropion activates POMC neurons (pro-opiomelanocortin) in the hypothalamus that emit a satiety signal. Normally, these neurons self-inhibit through beta-endorphin release. Naltrexone blocks this self-inhibition, allowing the satiety signal to persist longer. This mechanism was described in the COR-I trial (Greenway et al., 2010).
Difference from GLP-1 Medication
With GLP-1 agonists such as semaglutide (Ozempic/Wegovy) or tirzepatide (Mounjaro), satiety is enhanced through the gastrointestinal system. Mysimba works exclusively centrally in the brain. This explains why the side effect profiles and Mysimba experiences differ fundamentally from those of GLP-1 medication.
What Is the Dosing Schedule for Mysimba?
Mysimba is titrated over four weeks to minimise side effects. The complete dosing schedule is as follows:
| Week | Morning | Evening | Total tablets/day | |------|---------|---------|------------------| | Week 1 | 1 tablet | 0 | 1 | | Week 2 | 1 tablet | 1 tablet | 2 | | Week 3 | 2 tablets | 1 tablet | 3 | | Week 4+ | 2 tablets | 2 tablets | 4 |
The maximum maintenance dose is 4 tablets per day (2 in the morning, 2 in the evening), equalling 32 mg naltrexone and 360 mg bupropion daily. Tablets must be swallowed whole with water, preferably not with a high-fat meal as this increases the risk of side effects.
When to Discontinue Mysimba?
According to EMA guidelines, treatment should be discontinued if less than 5% weight loss is achieved after 16 weeks on the maximum dose. This is an important evaluation point that recurs in many Mysimba experiences: some users notice insufficient effect within this period.
What Results Do Clinical Studies Show with Mysimba?
Mysimba's efficacy has been studied in four large randomised, double-blind, placebo-controlled trials (the COR trials).
Results from the COR Trials
Realistic Expectations
Based on these studies, you can realistically expect:
For comparison: semaglutide 2.4 mg (Wegovy) showed an average weight loss of 14.9% after 68 weeks in the STEP-1 trial (Wilding et al., 2021). Tirzepatide (Mounjaro) showed 22.5% at the highest dose in the SURMOUNT-1 trial (Jastreboff et al., 2022). This explains why more people are choosing GLP-1 medication. View the pricing of GLP-1 treatments at Go Leaner for more information.
What Are Common Side Effects According to Mysimba Experiences?
Side effects are a recurring theme in Mysimba experiences. Most side effects occur in the first weeks and diminish as the body adjusts to the medication.
Common Side Effects (>10% of users)
Less Common but Important Side Effects
When to Contact a Doctor Immediately?
Seek immediate medical attention for:
Important: Mysimba is contraindicated in people with a history of epilepsy, eating disorders (anorexia/bulimia), uncontrolled hypertension, or concurrent use of MAO inhibitors.
What Does Mysimba Cost in the Netherlands?
Mysimba is not covered by basic health insurance in the Netherlands. Costs are entirely out-of-pocket.
| Period | Estimated cost | Note | |--------|---------------|------| | 1 month (titration) | €70 - €100 | Lower due to titration dosing | | 1 month (maintenance) | €100 - €140 | 4 tablets per day | | 6 months | €550 - €750 | Including titration phase | | 12 months | €1,100 - €1,500 | Full treatment duration |
Prices vary by pharmacy. Some supplementary insurance policies offer partial reimbursement. Always check your policy conditions.
For comparison: GLP-1 medication is also an investment but offers significantly higher weight loss percentages on average. View the cost overview at Go Leaner for a transparent picture of treatment costs.
How Do Mysimba Experiences Compare to GLP-1 Alternatives?
Many people sharing Mysimba experiences compare the medication with GLP-1 agonists. Below is an objective comparison:
| Feature | Mysimba | Wegovy (semaglutide) | Mounjaro (tirzepatide) | |---------|---------|---------------------|------------------------| | Administration | Oral tablet | Weekly injection | Weekly injection | | Average weight loss | 6-9% | 15% | 20-22% | | Mechanism | Central nervous system | GLP-1 receptor | GLP-1 + GIP receptor | | Most common side effect | Nausea, headache | Nausea, diarrhoea | Nausea, diarrhoea | | Basic insurance coverage | No | No | No | | Suitable for type 2 diabetes | Yes (limited effect) | Yes (strong effect) | Yes (strong effect) | | Epilepsy contraindication | Yes | No | No |
Who Is Mysimba Suitable For?
Mysimba may be a good choice for people who:
For people with a BMI above 30 seeking maximum results, clinical data overwhelmingly point towards GLP-1 medication. Calculate your BMI to see which options are relevant for you.
What Do Users Say About Their Mysimba Experiences?
While individual experiences do not constitute scientific evidence, they provide insight into daily use. Based on published patient reports and pharmacovigilance data, the following patterns emerge:
Positive Mysimba Experiences
Negative Mysimba Experiences
Dropout Rate
In the COR trials, approximately 24% of participants discontinued Mysimba prematurely due to side effects, versus 12% in the placebo group. This is a relevant consideration for anyone considering Mysimba.
What Contraindications and Interactions Does Mysimba Have?
Mysimba is not suitable for everyone. Important contraindications include:
Important Drug Interactions
Bupropion is metabolised via CYP2B6. Medications that inhibit or induce this enzyme can affect Mysimba's efficacy. Specifically:
Always discuss your complete medication list with a physician before starting Mysimba.
Frequently Asked Questions About Mysimba Experiences
How Much Weight Can You Lose with Mysimba?
On average, users lose 6-9% of their body weight after one year of use combined with a calorie-restricted diet. For a starting weight of 100 kg, this means 6-9 kg. Individual results vary significantly: some lose more, others do not reach the 5% threshold.
How Quickly Do You Notice Mysimba's Effect?
Most users notice reduced appetite within 2-4 weeks. Significant weight loss typically becomes visible after 8-12 weeks. If less than 5% weight loss is achieved after 16 weeks on maximum dose, the prescribing physician usually advises discontinuation.
Is Mysimba Addictive?
Naltrexone is an opioid antagonist with no addictive potential. Bupropion has a very low abuse risk. Mysimba is not classified as an addictive substance. No tapering schedule is necessary when stopping, although abrupt discontinuation may occasionally cause mild withdrawal symptoms.
Can You Drink Alcohol While Using Mysimba?
Alcohol use is strongly discouraged during Mysimba treatment. Alcohol lowers the seizure threshold (a risk of bupropion) and can intensify side effects. Additionally, alcohol undermines weight loss efforts.
Can You Combine Mysimba with Other Weight Loss Medications?
Combining Mysimba with GLP-1 medication has not been studied in standard clinical trials and is not routinely recommended. Combination with other centrally acting agents increases the risk of side effects. Always discuss potential combinations with a specialised physician.
Conclusion: Is Mysimba the Right Choice?
Mysimba experiences show a mixed picture. The medication offers an oral option for weight loss with average efficacy of 6-9% weight loss after one year. For people who experience emotional eating as their main problem and prefer not to use injections, it can be a valuable option. At the same time, clinical studies show that GLP-1 medication achieves significantly higher weight loss percentages (15-22%).
The choice of the right weight loss medication depends on your personal situation, BMI, medical history, and preferences. A consultation with a specialised physician is essential to determine the best option.
Need help choosing the right treatment? At Go Leaner, you are guided by registered physicians who determine together with you which medication best suits your situation and goals.
This article is informational and does not replace medical advice. Always consult a physician before starting weight loss medication.
Frequently Asked Questions
How much weight can you lose with Mysimba?
On average, users lose 6-9% of their body weight after one year of Mysimba use combined with a calorie-restricted diet. For a starting weight of 100 kg, this means 6-9 kg. Individual results vary: some lose more, others do not reach the 5% threshold and discontinue after 16 weeks.
How quickly do you notice Mysimba's effect?
Most users notice reduced appetite within 2-4 weeks. Significant weight loss typically becomes visible after 8-12 weeks. If less than 5% weight loss is achieved after 16 weeks on maximum dose, the physician usually advises discontinuation.
Is Mysimba addictive?
No, Mysimba is not addictive. Naltrexone is an opioid antagonist with no addictive potential and bupropion has a very low abuse risk. No tapering schedule is necessary when stopping, although abrupt discontinuation may occasionally cause mild withdrawal symptoms.
Can you drink alcohol while taking Mysimba?
Alcohol use is strongly discouraged during Mysimba treatment. Alcohol lowers the seizure threshold (a risk of bupropion) and intensifies side effects such as nausea and dizziness. Additionally, alcohol undermines the weight loss process.
What are the side effects of Mysimba?
The most common side effects are nausea, constipation, headache, vomiting, dizziness, and insomnia. These mainly occur in the first 4 weeks and usually diminish. Approximately 24% of users discontinue prematurely due to side effects. Serious side effects such as seizures are rare.
Is Mysimba covered by health insurance?
No, Mysimba is not covered by Dutch basic health insurance. The costs of approximately 100-140 euros per month are entirely out-of-pocket. Some supplementary insurance policies offer partial reimbursement. Always check your policy conditions.