Saxenda vs Mysimba: what is the difference and which suits you?

How does Saxenda (liraglutide) work?

Saxenda contains liraglutide, a GLP-1 receptor agonist. It mimics the gut hormone GLP-1, which is released after eating and tells your brain that you are full. As a result, you are less hungry, you feel full sooner and food stays in your stomach longer. You inject it once a day under the skin, in the abdomen, thigh or upper arm. Read more about how fast Saxenda works.

You build up the dosage over five weeks from 0.6 to 3.0 mg a day, to limit stomach and bowel complaints. The same substance is also found in other brands such as Vobexoryn and Nevolat; see our article on liraglutide. The dosing schedule and the pen are covered in Saxenda dosage.

Saxenda is the oldest of the GLP-1 medications for weight loss. Newer medications such as Wegovy (semaglutide) and Mounjaro (tirzepatide) work through the same mechanism, but weekly and with a larger average effect. In the Netherlands, those are not reimbursed for weight loss; Saxenda is, under certain conditions.

How does Mysimba (naltrexone/bupropion) work?

Mysimba combines two substances that have existed for longer: naltrexone, which is used for alcohol and opioid addiction, and bupropion, an antidepressant that also helps people stop smoking. Together they act in the brain: bupropion lowers appetite via dopamine, naltrexone reduces the urge to eat and the rewarding feeling of (comfort) eating.

According to the Farmacotherapeutisch Kompas (the Dutch national drug reference) of Zorginstituut Nederland, you build up over four weeks: week 1 one tablet in the morning, week 2 one tablet in the morning and one in the evening, week 3 two in the morning and one in the evening, from week 4 two tablets twice a day. You swallow them whole, with some food. This makes Mysimba an appetite suppressant in tablet form, for people who do not want to or cannot inject.

The medication works differently from a GLP-1 medication: not through the stomach and intestines, but through the nervous system. That explains both the different side effects and the different contraindications.

Is Mysimba better than Saxenda? What the studies show

No, in the registration studies Saxenda gives more weight loss on average than Mysimba. According to the assessment by the European Medicines Agency (EMA), participants on Mysimba lost an average of 3.7 to 5.7 percent of their body weight in three studies, compared with 1.3 to 1.9 percent on placebo; in a study with intensive lifestyle support, it was 8.1 compared with 4.9 percent. For Saxenda, the EMA reports 7.5 percent compared with 2.3 percent on placebo in the main study; in the SCALE trial (NEJM 2015), participants lost an average of 8.4 kilos in 56 weeks compared with 2.8 kilos on placebo.

The medications have never been compared with each other directly, and the variation between people is large. Someone who does not respond to one medication may get results with the other. "Better" therefore depends on your situation: what you tolerate, which conditions you have and whether you prefer swallowing a tablet or injecting. Results vary from person to person.

Side effects and contraindications side by side

Saxenda mainly causes stomach and bowel complaints, Mysimba mainly nervous system complaints alongside nausea. According to apotheek.nl from the Dutch pharmacists' organisation KNMP, 10 to 30 in 100 Mysimba users get nausea, vomiting, constipation or headache; anxiety, sleep problems, dizziness, palpitations, higher blood pressure, a dry mouth and trembling occur in 1 to 10 in 100. Rare but serious are epileptic seizures and worsening of bipolar disorder.

With Saxenda, more than 30 in 100 users get stomach and bowel complaints, especially in the build-up phase; pancreatitis and gallstones are rare. The overview per complaint is in Saxenda side effects.

The contraindications often determine the choice:

• Mysimba not with: epilepsy or an increased risk of seizures, uncontrolled high blood pressure, use of opioids (including morphine-like painkillers), bipolar disorder, bulimia or anorexia, severe liver failure, and certain antidepressants (MAO inhibitors). Take care when driving in the first week and after each increase, because dizziness and concentration problems occur.
• Saxenda not with: a previous pancreatitis, medullary thyroid cancer in the family, severe kidney or liver problems; caution with gallbladder complaints.
• Neither with: pregnancy, wanting to conceive or breastfeeding, and under the age of 18.

When are Saxenda and Mysimba reimbursed?

Both medications are reimbursed from basic health insurance (basisverzekering) under the conditions of bijlage 2, and in both cases only after a year of a combined lifestyle intervention (gecombineerde leefstijlinterventie, GLI) without sufficient results. According to the November 2022 advice from Zorginstituut Nederland (the Dutch National Health Care Institute), these limits apply:

• Mysimba: BMI 30 or higher, or BMI 27 to 30 combined with a comorbidity such as (risk factors for) cardiovascular disease, type 2 diabetes, sleep apnoea or osteoarthritis.
• Saxenda: BMI 40 or higher, or BMI 35 or higher with cardiovascular disease, sleep apnoea or osteoarthritis; not with type 2 diabetes and not after or before weight loss surgery.

This is how the route works: first a year of GLI via your GP (huisarts), then the doctor assesses whether you meet the BMI condition, then the prescription with a doctor's statement (artsenverklaring), and after 3 months (Saxenda, on the maintenance dose) or 16 weeks (Mysimba) the evaluation: less than 5 percent weight loss means stopping the reimbursed treatment. Your deductible (eigen risico) applies. Mysimba is therefore reimbursed for a larger group than Saxenda. The conditions per insurer are in our article on whether Saxenda is covered by insurance; the overview of all medications is in weight loss medication covered by insurance.

Already tried all sorts of things and want to know whether medication under a doctor's supervision is right for you? Read how medical weight loss with injections works with us →

Can you use Mysimba and Saxenda together?

No, you do not use Saxenda and Mysimba at the same time. The combination has not been studied, is not registered and is not reimbursed. Both medications cause nausea, and the combination increases this without it being known whether it produces extra weight loss.

What does happen is switching: from Mysimba to Saxenda if the tablet does too little or is not tolerated, or the other way round if injecting does not work out or the stomach and bowel complaints are too severe. That always happens through the doctor, with a short transition and a new build-up.

Which medication suits you? How the doctor chooses

The doctor chooses on the basis of your health, your BMI, previous attempts, other medication and your preference for swallowing or injecting. Broadly speaking:

• An injection is the obvious choice with a higher BMI or many weight-related complaints (larger average effect), with epilepsy, opioid use, high blood pressure or a psychiatric history (Mysimba not possible), or if you have already tolerated a GLP-1 medication well.
• A tablet is the obvious choice if you do not want to or cannot inject, with a previous pancreatitis or thyroid cancer in the family (Saxenda not possible), or if you meet the reimbursement conditions for Mysimba but not those for Saxenda.
• Neither during pregnancy, when wanting to conceive, while breastfeeding or under 18.

With us, the doctor assesses whether medical weight loss is right for you and which medication goes with it. We offer both medical weight loss with injections and medical weight loss with pills. A programme with liraglutide (Saxenda) costs €850 per month, plus a one-off €400 support fee; the doctor assesses which tablet suits your situation.

Want to know whether medical weight loss is right for you? Complete the eligibility check and the doctor will assess your situation →

Frequently asked questions about Saxenda and Mysimba

Is Mysimba better than Saxenda?

No, in the registration studies Saxenda gave more weight loss on average (7.5 compared with 2.3 percent on placebo) than Mysimba (3.7 to 5.7 compared with 1.3 to 1.9 percent). The medications have never been compared directly and the response varies from person to person. The doctor assesses which medication is suitable.

How many kilos do you lose with Mysimba?

That varies from person to person. In the registration studies, participants lost an average of 3.7 to 5.7 percent of their body weight in a year, and 8.1 percent with intensive lifestyle support. At 100 kilos, that is 4 to 8 kilos. If it does not work after 16 weeks (less than 5 percent), you stop.

Can I use Mysimba and Saxenda together?

No. The combination has not been studied and is not registered. Switching from one medication to the other is possible, through the doctor.

What is the difference between Mysimba and Ozempic?

Ozempic contains semaglutide, a weekly GLP-1 injection registered for diabetes. Mysimba is a tablet that acts in the brain. Ozempic is not reimbursed for weight loss, Mysimba is, under certain conditions. The comparison between the injections is in Saxenda vs Ozempic.

Mysimba or Mounjaro: what is the difference?

Mounjaro (tirzepatide) is a weekly injection that acts on two gut hormones and gives the largest average weight loss in research; it is not reimbursed for weight loss. Mysimba is a tablet with a smaller effect, which is reimbursed after a year of GLI. See also Mounjaro vs Saxenda.

What does Mysimba cost if it is not reimbursed?

On the full dose of four tablets a day, Mysimba costs €3.85 per day, about €115 per month (Farmacotherapeutisch Kompas, September 2026), plus pharmacy and doctor's costs.

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