Semaglutide vs Tirzepatide: Weight Loss, Side Effects and Cost
Tirzepatide caused more weight loss than semaglutide in the SURMOUNT-5 trial: 20.2% against 13.7% over 72 weeks, in adults with obesity without diabetes. Both cause similar stomach side effects.
Without insurance, Zepbound starts at $299 a month from LillyDirect, and the Wegovy pen costs $199 for the first two low-dose fills, then $349.
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In this article
- 01Does semaglutide or tirzepatide produce more weight loss?
- 02How do semaglutide and tirzepatide costs compare?
- 03Which has more side effects: semaglutide or tirzepatide?
- 04Which forms of semaglutide and tirzepatide are approved?
- 05How do the heart, kidney and sleep-apnea indications differ?
- 06How do semaglutide and tirzepatide work?
- 07Can you switch from semaglutide to tirzepatide?
- 08What should you discuss with your prescriber before choosing?
- 09Sources
Tirzepatide produced greater average weight loss than semaglutide in SURMOUNT-5: 20.2% versus 13.7% over 72 weeks.
That 2025 trial enrolled adults with obesity without diabetes and compared maximum-tolerated weekly injections: tirzepatide 10 or 15 mg and semaglutide 1.7 or 2.4 mg.
It did not compare oral medicines, compounded products or the newer 7.2 mg Wegovy injection. The average result is useful evidence, but it does not establish which treatment you should take.
Your prescriber also needs to consider the exact brand, medical indication, side effects, other medicines and access cost.
Tirzepatide (Zepbound, Mounjaro) produced more weight loss in the one head-to-head obesity trial.
Semaglutide (Wegovy, Ozempic, Rybelsus) also comes as a pill, and Wegovy carries a heart-risk indication for adults with established heart disease. Your diagnosis, your insurance and how you tolerate each one decide the rest.
Where to start, depending on what matters to you:
- •Weight-loss evidence: Read the trial comparison below, then compare Wegovy and Zepbound, the weight-management brands.
- •Compounded semaglutide: Check Embody’s current plans and total costs. A compounded offer is not evidence of equivalence to Wegovy.
- •Brand-name semaglutide: Compare NovoCare’s current Wegovy offers with Hers’ medication and membership costs, and read Hers’ FDA warning-letter record before choosing. Match the formulation, prescribed dose, introductory period and ongoing fees.
- •Side effects: Both can cause gastrointestinal symptoms. A group-level trial rate cannot predict which medicine you will tolerate better.
- •Heart or kidney disease: Compare the exact indications in the current Ozempic, Mounjaro and Wegovy labels with your clinician.
- •Prefer a pill? Our oral GLP-1 guide separates approved oral semaglutide and orforglipron from compounded tablets. They are not interchangeable with the injections in SURMOUNT-5.
This guide compares the two ingredients across every brand: Wegovy, Ozempic and Rybelsus against Zepbound and Mounjaro. For the brand-name weight-loss comparison only, see Wegovy vs Zepbound.
See what each one costs and how to get it
Each page lists who prescribes it and what you pay. Your prescriber decides which one suits you.
See semaglutide program costs →Does semaglutide or tirzepatide produce more weight loss?
The clearest weight-loss comparison is the randomized SURMOUNT-5 trial, published by Aronne and colleagues in 2025. It studied 751 adults with obesity without type 2 diabetes.
Tirzepatide produced a larger average reduction, but the trial was open-label and funded by Eli Lilly.
| Question | What SURMOUNT-5 studied |
|---|---|
| Population | Adults with obesity, without type 2 diabetes |
| Tirzepatide | Maximum tolerated 10 or 15 mg injection once weekly |
| Semaglutide | Maximum tolerated 1.7 or 2.4 mg injection once weekly |
| Follow-up | 72 weeks |
| Average body-weight change | 20.2% reduction with tirzepatide; 13.7% with semaglutide |
| Difference | 6.5 percentage points; not 6.5% of the semaglutide result |
| Not tested here | Wegovy 7.2 mg, oral products, compounded products or dose conversion |
This is evidence about specific treatments, not a promise that one person will lose a set amount. It also does not show how much weight a person with diabetes would lose.
For the diabetes comparison, use Mounjaro vs Ozempic, which explains SURPASS-2 and its semaglutide 1 mg comparator.
Your dose, tolerability, medical history and ability to continue treatment matter. For a practical discussion of timing and expectations, see our semaglutide before-and-after evidence guide.
How do semaglutide and tirzepatide costs compare?
Compare the exact product, prescribed dose and payment route. The makers' prices below carry the date we checked them; eligibility and offer terms can change.
A compounded introductory price is not a price for branded Wegovy or Zepbound.
| Scenario | Semaglutide (Wegovy) | Tirzepatide (Zepbound) |
|---|---|---|
| List price (injectable) | ~$1,349/mo | ~$1,086/mo |
| Manufacturer self-pay (injectable) | $199/mo first two low-dose fills, then $349 standard / $399 HD (NovoCare) | $299-449/mo (LillyDirect vials, dose/refill terms apply) |
| Commercial insurance + savings card | As low as $25/mo | As low as $25/mo |
| Without insurance or savings card | ~$1,349/mo | ~$1,086/mo |
| Oral Wegovy (self-pay starter) | ~$149/mo | N/A (injection only) |
| Medicare GLP-1 Bridge | Separate $50/month program for eligible patients and covered products; see eligibility guide | Separate $50/month program for eligible patients and covered products; see eligibility guide |
For patients paying out of pocket, Eli Lilly's LillyDirect Zepbound lists a $299 starting-dose offer, with higher-dose and refill conditions, while Novo Nordisk's NovoCare listed the Wegovy pen at $199/month for the first two low-dose fills, then $349/month at standard strengths ($399 for HD) and pill from $149/month in the August 7 check; a prescription is required and pricing is dose-dependent.
Telehealth services advertise compounded options including Enhance MD compounded tirzepatide plans, Shed at $299/month, and Sprout Health compounded tirzepatide at $199 every 4 weeks (2025 FDA warning for misleading compounded-drug marketing).
Those listings do not establish that a particular pharmacy, prescription, or batch meets section 503A, section 503B, or state-law conditions; 503A pharmacies are state-licensed rather than FDA-registered.
Hers lists Wegovy pill medication from $149 or pen from $199 plus required $39 first-month/$149 ongoing membership.
Use our cost calculator to compare prices separately from regulatory and product-safety questions.
For insured patients, both manufacturers offer savings cards that can bring copays as low as $25/month with eligible commercial insurance.
Which drug your plan prefers varies: some insurers have exclusive deals with Novo Nordisk and others with Lilly.
The most reliable strategy is to ask your provider to check coverage for both and go with whichever is on your formulary.
Compounded telehealth offers often use a prepaid monthly equivalent rather than a recurring monthly charge.
Our bmiMD pricing breakdown separates semaglutide from tirzepatide, month-to-month prices from prepaid totals, and introductory terms from longer commitments.
Use that current pricing record rather than treating a copied promotional number as a guaranteed quote.
The Medicare GLP-1 Bridge guide explains the program that began in July 2026, its eligible products and its limits.
The $50 copay is not a promise that every Medicare enrollee or every formulation qualifies. Coverage for another approved medical indication may follow a different route.
FDA's shortage-based enforcement-discretion periods for semaglutide ended in 2025.
Any current compounded preparation must independently satisfy the applicable 503A or 503B requirements and state law; availability or a documented clinical rationale alone does not establish compliance.
See our compounded semaglutide crackdown guide for the regulatory framework, then use our provider rankings to compare advertised program prices separately from prescription and pharmacy evidence. Willow's $299/mo program is one advertised post-shortage price benchmark, not a compliance determination.
Which has more side effects: semaglutide or tirzepatide?
Both can cause nausea, vomiting, diarrhea and constipation.
The SURMOUNT-5 abstract describes gastrointestinal events as the most common adverse events in both groups, usually mild to moderate and concentrated during dose escalation.
That does not mean either medicine is automatically easier for you to tolerate.
| What to compare | Why it matters |
|---|---|
| Same trial, population and doses | Separate STEP and SURMOUNT percentages are not a randomized tolerability comparison. |
| Symptoms versus stopping treatment | A discontinuation rate does not describe every participant’s symptoms. |
| Your current dose and other medicines | Your prescriber needs this context when considering a change. |
| Severity and persistence | Persistent or severe symptoms need clinical assessment, not a switch based on a comparison chart. |
The current Wegovy and Zepbound labels report side effects from their respective trials.
Their tables use different study populations and dose schedules, so we do not turn those numbers into a blanket “better tolerated” recommendation.
If side effects are limiting treatment, tell your clinician what happened, when it started, your dose and any other medicines you use. Ask about the options before changing or stopping a prescription.
Our side-effect management guide distinguishes day-to-day symptoms from signs that need care.
Both semaglutide and tirzepatide carry FDA boxed warnings about thyroid C-cell tumors (observed in rodent studies, not confirmed in humans).
Both have warnings for pancreatitis, gallbladder disease, hypoglycemia (especially when combined with insulin), and acute kidney injury.
Both are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Neither should be used during pregnancy.
A different medicine may suit some patients, but this page cannot identify a safe switching dose. See the switching section below and our Zepbound side-effects guide.
Which forms of semaglutide and tirzepatide are approved?
Semaglutide has oral and injectable branded formulations; the approved tirzepatide brands are injections.
The Wegovy label now includes 25 mg daily tablet maintenance and a 7.2 mg injection option.
Older comparisons describing 2.4 mg as the universal maximum or oral maintenance as “TBD” are out of date.
| Brand | Ingredient | Form | Where to check the distinction |
|---|---|---|---|
| Wegovy | Semaglutide | Weekly injection or daily tablet | Formulation-specific weight-management and cardiovascular indications; injection also has a MASH indication |
| Ozempic | Semaglutide | Weekly injection | Type 2 diabetes, plus defined cardiovascular and kidney indications |
| Mounjaro | Tirzepatide | Weekly injection | Type 2 diabetes, plus defined cardiovascular indication |
| Zepbound | Tirzepatide | Weekly injection | Weight management; moderate to severe OSA in adults with obesity |
For dose schedules, use our Wegovy dosage guide and Mounjaro dosage guide alongside the prescribed product’s label. Foundayo contains orforglipron, a different molecule; it is not oral tirzepatide.
Our oral GLP-1 guide also explains other semaglutide brands and formulations.
Some providers market compounded oral dissolving tirzepatide. Those products are not FDA-approved Mounjaro or Zepbound tablets, and the injection trial results above cannot be assigned to them.
A similar ingredient name is not evidence of equivalent absorption, safety or effectiveness.
How do the heart, kidney and sleep-apnea indications differ?
Compare the brand and indication, not a general claim that one molecule is “better for the heart.” The current Wegovy, Ozempic, Mounjaro and Zepbound labels cover different populations and outcomes.
Wegovy’s cardiovascular evidence includes SELECT, which studied semaglutide 2.4 mg injections in adults with established cardiovascular disease and overweight or obesity, without diabetes.
The result does not become an Ozempic trial merely because both contain semaglutide.
Ozempic’s label includes cardiovascular risk reduction in adults with type 2 diabetes and established cardiovascular disease, plus kidney-related risk reduction in adults with type 2 diabetes and chronic kidney disease.
Mounjaro’s August 2026 label now includes cardiovascular risk reduction for adults with type 2 diabetes at high cardiovascular risk.
Its SURPASS-CVOT study compared tirzepatide with dulaglutide, not semaglutide. It cannot establish which of Mounjaro and Ozempic is superior for heart outcomes.
Zepbound has an indication for moderate to severe obstructive sleep apnea in adults with obesity.
This is separate from weight-loss averages and does not establish that every compounded tirzepatide preparation treats sleep apnea.
Bring the relevant diagnosis and treatment goal to your prescriber. A price comparison should follow that decision rather than replace it.
How do semaglutide and tirzepatide work?
The main difference is which receptors each drug targets.
Semaglutide is a GLP-1 receptor agonist. It mimics a single gut hormone, glucagon-like peptide-1, that your body naturally releases after eating.
By binding to GLP-1 receptors in the brain, gut, and pancreas, semaglutide suppresses appetite, slows gastric emptying (so you feel full longer), and improves blood sugar regulation.
It was developed by Novo Nordisk and first approved by the FDA in 2017 (as Ozempic for Type 2 diabetes). The weight-loss version, Wegovy, was approved in June 2021.
Tirzepatide is a dual GIP/GLP-1 receptor agonist, what researchers call a "twincretin." It activates both the GLP-1 receptor and the GIP (glucose-dependent insulinotropic polypeptide) receptor simultaneously.
GIP is another incretin hormone involved in glucose metabolism, fat storage, and energy balance. By hitting two targets instead of one, tirzepatide engages additional metabolic pathways that semaglutide doesn't directly activate.
It was developed by Eli Lilly and first approved in 2022 (as Mounjaro for Type 2 diabetes). Zepbound (the weight-loss brand) followed in November 2023.
Receptor activity describes how a medicine works; the outcomes must still be tested. The direct SURMOUNT-5 trial supports a weight-loss advantage for the studied tirzepatide injections.
It does not prove every product described as GLP-1 + GIP will produce the same result.
The injections of both medicines are given weekly. Semaglutide also has daily oral formulations with separate dosing instructions.
See the current Wegovy label rather than transferring an injection dose to a tablet.
Can you switch from semaglutide to tirzepatide?
A prescriber can assess a switch, but there is no simple milligram-for-milligram conversion between these medicines. A higher number on a tirzepatide pen does not mean it is an equivalent dose of semaglutide.
The Mounjaro and Wegovy labels use different dose schedules and formulations.
Tell your clinician your current product, dose, last injection or tablet, side effects and other medicines. Ask for a written plan for the change rather than using a comparison table as dosing instructions.
Do not combine them on your own. The Zepbound label advises against coadministration with another tirzepatide-containing product or a GLP-1 receptor agonist.
What should you discuss with your prescriber before choosing?
Start with the treatment goal, the exact product and a sustainable access plan. A greater trial average is one input; it does not outweigh a contraindication or tell you how you will respond.
Questions about semaglutide:
- •Does a particular semaglutide brand’s approved indication fit my diagnosis?
- •Would a tablet or an injection be appropriate, and what instructions differ? See oral versus injectable options.
- •Which product does my plan cover, at my prescribed dose and for my indication?
- •If I already take semaglutide, would changing brands or formulations require a new treatment plan?
Questions about tirzepatide:
- •Does Mounjaro or Zepbound fit my diagnosis and treatment goals?
- •What do the weight-loss results mean for someone with my medical history?
- •How would we assess side effects and decide whether to adjust treatment?
- •What is the full cost at the prescribed dose after any introductory offer?
Once the clinical options are clear, compare semaglutide programs, tirzepatide programs and the cost calculator.
Check medication, route, fees and commitment together; the lowest headline price may refer to a different product.
Our program finder helps narrow shopping preferences. It cannot diagnose a condition, confirm clinical eligibility or prescribe a medicine.
Our beginner’s GLP-1 guide explains the questions to bring to an appointment.
This article is for informational purposes only and does not constitute medical advice. Semaglutide and tirzepatide are prescription medications with significant side effects and contraindications.
Do not start, stop, or change medications without consulting your physician or healthcare provider. The clinical trial data cited here represents population averages, not guaranteed individual outcomes.
Always discuss the benefits and risks with your doctor before starting treatment.
Sources
- SURMOUNT-5: Tirzepatide as Compared with Semaglutide for the Treatment of Obesity, Aronne et al., NEJM, 2025
- SURPASS-2: Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes, Frías et al., NEJM, 2021
- Wegovy prescribing information, Novo Nordisk, revised June 2026
- Ozempic prescribing information, Novo Nordisk, revised May 2026
- Mounjaro prescribing information, Eli Lilly, revised August 2026
- Zepbound prescribing information, Eli Lilly, revised August 2026
- Medicare GLP-1 Bridge, CMS
- LillyDirect Zepbound product and self-pay terms, checked September 12, 2026
Affiliate disclosure: Some links in this article are affiliate links. If you join a program through one, we may earn a commission at no extra cost to you.
Where to go next
Medicare & GLP-1
Medicare GLP-1 Coverage Guide
On Medicare? From July 1, 2026, the Medicare GLP-1 Bridge sets a $50 monthly copay for Wegovy, Zepbound and Foundayo. Our guide explains who qualifies and what it covers.
Read the Medicare guide →What the doctors say
Quotes from named doctors and medical bodies, each linked to where they said it. We did not ask for them, and they do not endorse any provider.
“More options for people with these challenging diseases will be very helpful, particularly if the new oral tablet medicines are priced reasonably.”
“People with overweight or obesity have individual preferences, and with oral semaglutide as a potential new treatment option, more of those who are not on treatment today may consider starting GLP-1 treatment.”
“We now have medicines that not only reduce heart attacks, strokes, and peripheral arterial disease, but also simultaneously lead to meaningful weight loss, which in turn lowers the risk of many weight-related conditions. These treatments also improve patients' quality of life in a meaningful way, making this a genuine win, win.”
Quotes are general medical commentary about GLP-1 medications, independently sourced and not solicited by GLP-1 Picks. They are not an endorsement of any provider, our provider scores are set solely by our published methodology.