Quick Summary
Wegovy (semaglutide) and Zepbound (tirzepatide) are both FDA-approved for chronic weight management in adults with obesity, or overweight with at least one weight-related condition, making this one of the most direct comparisons in the GLP-1 medication class. Wegovy, made by Novo Nordisk, is a GLP-1 receptor agonist and also carries an approval for cardiovascular risk reduction based on the SELECT trial. Zepbound, made by Eli Lilly, is a dual GIP/GLP-1 receptor agonist and received an additional FDA approval in December 2024 for the treatment of moderate-to-severe obstructive sleep apnea in adults with obesity.
In their respective pivotal trials, both medications demonstrated substantial weight loss. In the STEP 1 trial, semaglutide 2.4 mg produced approximately 16.9% mean weight loss over 68 weeks. In the SURMOUNT-1 trial, tirzepatide at its highest dose (15 mg) produced approximately 22.5% mean weight loss over 72 weeks. While these cross-trial numbers are frequently cited, they come from studies with different designs and populations. More definitive evidence comes from the SURMOUNT-5 trial, a head-to-head study reported in May 2025, in which tirzepatide demonstrated statistically superior weight loss compared to semaglutide, according to Eli Lilly.
Both medications are administered as once-weekly subcutaneous injections and share a similar side effect profile, with gastrointestinal symptoms being the most commonly reported adverse events in clinical trials. The choice between Wegovy and Zepbound may depend on factors including the patient's complete medical profile, whether they have conditions like obstructive sleep apnea or elevated cardiovascular risk, formulary availability, and out-of-pocket cost. Patients should discuss these factors with their doctor to determine which medication is the best fit for their individual circumstances.
Wegovy vs Zepbound: Full Comparison
| Feature | Wegovy(semaglutide) | Zepbound(tirzepatide) |
|---|---|---|
| Active Ingredient | semaglutide | tirzepatide |
| Drug Class | GLP-1 receptor agonist | Dual GIP and GLP-1 receptor agonist |
| Manufacturer | Novo Nordisk | Eli Lilly |
| FDA Approved | 2021-06-04 | 2023-11-08 |
| Approved Indications |
|
|
| Route | subcutaneous injection | subcutaneous injection |
| Frequency | Once weekly | Once weekly |
| Starting Dose | 0.25 mg weekly | 2.5 mg weekly |
| Maintenance Dose | 2.4 mg weekly | 5 mg, 10 mg, or 15 mg weekly |
| Max Dose | 7.2 mg weekly (Wegovy HD, approved March 19, 2026) | 15 mg weekly |
| Weight Loss (%) | 16.9% | 22.5% |
| A1C Reduction | N/A (not indicated for diabetes) | N/A (not indicated for diabetes) |
| Key Trial | STEP 1 (68 weeks) | SURMOUNT-1 / SURMOUNT-5 (head-to-head vs semaglutide) (72 weeks) |
| List Price | $1,349-$1,650/month | $1,060-$1,176/month |
| With Insurance | $25-$250/month (varies by plan; many plans exclude weight-loss drugs) | $25-$250/month (varies; weight-loss coverage is limited) |
| Savings Card | $0/month for eligible patients (NovoCare savings program) | $25/month (Lilly savings card, commercially insured) |
Side Effects: Wegovy vs Zepbound
| Side Effect | Wegovy | Zepbound |
|---|---|---|
| Nausea | 44% | 24-33% |
| Diarrhea | 30% | 18-25% |
| Vomiting | 24% | 10-18% |
| Constipation | 24% | 13-17% |
| Abdominal pain | 20% | 10-14% |
| Headache | 14% | Not reported |
| Fatigue | 11% | Not reported |
| Pancreatitis (rare) | <1% | <1% |
| Gallbladder events | 2.6% | 1.6% |
| Dyspepsia | Not reported | 7-10% |
| Injection site reaction | Not reported | 3-7% |
| Hair loss | Not reported | 5-6% |
Severity scale: 1 (mild) to 5 (serious). Based on FDA prescribing information and clinical trial data.
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This content is for informational purposes only and is not medical advice. Always consult your healthcare provider before making medication decisions. See our full medical disclaimer.