Ozempic vs Mounjaro compared from the FDA labels and the SURPASS-2 head-to-head trial: approved uses, how each works, blood sugar and weight results, heart and kidney protection, side effects and dated self-pay prices.
Fact-checked against FDA labels and official sources; not yet reviewed by a licensed clinician. This page is education, not medical advice. Talk to your doctor before starting, stopping or changing any treatment.
Key takeaways
- Ozempic and Mounjaro are FDA approved for type 2 diabetes, not weight loss; their weight-management versions are Wegovy and Zepbound.[2]
- In SURPASS-2 (40 weeks), HbA1c fell 2.0 to 2.3 points with tirzepatide and 1.9 points with semaglutide 1 mg.[3]
- Weight fell 7.6 to 11.2 kg with tirzepatide and 5.7 kg with semaglutide 1 mg in SURPASS-2; nausea was similar (17-22% vs 18%).[3]
- Only Ozempic has a kidney-protection indication (FLOW); both have heart-protection indications from different trials.[1]
- The Mounjaro label advises a non-oral or back-up birth control method for 4 weeks after starting and after each dose increase.[2]
In short: Ozempic (semaglutide, from Novo Nordisk) and Mounjaro (tirzepatide, from Eli Lilly) are both once-weekly injections that the FDA approves for type 2 diabetes, not for weight loss. Ozempic acts on one gut-hormone receptor (GLP-1), while Mounjaro acts on two (GIP and GLP-1). In the one head-to-head trial, SURPASS-2, Mounjaro lowered HbA1c a little more and led to more weight loss than Ozempic 1 mg over 40 weeks, with similar stomach side effects. Their extra approvals also differ: Ozempic for heart and kidney protection, Mounjaro for heart protection and for children 10 and older.
This page compares the two brand-name diabetes medicines label by label, using what the FDA prescribing information says as of October 2026 and the trial that tested them against each other. For each one in full, see our pages on Ozempic and Mounjaro. How is this different from our semaglutide vs tirzepatide comparison? That page compares the two molecules across every brand, including the weight-loss versions Wegovy and Zepbound. This page sticks to the two diabetes brands people most often ask about together. If your question is really about weight, read Ozempic for weight loss first. This is general education, not medical advice: which medicine fits a person is a decision for you and your clinician.
The two medicines in one table
| Ozempic | Mounjaro | |
|---|---|---|
| Active ingredient | Semaglutide | Tirzepatide |
| Maker | Novo Nordisk | Eli Lilly |
| How it works | GLP-1 receptor agonist (one receptor) | GIP and GLP-1 receptor agonist (two receptors) |
| First FDA approval | 2017 | 2022 |
| Approved uses (label) | Blood sugar control in adults with type 2 diabetes; lowering the risk of heart attack, stroke and heart death in adults with type 2 diabetes and heart disease; lowering the risk of kidney decline, kidney failure and heart death in adults with type 2 diabetes and chronic kidney disease | Blood sugar control in adults and children 10 and older with type 2 diabetes; lowering the risk of heart attack, stroke and heart death in adults with type 2 diabetes at high risk of these events |
| Ages | Adults (not established in children) | Adults and children 10 and older |
| How it is given | Weekly injection under the skin (pens or single-dose syringes) | Weekly injection under the skin (single-dose pens, vials or a 4-dose KwikPen) |
| Dose steps on the label | Starts at 0.25 mg; steps of at least 4 weeks; 0.5, 1 or 2 mg to keep going; maximum 2 mg | Starts at 2.5 mg; steps of 2.5 mg after at least 4 weeks; maximum 15 mg (10 mg in children) |
| Half-life | About 1 week | About 5 days |
| Missed dose (label rule) | Take within 5 days, otherwise skip | Take within 4 days, otherwise skip |
| Boxed warning | Both: risk of thyroid C-cell tumors seen in rodents; not for people with a personal or family history of medullary thyroid carcinoma or MEN 2 | |
Both labels describe the dose steps as a way to lower the risk of stomach side effects, and both say the shot can go in at any time of day, with or without meals. The doses are not interchangeable: milligrams of semaglutide and milligrams of tirzepatide are different amounts of different molecules, so “2 mg” of one says nothing about “2.5 mg” of the other. Ozempic is also sold as daily tablets that share a label with Rybelsus; this page compares the weekly injections.
One receptor or two: what the difference means
GLP-1 and GIP are hormones the gut releases after you eat. Both medicines copy GLP-1: according to the Ozempic label, semaglutide helps the pancreas release insulin and lowers glucagon only when blood sugar is high, and it slows how fast the stomach empties. Tirzepatide also activates the GIP receptor. Our guide to how GLP-1 medicines work explains the shared mechanism, and the pages on semaglutide and tirzepatide cover each molecule in depth. How much the GIP part adds in people is still being studied, so the useful question is what the trials measured.
The head-to-head trial: SURPASS-2
SURPASS-2, published in the New England Journal of Medicine in 2021, is the only large trial in this comparison that tested the two medicines against each other. It enrolled 1,879 adults with type 2 diabetes whose blood sugar was not controlled on metformin alone (average HbA1c 8.3%, average weight about 94 kg). They were randomly assigned to add tirzepatide 5, 10 or 15 mg or semaglutide 1 mg once a week for 40 weeks. The main question was blood sugar.
SURPASS-2 at 40 weeks
- -1.9 pointsHbA1c change with semaglutide 1 mg (the Ozempic ingredient)Mounjaro label, Table 5
- -2.0 to -2.3 pointsHbA1c change with tirzepatide 5, 10 and 15 mg (the Mounjaro ingredient)Mounjaro label, Table 5
- 79% vs 82-86%reached an HbA1c under 7% (semaglutide vs tirzepatide doses)Mounjaro label, Table 5
Checked on October 7, 2026
Every tirzepatide dose lowered HbA1c more than semaglutide 1 mg, by 0.15 to 0.45 percentage points according to the paper. That is a real but modest gap: both medicines brought most people under the common 7% target. Weight is where the difference was larger.
| Item | Value |
|---|---|
| Semaglutide 1 mg | 5.7 kg |
| Tirzepatide 5 mg | 7.6 kg |
| Tirzepatide 10 mg | 9.3 kg |
| Tirzepatide 15 mg | 11.2 kg |
Average weight lost from a starting weight of about 93-95 kg, in adults with type 2 diabetes on metformin. Open-label trial funded by Eli Lilly; it used semaglutide 1 mg, not the 2 mg maximum Ozempic dose.
Source: Mounjaro prescribing information, section 14 (Table 5, SURPASS-2); Frias JP et al., NEJM 2021 (checked on October 7, 2026)
Average weight loss was 5.7 kg (about 13 lb) with semaglutide 1 mg and 7.6 to 11.2 kg (about 17 to 25 lb) with tirzepatide, depending on the dose. Three details matter when you read these numbers:
- The Ozempic dose was 1 mg. Ozempic’s label now goes up to 2 mg. In a separate 40-week trial on the Ozempic label, 2 mg lowered HbA1c by 2.1 points and weight by 6.4 kg, compared with 1.9 points and 5.6 kg on 1 mg (the weight difference was not statistically significant). That trial did not include tirzepatide, so it is not a head-to-head result.
- It was open label. People knew whether they were on semaglutide or tirzepatide (only the tirzepatide dose was blinded).
- Lilly, the maker of Mounjaro, paid for it. That is common for drug trials, and the results went through peer review, but it is worth knowing.
Heart and kidney protection
For many people with type 2 diabetes, protecting the heart and kidneys matters as much as the HbA1c number. Here the two labels rest on different trials with different comparison groups, so the numbers can’t be lined up as if the medicines had faced each other.
| Item | The medicine | Its comparison group |
|---|---|---|
| Ozempic vs placebo (SUSTAIN-6) | 6.6% | 8.9% |
| Mounjaro vs dulaglutide (SURPASS-CVOT) | 12.1% | 13% |
Not head-to-head: different trials, lengths and comparison groups. SUSTAIN-6 compared Ozempic with a placebo; SURPASS-CVOT compared Mounjaro with dulaglutide (Trulicity), itself a heart-protective GLP-1 medicine.
Source: Ozempic prescribing information, section 14.2 (Table 9); Mounjaro prescribing information, section 14.6 (Table 10) (checked on October 7, 2026)
- Ozempic, heart (SUSTAIN-6). 3,297 adults with type 2 diabetes and heart disease or high risk, followed for at least 2 years. Major heart events happened in 6.6% on Ozempic and 8.9% on placebo (hazard ratio 0.74).
- Ozempic, kidneys (FLOW). Adults with type 2 diabetes and chronic kidney disease. The combined outcome of serious kidney decline, kidney failure or death from kidney or heart causes happened in 18.7% on Ozempic and 23.2% on placebo (hazard ratio 0.76). This is why Ozempic has a kidney indication and Mounjaro does not.
- Mounjaro, heart (SURPASS-CVOT). 13,299 adults with type 2 diabetes and established heart disease, followed for a median of about 4 years. Major heart events happened in 12.1% on Mounjaro and 13.0% on dulaglutide (hazard ratio 0.92). The label says Mounjaro was noninferior (not worse); it was not shown to be better than dulaglutide.
The higher event rates in SURPASS-CVOT don’t mean Mounjaro is riskier: that trial enrolled people with more established heart disease, ran longer and compared against an active heart-protective medicine. If kidney disease or heart disease is part of your picture, these differences in approved uses are worth raising with your care team. Our guide to type 2 diabetes and weight covers the wider picture.
Side effects and safety
The two medicines share most of their safety story. Both carry the same boxed warning about thyroid C-cell tumors in rodents, both are not for people with a personal or family history of medullary thyroid carcinoma or MEN 2, and both list the same main warnings: pancreatitis, low blood sugar when combined with insulin or sulfonylureas, serious allergic reactions, kidney injury from dehydration, severe stomach side effects (neither is recommended with severe gastroparesis), diabetic eye problems in people with a history of retinopathy, gallbladder disease, and the risk of inhaling stomach contents during anesthesia or deep sedation. Neither pen may be shared, even with a new needle.
| Item | Ozempic 1 mg | Mounjaro 15 mg |
|---|---|---|
| Nausea | 20.3% | 18% |
| Diarrhea | 8.8% | 17% |
| Vomiting | 9.2% | 9% |
| Constipation | 3.1% | 7% |
Not head-to-head: separate placebo-controlled trial pools (placebo nausea 6.1% for Ozempic, 4% for Mounjaro). The labels warn that rates from one drug's trials cannot be compared directly with another's.
Source: Ozempic prescribing information, Table 1; Mounjaro prescribing information, Table 1 (checked on October 7, 2026)
The fairer comparison is again SURPASS-2, where both groups were treated the same way. There, stomach side effects were the most common for both and mostly mild to moderate: nausea in 17% to 22% on tirzepatide and 18% on semaglutide, diarrhea in 13% to 16% and 12%, and vomiting in 6% to 10% and 8%. Serious adverse events were reported in 5% to 7% on tirzepatide and 3% on semaglutide. Our pages on Ozempic side effects, Mounjaro side effects and GLP-1 side effects in general go through each one and what helps.
Two label differences are easy to miss:
- Birth control pills (Mounjaro). Because Mounjaro slows stomach emptying most after the first dose, its label advises people using oral hormonal contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after starting and for 4 weeks after each dose increase. The Ozempic label has no such instruction.
- Planning a pregnancy (Ozempic). The Ozempic label says to stop at least 2 months before a planned pregnancy because semaglutide takes a long time to leave the body. The Mounjaro label says there are not enough data in pregnancy and that it should be used only if the benefit justifies the risk. Either way, this is a conversation to have before trying to conceive.
What they cost (checked 2026-10-07)
With insurance, what you pay depends on your plan’s formulary, prior authorization and copay. Both makers offer savings cards that bring the cost down to as little as $25 for people whose commercial insurance covers the drug (government plans such as Medicare and Medicaid are excluded from these cards). Without coverage, the makers list these self-pay prices:
| Item | Value |
|---|---|
| Ozempic 0.25-1 mg | $349 |
| Ozempic 2 mg | $499 |
| Mounjaro (any dose, from) | $499 |
Ozempic: $199 for each of the first 2 monthly fills of 0.25 or 0.5 mg for new patients, through December 31, 2026, then $349. Mounjaro: LillyDirect lists 'starting at $499/month' for single-dose pens; the savings card also lists 'as low as $499' when commercial insurance does not cover it. Prices change; check before filling.
Source: NovoCare Pharmacy (Ozempic); LillyDirect (Mounjaro) (checked on October 7, 2026)
Medicare Part D plans can cover both medicines for type 2 diabetes, but plan rules vary. Our cost guides for Ozempic and Mounjaro go through insurance, savings cards and appeals, and GLP-1 coverage explains how plans decide. Be wary of very cheap “semaglutide” or “tirzepatide” sold online: compounded versions are not FDA approved and the FDA has warned about counterfeit Ozempic pens. See our guide to compounded GLP-1s before buying anywhere other than a state-licensed pharmacy.
Side by side: the main differences
| Question | Ozempic | Mounjaro | Where it comes from |
|---|---|---|---|
| HbA1c drop vs each other | -1.9 points (1 mg) | -2.0 to -2.3 points | SURPASS-2, 40 weeks (head-to-head) |
| Weight change vs each other | -5.7 kg (1 mg) | -7.6 to -11.2 kg | SURPASS-2, 40 weeks (head-to-head) |
| Heart protection on the label | Yes (with heart disease) | Yes (at high heart risk) | SUSTAIN-6 vs placebo; SURPASS-CVOT vs dulaglutide |
| Kidney protection on the label | Yes (with chronic kidney disease) | No kidney indication | FLOW |
| Children with type 2 diabetes | Not established | 10 and older | Labels, section 8.4 |
| Birth control pill advice | None on the label | Back-up method for 4 weeks after starting and each dose increase | Mounjaro label, 7.2 and 8.3 |
| Before a planned pregnancy | Stop at least 2 months ahead | Insufficient data; discuss | Labels, section 8 |
| Weight-loss version of the same ingredient | Wegovy | Zepbound | Wegovy and Zepbound labels |
What people weigh up with their clinician
There is no single right answer, and this page does not pick one. These are the trade-offs the labels and trials point to, which people with type 2 diabetes often talk through with their prescriber:
- Kidney disease. Only Ozempic has a kidney-outcome indication, based on FLOW.
- How much blood sugar and weight need to change. In SURPASS-2, tirzepatide lowered both somewhat more than semaglutide 1 mg.
- Other medicines. Insulin or a sulfonylurea may need a lower dose with either one to avoid low blood sugar. People on birth control pills have an extra step with Mounjaro.
- Coverage. A plan may cover one and not the other, or require trying one first.
- Age and family plans. Mounjaro is approved from age 10; Ozempic’s label asks for a 2-month washout before a planned pregnancy.
Preparing for the conversation
- Bring your numbersYour latest HbA1c, kidney tests (eGFR, urine albumin) and any heart history.
- List every medicineEspecially insulin, sulfonylureas and birth control pills.
- Check your coverageLook up both drugs on your plan's formulary and ask about prior authorization.
- Ask about side effectsHow the dose steps work and what to do if nausea or vomiting is hard to manage.
- Plan follow-upWhen to recheck HbA1c and how to reach the care team between visits.
Our printable questions to ask before starting a GLP-1 can help, and if you’d like a specialist, see how to find an obesity medicine clinician. To see these two alongside every other option, including the medicines approved for weight, visit every FDA-approved weight-loss medication compared, Wegovy vs Zepbound and Ozempic vs Wegovy, or browse all medications.
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- Given my kidney and heart history, does either medicine's approved use matter for me?
- Do my insulin or sulfonylurea doses need to change if I start either one?
- Does my plan cover Ozempic, Mounjaro or both, and is prior authorization needed?
- I use birth control pills: what back-up method should I use if I start Mounjaro?
- How will we handle nausea or vomiting during the dose increases?
Frequently asked questions
Is Ozempic or Mounjaro better?
Neither is better for everyone. In the SURPASS-2 trial, Mounjaro lowered HbA1c a bit more and led to more weight loss than Ozempic 1 mg over 40 weeks. Ozempic has a kidney-protection indication that Mounjaro does not. The right fit depends on your health, other medicines and coverage, which is a decision for you and your clinician.
Are Ozempic and Mounjaro the same thing?
No. Ozempic is semaglutide, which acts on the GLP-1 receptor. Mounjaro is tirzepatide, which acts on both the GIP and GLP-1 receptors. They come from different companies and their doses are not interchangeable.
Can Ozempic or Mounjaro be used for weight loss?
Neither is FDA approved for weight loss. The same ingredients are approved for chronic weight management as Wegovy (semaglutide) and Zepbound (tirzepatide). Using Ozempic or Mounjaro only for weight is off-label.
Which one causes more nausea?
In SURPASS-2, where both were tested the same way, nausea was reported by 17% to 22% on tirzepatide and 18% on semaglutide 1 mg. Stomach side effects were mostly mild to moderate and most common while the dose was being increased.
How much do Ozempic and Mounjaro cost without insurance?
As checked on 2026-10-07, NovoCare lists Ozempic pens at $349 a month for 0.25 to 1 mg and $499 for 2 mg (with a $199 introductory price for the first 2 fills through 2026), and LillyDirect lists Mounjaro starting at $499 a month. Prices change, so check before filling.
Can I switch from Ozempic to Mounjaro?
People do switch, but only under a prescriber's direction: the medicines are not taken together and the doses do not convert milligram for milligram. Your clinician decides the starting dose and timing.
References
- OZEMPIC (semaglutide) injection: prescribing information. Novo Nordisk, via DailyMed, 2026. (accessed October 7, 2026) Drug label
- MOUNJARO (tirzepatide) injection: prescribing information. Eli Lilly and Company, via DailyMed, 2026. (accessed October 7, 2026) Drug label
- Frias JP, Davies MJ, Rosenstock J, et al.. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes (SURPASS-2). New England Journal of Medicine, 2021. doi:10.1056/NEJMoa2107519 · PMID 34170647 · NCT03987919 (accessed October 7, 2026) Randomized trial
- Marso SP, Bain SC, Consoli A, et al.. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (SUSTAIN-6). New England Journal of Medicine, 2016. doi:10.1056/NEJMoa1607141 · PMID 27633186 · NCT01720446 (accessed October 7, 2026) Randomized trial
- Perkovic V, Tuttle KR, Rossing P, et al.. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes (FLOW). New England Journal of Medicine, 2024. doi:10.1056/NEJMoa2403347 · PMID 38785209 · NCT03819153 (accessed October 7, 2026) Randomized trial
- Ozempic online pharmacy: self-pay prices and savings. Novo Nordisk (NovoCare Pharmacy). (accessed October 7, 2026) Other
- Mounjaro at LillyDirect: self-pay prices. Eli Lilly and Company. (accessed October 7, 2026) Other
- Mounjaro savings and resources. Eli Lilly and Company. (accessed October 7, 2026) Other
Facts checked on October 7, 2026
Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.