Wegovy vs Zepbound compared: semaglutide vs tirzepatide, approved uses, SURMOUNT-5 head-to-head results, side effects and dated prices, with no winner declared.
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
- Wegovy and Zepbound are both weekly injections FDA approved for chronic weight management in adults with obesity, or overweight with a weight-related condition.[2]
- In the head-to-head SURMOUNT-5 trial, average weight change at 72 weeks was -20.2% with tirzepatide and -13.7% with semaglutide.[3]
- Wegovy is also approved for cardiovascular risk reduction and for teens 12+; Zepbound is also approved for obstructive sleep apnea in adults with obesity.[1]
- Both carry a boxed warning about thyroid C-cell tumors seen in rodents, and both mostly cause digestive side effects.[1]
The short answer
Both are once-weekly injections FDA approved for chronic weight management in adults with obesity, or overweight with a weight-related condition. They differ in active ingredient (semaglutide vs tirzepatide), other approved uses, trial results and price. In the one head-to-head trial, SURMOUNT-5, average weight loss was larger with tirzepatide; side effects were similar in kind.
Scorecards
| Wegovy (semaglutide): uses, side effects, cost and FDA statusFDA approved for weight managementPrescriptionInjection | Zepbound (tirzepatide): uses, side effects, cost and FDA statusFDA approved for weight managementPrescriptionInjection | |
|---|---|---|
| Medical supervision | Required | Required |
No overall score and no winner: what matters depends on you. Hover a value for its definition.
Facts side by side
| Wegovy (semaglutide): uses, side effects, cost and FDA statusFDA approved for weight managementPrescriptionInjection | Zepbound (tirzepatide): uses, side effects, cost and FDA statusFDA approved for weight managementPrescriptionInjection | |
|---|---|---|
| Purpose | Reduce excess body weight and maintain weight reduction long term (with reduced-calorie diet and increased physical activity); Reduce excess body weight and maintain weight reduction long term (injection); Reduce the risk of major adverse cardiovascular events (CV death, nonfatal heart attack, nonfatal stroke); Noncirrhotic MASH with moderate to advanced liver fibrosis (F2 to F3), accelerated approval (injection); Weight reduction and maintenance, and cardiovascular risk reduction (Wegovy tablets) | Reduce excess body weight and maintain weight reduction long term (with reduced-calorie diet and increased physical activity); Moderate to severe obstructive sleep apnea (with reduced-calorie diet and increased physical activity) |
| Class or type | GLP-1 receptor agonist | GIP/GLP-1 dual agonist |
| Regulatory status | FDA approved for weight managementPrescriptionInjection | FDA approved for weight managementPrescriptionInjection |
| Prescription required | Yes | Yes |
| How it works | Wegovy (semaglutide): FDA-approved uses, who the label covers, how it is taken in general, trial results, side effects, boxed warning and dated prices. | Zepbound (tirzepatide): FDA-approved uses for weight and sleep apnea, label population, general dosing, trials, side effects, boxed warning and dated prices. |
| How it is done or taken | Injection | Injection |
| How often | Weekly | Weekly |
| Average outcomes in studies |
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| Main risks |
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| Cost (dated) | from 25 USD per month with commercial coverage (max savings $100 a month; government beneficiaries excluded) (checked October 6, 2026) | from 25 USD per 1- to 3-month fill with commercial coverage (card expires 2026-12-31) (checked October 6, 2026) |
| Official resources | dailymed.nlm.nih.gov | dailymed.nlm.nih.gov |
What the trials showed
- SURMOUNT-5 (NCT05822830) 751 adults with obesity, no type 2 diabetes, 72 weeks, open label: weight change -20.2% with tirzepatide vs -13.7% with semaglutide; waist -18.4 cm vs -13.0 cm.[3]
Side effects compared
| Wegovy (semaglutide): uses, side effects, cost and FDA statusFDA approved for weight managementPrescriptionInjection | Zepbound (tirzepatide): uses, side effects, cost and FDA statusFDA approved for weight managementPrescriptionInjection | |
|---|---|---|
| From the label |
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Cost and coverage
| Option | Price | Amount | Basis | Checked on |
|---|---|---|---|---|
| Wegovy (semaglutide): uses, side effects, cost and FDA status | List price | 1,349.02 USD | per package (pen, HD pen or pill) | October 6, 2026 |
| Wegovy (semaglutide): uses, side effects, cost and FDA status | Self-pay / cash | 349 USD | per month, pens 0.25 mg to 2.4 mg, NovoCare Pharmacy | October 6, 2026 |
| Wegovy (semaglutide): uses, side effects, cost and FDA status | Self-pay / cash | 399 USD | per month, Wegovy HD 7.2 mg pen, NovoCare Pharmacy | October 6, 2026 |
| Wegovy (semaglutide): uses, side effects, cost and FDA status | Self-pay / cash | 199 USD | per month, first 2 fills of 0.25 mg and 0.5 mg for new patients, through 2026-12-31 | October 6, 2026 |
| Wegovy (semaglutide): uses, side effects, cost and FDA status | With savings program | 25 USD | per month with commercial coverage (max savings $100 a month; government beneficiaries excluded) | October 6, 2026 |
| Zepbound (tirzepatide): uses, side effects, cost and FDA status | Self-pay / cash | 299 USD | per month, 2.5 mg KwikPen or vials (LillyDirect and other pharmacies) | October 6, 2026 |
| Zepbound (tirzepatide): uses, side effects, cost and FDA status | Self-pay / cash | 399 USD | per month, 5 mg KwikPen | October 6, 2026 |
| Zepbound (tirzepatide): uses, side effects, cost and FDA status | Self-pay / cash | 449 USD | per month, 7.5 mg to 15 mg KwikPen, refill within 45 days (regular $499 for 7.5 mg, $699 for 10 to 15 mg) | October 6, 2026 |
| Zepbound (tirzepatide): uses, side effects, cost and FDA status | With savings program | 25 USD | per 1- to 3-month fill with commercial coverage (card expires 2026-12-31) | October 6, 2026 |
Prices change often and depend on pharmacy, plan and location. Insurance can change what you pay. Every price shows the date we checked it.
Things people weigh up
- Other conditions: Wegovy is approved to reduce cardiovascular risk in adults with heart disease and for MASH; Zepbound is approved for obstructive sleep apnea in adults with obesity.
- Age: the Wegovy injection is approved for teens 12 and older with obesity; Zepbound is for adults.
- Form: Wegovy also comes as a daily tablet; Zepbound comes as pens, vials and a multi-dose KwikPen.
- Average weight loss in SURMOUNT-5 was larger with tirzepatide; individual responses vary widely.
- Side effects are mostly digestive with both; tolerability differs from person to person.
- Insurance coverage, prior authorization and self-pay prices differ by plan and by month.
- Contraception: the Zepbound label advises a non-oral or added barrier method during the first weeks and after dose increases.
These are the differences people commonly consider, not a recommendation. A clinician can help you decide what fits you.
In short: Wegovy (semaglutide) and Zepbound (tirzepatide) are both once-weekly injections FDA approved for chronic weight management in adults with obesity, or overweight with a weight-related condition. They differ in active ingredient, in their other approved uses (Wegovy: heart-risk reduction, teens 12+ and a fatty-liver indication; Zepbound: obstructive sleep apnea), in trial results and in price. In the one head-to-head trial, average weight loss was larger with tirzepatide; side effects were similar in kind (labels checked on 2026-10-06).
There is no single right answer here. This page lays out the facts side by side so you can have a better conversation with your clinician, who can weigh them against your health history, preferences and coverage.
The basics side by side
| Wegovy | Zepbound | |
|---|---|---|
| Active ingredient | Semaglutide (GLP-1 receptor agonist) | Tirzepatide (GIP and GLP-1 receptor agonist) |
| Maker | Novo Nordisk | Eli Lilly |
| First approved for weight | June 4, 2021 | November 8, 2023 |
| Other approved uses | Cardiovascular risk reduction in adults with heart disease and obesity or overweight; MASH with moderate to advanced fibrosis (injection, accelerated approval) | Moderate to severe obstructive sleep apnea in adults with obesity |
| Ages | Adults; teens 12+ with obesity (injection) | Adults |
| Forms | Weekly pens and syringes; daily tablet (Wegovy pill) | Weekly single-dose pens, vials, KwikPen |
| Boxed warning | Thyroid C-cell tumors in rodents | Thyroid C-cell tumors in rats |
What the trials showed
Head to head: SURMOUNT-5. This open-label trial, published in the New England Journal of Medicine in 2025, randomized 751 adults with obesity but without type 2 diabetes to the highest tolerated weekly dose of tirzepatide or semaglutide for 72 weeks. Average weight change was -20.2% with tirzepatide and -13.7% with semaglutide. Waist size fell by 18.4 cm and 13.0 cm, and more people on tirzepatide reached losses of 10%, 15%, 20% and 25%. Digestive side effects were the most common in both groups and mostly mild to moderate. The trial was sponsored by Eli Lilly, and participants knew which medicine they were taking.
Against placebo. In STEP 1, semaglutide 2.4 mg led to -14.9% at 68 weeks versus -2.4% on placebo. In SURMOUNT-1, tirzepatide led to -15.0% to -20.9% at 72 weeks by dose versus -3.1%. Those were separate trials with different people, so they are less useful for comparing the two than SURMOUNT-5.
Beyond weight. Semaglutide has a dedicated cardiovascular outcomes trial in people with obesity: in SELECT, major cardiovascular events were 6.5% versus 8.0% with placebo, which is why Wegovy carries that indication. Tirzepatide has a sleep apnea program: in SURMOUNT-OSA, breathing interruptions fell by about 25 to 29 per hour versus about 5 with placebo, which is why Zepbound carries that indication. Neither medicine has the other’s indication on its label as of 2026-10-06.
Side effects compared
The labels report results from different trials, so the rates below are not a direct comparison, but they show the pattern: digestive effects are common with both, especially while doses increase.
| Side effect (label) | Wegovy 2.4 mg vs placebo | Zepbound 5 to 15 mg vs placebo |
|---|---|---|
| Nausea | 44% vs 16% | 25% to 29% vs 8% |
| Diarrhea | 30% vs 16% | 19% to 23% vs 8% |
| Vomiting | 24% vs 6% | 8% to 13% vs 2% |
| Constipation | 24% vs 11% | 11% to 17% vs 5% |
The serious warnings overlap: pancreatitis, gallbladder disease, low blood sugar with insulin or sulfonylureas, kidney injury from dehydration, diabetic eye complications and aspiration during anesthesia. Wegovy’s label also lists a faster heart rate. Zepbound’s label adds advice about birth-control pills: use a non-oral or added barrier method for four weeks after starting and after each dose increase. More in GLP-1 side effects.
Cost and coverage
Checked on 2026-10-06 on the manufacturers’ sites. Wegovy pens are $349 a month self-pay through NovoCare Pharmacy ($399 for Wegovy HD, with a $199 introductory price for new patients’ first two fills of the lowest strengths through December 31, 2026), and Wegovy pills $149 to $299. Zepbound KwikPen self-pay is $299 a month for the starting dose, $399 for 5 mg and $449 for higher doses with on-time refills; vials start at $299. Both companies offer a savings card for people whose commercial insurance covers the drug. Medicare’s GLP-1 Bridge, from July 2026 through 2027, covers both for weight management with a $50 copay for people who meet its criteria. Full tables: Wegovy cost and Zepbound cost.
Stopping and keeping results
Both medicines showed weight regain after stopping in trials: in STEP 4, people switched from semaglutide to placebo regained 6.9% over 48 weeks; in SURMOUNT-4, people switched from tirzepatide to placebo regained 14.0% over a year. Plans for the long term matter whichever is used; see life after a GLP-1.
For the molecule-level view, read semaglutide vs tirzepatide; for pills, see Wegovy vs Foundayo. Compounded versions of either drug are not FDA approved; see compounded GLP-1s. All approved options are on the medications hub.
Compared with the items
FDA approved for weight managementPrescriptionInjectionWegovy (semaglutide): uses, side effects, cost and FDA statusSemaglutide: one ingredient, several brands · Injection · Weekly
FDA approved for weight managementPrescriptionInjectionZepbound (tirzepatide): uses, side effects, cost and FDA statusTirzepatide: how the dual GIP/GLP-1 drug works (Zepbound, Mounjaro) · Injection · WeeklyRelated comparisons
Related guides
GLP-1 Side Effects: common, serious and how they are managedGLP-1 side effects from the FDA labels: common digestive effects by brand, serious risks, the thyroid…
GLP-1 Medications: how they work and which are approved for weightGLP-1 medications explained: what GLP-1 is, how the drugs work, which brands are FDA approved for…
Stopping a GLP-1: regain, what trials show and keeping resultsWhat happens when you stop a GLP-1: STEP 1 extension, STEP 4, SURMOUNT-4 and BMJ meta-analysis…Questions to ask a professional
- Do I have a condition, such as heart disease or sleep apnea, that makes one of the approved uses more relevant to me?
- Given my history, which side effects should we watch most closely with each?
- What does my insurance cover, and what would each cost me per month?
- Would a daily pill be an option for me instead of a weekly injection?
- What is our plan if I stop, and how do we protect muscle along the way?
Frequently asked questions
Which works better, Wegovy or Zepbound?
In SURMOUNT-5, the only head-to-head trial, average weight loss was larger with tirzepatide (Zepbound). Averages do not predict individual results, and the other differences (approved uses, side effects, cost, coverage) may matter as much. A clinician can help weigh them for you.
Can you switch from Wegovy to Zepbound?
Switching between them is a prescriber decision. Neither label recommends using them together, and the new medicine is usually started according to its own label.
Are the side effects different?
Both mostly cause nausea, diarrhea, vomiting and constipation, especially as doses increase. The label rates come from different trials, so they cannot be compared directly.
Is one cheaper?
It depends on dose, form and coverage. On 2026-10-06, Wegovy pens were $349 a month self-pay and Zepbound KwikPens $299 to $449 by dose. Check the dated cost pages and your plan.
References
- WEGOVY (semaglutide) injection and tablets: prescribing information. Novo Nordisk, via DailyMed, 2026. (accessed October 7, 2026) Drug label
- ZEPBOUND (tirzepatide) injection: prescribing information. Eli Lilly and Company, via DailyMed, 2026. (accessed October 7, 2026) Drug label
- Aronne LJ, Horn DB, le Roux CW, et al.. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity (SURMOUNT-5). New England Journal of Medicine, 2025. doi:10.1056/NEJMoa2416394 · PMID 40353578 · NCT05822830 (accessed October 6, 2026) Randomized trial
- Wilding JPH, Batterham RL, Calanna S, et al.. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). New England Journal of Medicine, 2021. doi:10.1056/NEJMoa2032183 · PMID 33567185 · NCT03548935 (accessed October 7, 2026) Randomized trial
- Jastreboff AM, Aronne LJ, Ahmad NN, et al.. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). New England Journal of Medicine, 2022. doi:10.1056/NEJMoa2206038 · PMID 35658024 · NCT04184622 (accessed October 7, 2026) Randomized trial
- Lincoff AM, Brown-Frandsen K, Colhoun HM, et al.. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). New England Journal of Medicine, 2023. doi:10.1056/NEJMoa2307563 · PMID 37952131 · NCT03574597 (accessed October 7, 2026) Randomized trial
- Malhotra A, Grunstein RR, Fietze I, et al.. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (SURMOUNT-OSA). New England Journal of Medicine, 2024. doi:10.1056/NEJMoa2404881 · PMID 38912654 · NCT05412004 (accessed October 6, 2026) Randomized trial
- Rubino D, Abrahamsson N, Davies M, et al.. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance (STEP 4). JAMA, 2021. doi:10.1001/jama.2021.3224 · PMID 33755728 · NCT03548987 (accessed October 7, 2026) Randomized trial
- Aronne LJ, Sattar N, Horn DB, et al.. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA, 2024. doi:10.1001/jama.2023.24945 · PMID 38078870 · NCT04660643 (accessed October 7, 2026) Randomized trial
- Wegovy at NovoCare Pharmacy: self-pay prices. Novo Nordisk (NovoCare Pharmacy). (accessed October 7, 2026) Other
- Zepbound coverage and savings. Eli Lilly and Company. (accessed October 6, 2026) Other
- Medicare GLP-1 Bridge: information for providers. Centers for Medicare and Medicaid Services. (accessed October 7, 2026) Government page
Facts checked on October 6, 2026
Educational information, not medical advice. Talk with a qualified healthcare professional about your own situation. In an emergency call 911.