Zepbound (tirzepatide) produces more weight loss than Wegovy (semaglutide): 20.2% of body weight vs 13.7% at 72 weeks in the head-to-head SURMOUNT-5 trial. At one year (week 52, read from the trial curves) the averages are 19.5% for Zepbound 15 mg, 14.3% for Wegovy and 7.3% for Saxenda, and self-pay runs $299–449 a month for Zepbound vials vs $349 for Wegovy pens. Last known price, Oct 7, 2026 — may have changed · confirm on LillyDirect; Oct 26, 2026 · novocare.com
Tick drugs to overlay their trial curves. The table shows what separates them: weight lost, dosing, who each suits, what to watch for.
| Wegovy (semaglutide 2.4 mg) | Wegovy HD (semaglutide 7.2 mg) | Zepbound (tirzepatide) | Wegovy pill (oral semaglutide 25 mg) | Foundayo (orforglipron pill) | Saxenda (liraglutide 3.0 mg) | |
|---|---|---|---|---|---|---|
| Mechanism | GLP-1 receptor agonist | Not applicable: Same molecule as Wegovy (semaglutide), at a higher dose | Dual GIP and GLP-1 receptor agonist | GLP-1 receptor agonist, tablet: the same molecule as the Wegovy injection, a different product from Rybelsus | Small-molecule (non-peptide) GLP-1 receptor agonist, taken by mouth | GLP-1 receptor agonist, short-acting (daily) |
| Trial average loss | −14.9% at 68 wk (STEP 1) | −18.8% at 72 weeks across everyone randomized (STEP UP, Wegovy prescribing information); −20.7% among people who stayed on treatment (STEP UP paper) | −15.0 / −19.5 / −20.9% at 72 wk for 5 / 10 / 15 mg (SURMOUNT-1) | −13.6% at 64 wk (OASIS 4) | −11.1% at 72 weeks on 17.2 mg, the highest dose (−7.4% on 5.5 mg, −8.3% on 9 mg; placebo −2.1%), everyone randomized (ATTAIN-1, Foundayo prescribing information) | −7.4% at 56 weeks, everyone randomized (SCALE, Saxenda prescribing information; the published paper reports −8.0% with a different analysis) |
| Head to head | SURMOUNT-5 vs tirzepatide: −13.7% vs −20.2% at 72 weeks; STEP 8 vs liraglutide: −15.8% vs −6.4% at 68 weeks | No published data: No head-to-head trial | SURMOUNT-5 vs semaglutide: −20.2% vs −13.7% at 72 weeks | No published data: No head-to-head trial | No published data: No head-to-head trial with these drugs | STEP 8 vs semaglutide: −6.4% vs −15.8% at 68 weeks |
| How it's taken | Weekly injection | Weekly injection | Weekly injection | One tablet each morning on an empty stomach with up to 4 ounces of plain water, swallowed whole; wait at least 30 minutes before eating, drinking anything else or taking other oral medicines | One tablet once daily, with or without food, swallowed whole | Daily injection |
| Label titration | 0.25 → 0.5 → 1 → 1.7 → 2.4 mg, each step 4 weeks; full dose from week 17 | After at least 4 weeks on 2.4 mg, if more weight reduction is clinically indicated, the dose may be raised to 7.2 mg once weekly | 2.5 → 5 → 7.5 → 10 → 12.5 → 15 mg, each step ≥4 weeks; 5 mg is the lowest maintenance dose | 1.5 mg, then 4 mg, then 9 mg, each for 30 days, then the 25 mg once-daily maintenance dose | 0.8 mg, then 2.5 mg, then 5.5 mg, each for at least 30 days; may then rise to 9, 14.5 or 17.2 mg (the maximum) | 0.6 → 1.2 → 1.8 → 2.4 → 3.0 mg, weekly steps; full dose from week 5 |
| Approved uses beyond adult weight management | Adolescents 12+ with obesity; reducing the risk of major cardiovascular events in adults with established heart disease (SELECT: a 20% lower relative risk of heart attack, stroke or cardiovascular death); MASH with moderate-to-advanced liver fibrosis in adults | Not applicable: None: 7.2 mg is for adult weight reduction only | Moderate to severe obstructive sleep apnea in adults with obesity | Approved Dec 22, 2025 for adults with obesity, or overweight plus a weight-related condition; also reduces major cardiovascular events in adults with established heart disease. Not approved for adolescents | Not applicable: None: adults only | Adolescents 12+ |
| Tends to suit | People with existing heart disease (cardiovascular outcome data) | Not yet added | People aiming for a larger loss (the highest trial averages here, in separate trials); sleep apnea | Needle-averse people; travel; those who can keep the morning empty-stomach routine | Not yet added | Cost-driven choice (generic available), or where weekly drugs aren't covered; adolescents |
| Main GI side effects (trial rate) | Nausea 44%, diarrhea 32%, vomiting 25%, constipation 23% (STEP 1) | Nausea 39%, vomiting 22%, constipation 20%, dysesthesia (unusual skin sensations) 22%; placebo 13%, 6%, 8%, 0% (Wegovy prescribing information) | 15 mg: nausea 31%, diarrhea 23%, vomiting 12%, constipation 12% (SURMOUNT-1) | Similar types and rates to the injection; nausea most common (Wegovy prescribing information) | 17.2 mg: nausea 35%, diarrhea 25%, constipation 24%, vomiting 24%; placebo 10%, 11%, 9%, 4% (Foundayo prescribing information) | Nausea 40%, diarrhea 21%, constipation 20%, vomiting 16% (SCALE) |
| Stopped for side effects | 7% (placebo 3%), STEP 1 | 5% (placebo 2%), Wegovy prescribing information | About 5% to 7% across doses (placebo 3%), Zepbound prescribing information | 7% (placebo 6%), Wegovy prescribing information | 6% to 10% across doses (placebo 3%), Foundayo prescribing information | 10% (placebo 4%), Saxenda prescribing information |
| Boxed warning | Risk of thyroid C-cell tumors (seen in rodents) | Risk of thyroid C-cell tumors (seen in rodents) | Risk of thyroid C-cell tumors (seen in rodents) | Risk of thyroid C-cell tumors (seen in rodents) | Risk of thyroid C-cell tumors; orforglipron is not active in rodents and did not cause tumors in them, but the warning still applies | Risk of thyroid C-cell tumors (seen in rodents) |
| Do not use (label contraindications) | A personal or family history of medullary thyroid carcinoma or MEN 2; a prior serious allergic reaction to semaglutide or any ingredient | A personal or family history of medullary thyroid carcinoma or MEN 2; a prior serious allergic reaction to semaglutide or any ingredient | A personal or family history of medullary thyroid carcinoma or MEN 2; a known serious allergic reaction to tirzepatide or any ingredient | A personal or family history of medullary thyroid carcinoma or MEN 2; a prior serious allergic reaction to semaglutide or any ingredient | A personal or family history of medullary thyroid carcinoma or MEN 2; a known serious allergic reaction to orforglipron or any ingredient | A personal or family history of medullary thyroid carcinoma or MEN 2; a serious allergic reaction to liraglutide or any ingredient |
| Pregnancy and birth control | May cause fetal harm: stop when pregnancy is recognized, and stop at least 2 months before a planned pregnancy | May cause fetal harm: stop when pregnancy is recognized, and stop at least 2 months before a planned pregnancy | May cause fetal harm: stop when pregnancy is recognized. Can make birth-control pills less reliable: use a non-oral method or add a barrier method for 4 weeks after starting and after each dose increase | May cause fetal harm: stop when pregnancy is recognized, and stop at least 2 months before a planned pregnancy; breastfeeding is not recommended with the tablets | May cause fetal harm: stop when pregnancy is recognized. Can make birth-control pills less reliable: use a non-oral method or add a barrier method for 30 days after starting and after each dose increase | May cause fetal harm: stop when pregnancy is recognized; weight loss offers no benefit during pregnancy |
| Manufacturer self-pay, per month | $349 via NovoCare pens Price checked Oct 26, 2026 · novocare.com | $399 via NovoCare Price checked Oct 26, 2026 · novocare.com | $299–449 via LillyDirect vials, by dose Last known price, Oct 7, 2026 — may have changed · confirm on LillyDirect | $149–299 via NovoCare, by strength Price checked Oct 26, 2026 · novocare.com | Check LillyDirect | Generic liraglutide is available; price varies by pharmacy |
Rates come from each drug's own placebo-controlled trials, so they don't compare perfectly across trials. The boxed-warning, contraindication and pregnancy rows are each drug's own label: pregnancy is not a contraindication on any of them, but every label says to stop when pregnancy is recognized, and only the Wegovy label adds stopping at least 2 months before a planned pregnancy. "Not applicable", "No published data" and "Not yet added" say why a cell has no figure. See side effects.
Goal of 10%? On the trial average curves, any weekly option gets the average person there by about week 24. Goal of 20% or more? Counting everyone randomized, only tirzepatide 15 mg averaged above 20% (SURMOUNT-1, 72 weeks: 20.9%; SURMOUNT-5: 20.2%). Wegovy 7.2 mg averaged 18.8% counting everyone, and 20.7% among people who stayed on treatment (STEP UP, 72 weeks).
Semaglutide has published outcome data: fewer heart attacks and strokes in people who already had cardiovascular disease. Tirzepatide's outcome trial (SURPASS-CVOT) reported non-inferiority in 2025. Have a cardiac history? Raise this with your prescriber.
Stopping because of side effects ran from about 5% to 10% across these drugs' own placebo-controlled trials (not head to head); daily dosing may be harder for some people to keep up. The Wegovy pill needs an empty stomach and a 30-minute wait every morning; Foundayo can be taken with or without food. The best drug is the one you can keep taking.
Ozempic and Mounjaro are the same molecules as Wegovy and Zepbound, approved for type 2 diabetes: Ozempic tops out at 2 mg weekly versus 2.4 mg (or 7.2 mg) for Wegovy, and Mounjaro uses the same doses as Zepbound. For weight alone they're off-label and often not covered.
Coverage decides this far more often than trial results do. Here is the order the decision really falls in.
1. Does your plan cover one of them? If your formulary covers only one, that's almost always your answer. Around $25 a covered month with a savings card vs hundreds self-pay: no difference in average results is worth that gap. Call the number on your insurance card and ask which GLP-1s are on formulary for weight management, and what the prior-authorization criteria are. Last known price, Oct 7, 2026 — may have changed · confirm on LillyDirect
2. Do you have established cardiovascular disease? Wegovy (the injection and the pill) has an FDA indication for reducing major cardiovascular events in adults with known cardiovascular disease who are overweight or have obesity. That indication often gets it approved, so say so explicitly at the appointment.
3. Do you have moderate-to-severe obstructive sleep apnea? Zepbound has an indication for it in adults with obesity. A documented sleep study can unlock coverage.
4. Do you have type 2 diabetes? Then it's a different conversation. Mounjaro and Ozempic are the diabetes-labeled versions of the same two molecules, usually covered through a different part of the formulary. Bring your A1c.
5. Paying cash? Only now do prices decide it, and the monthly price is the wrong comparison: Wegovy is the cheaper month, but tirzepatide takes off more weight in the same time, so it is not automatically the cheaper pound. For the first year from your first dose, at a 230 lb start and the trial average for the same dose that is priced: Zepbound self-pay is $126 per pound at 15 mg and $149 at 5 mg, Wegovy 2.4 mg $129 (the same figures as the cost table and calculator). Every route by cost per pound, with a calculator for your own weight, is on GLP-1 cost by route; the monthly price at each Zepbound dose, against compounded tirzepatide, is under Zepbound cost by dose. Last known price, Oct 7, 2026 — may have changed · confirm on LillyDirect; Last known price, Oct 22, 2026 — may have changed · confirm on NovoCare Pharmacy
The head-to-head result, −20.2% against −13.7% at 72 weeks in SURMOUNT-5, is charted above; it is the strongest argument for tirzepatide on results alone, and worth little if your plan will not pay for it.
Brand names. Wegovy and Ozempic are the same molecule, semaglutide, labeled for different conditions. Zepbound and Mounjaro are both tirzepatide. Your brand name depends on what the prescription is written for, not on what you inject.
Side-effect horror stories. Common effects are broadly similar for both: nausea, constipation, reflux, mostly during dose escalation. This rarely separates the two drugs. The side-effect page breaks them down by dose.
Needles. A real blocker for some. The Wegovy pill (oral semaglutide, approved Dec 22, 2025; 25 mg once daily) now exists at a similar self-pay price. It doesn't reach the injection numbers, but if needles are what's stopping you, name it at the appointment.
Prescribers move faster with the paperwork case ready. Bring:
The label check covers what the labels require and what plans usually add.
No prescriber yet? Every provider we track lists the licensed US platforms that prescribe the brand-name versions.
Saxenda (liraglutide 3.0 mg) is the daily-injection option from the generation before weekly semaglutide. At one year the trial averages sit far apart, and Saxenda has no manufacturer self-pay program to close the gap.
| Drug | Average loss at 52 weeks (trial) | Manufacturer self-pay, per month | Notes |
|---|---|---|---|
| Zepbound (tirzepatide) | −19.5% on 15 mg, −14.8% on 5 mg (SURMOUNT-1) | $299–449 by dose, LillyDirect vials Last known price, Oct 7, 2026 — may have changed · confirm on LillyDirect | Weekly injection; the largest average loss of the three, in separate trials |
| Wegovy (semaglutide 2.4 mg) | −14.3% (STEP 1) | $349, NovoCare pens Price checked Oct 26, 2026 · novocare.com | Weekly injection; beat liraglutide head to head in STEP 8 (−15.8% vs −6.4% at 68 weeks) |
| Saxenda (liraglutide 3.0 mg) | −7.3% (SCALE) | None: the Saxenda savings offer closed to new enrollees on June 30, 2023, and NovoCare lists the brand as discontinued from early 2027; generic liraglutide 3 mg is sold and its price varies by pharmacy | Daily injection; the highest rate of stopping for side effects of the three (10%), in separate placebo-controlled trials |
Weight-loss figures are the 52-week points on the published mean curves used across this site (trials.json): SURMOUNT-1 (Jastreboff et al., NEJM 2022), STEP 1 (Wilding et al., NEJM 2021), SCALE (Pi-Sunyer et al., NEJM 2015), STEP 8 (Rubino et al., JAMA 2022). Prices: LillyDirect and NovoCare self-pay pages (each price shows the date it was last confirmed); Saxenda program status from NovoCare, read 2026-09-25. The trials ran on different populations and are compared here as published averages, not head to head, except STEP 8.
Three questions tell you the cheapest way to start — with insurance, direct from Lilly or Novo, or through a compounding pharmacy.
Find my cheapest route →One short email a week on GLP-1 treatment: what the trials and prescribing labels describe at each stage, and changes in cost and access. General information, not tied to a particular medication or dose. For the trial average for your own medication, use the curve calculator.
No spam. Unsubscribe any time. Educational information only, not medical advice.
Embody · from $69/mowith one-year prepay ($828 upfront)
Check price →