Blog · Weight Loss
Zepbound vs Wegovy is really a comparison of two medicines: tirzepatide, which Eli Lilly sells as Zepbound, and semaglutide, which Novo Nordisk sells as Wegovy. Both are approved for long-term weight management. Both are used with a reduced-calorie diet and more physical activity. Both act on the receptor for GLP-1, a natural hormone that helps regulate appetite and how much you eat. This guide compares the two brands the way their U.S. labels describe them: results, doses, forms, other approved uses and side effects. For the medicine-level comparison, see our semaglutide vs. tirzepatide guide.
The biggest difference is how many hormone signals each one copies. Wegovy contains semaglutide, which acts on the GLP-1 receptor. Zepbound contains tirzepatide, which acts on the GLP-1 receptor and a second one, the receptor for a gut hormone called GIP. The NIH describes both medicines as copying these hormones to target areas of the brain that regulate appetite and food intake.
They also come from different companies, arrived at different times, and carry different extra approvals. Wegovy was first approved in June 2021, and Zepbound in November 2023. Neither is a generic of the other, and their doses sit on different scales. Each one also has a diabetes twin with the same ingredient: Zepbound has Mounjaro, and Wegovy has Ozempic. Our guides to Mounjaro vs. Zepbound and Wegovy vs. Ozempic explain those pairs.
| Feature | Zepbound | Wegovy |
|---|---|---|
| Medicine | Tirzepatide | Semaglutide |
| Maker | Eli Lilly | Novo Nordisk |
| Hormone receptors it acts on | GIP and GLP-1 | GLP-1 |
| First U.S. approval | November 2023 | June 2021 |
| Forms on the label | Weekly shot from a pen or a vial | Weekly shot from a pen or a syringe, or a once-daily tablet |
| Starting dose | Zepbound: 2.5 mg a week. Wegovy shot: 0.25 mg a week. | |
| Maintenance dose for weight | Zepbound: 5, 10 or 15 mg a week. Wegovy shot: 2.4 mg a week (or 1.7 mg), with up to 7.2 mg for some adults. | |
| Ages approved for weight management | Zepbound: adults. Wegovy shot: adults, and children 12 and older with obesity. | |
| Other approved uses | Moderate to severe obstructive sleep apnea in adults with obesity | Lowering heart risk in adults with heart disease and excess weight, plus a liver disease called MASH |
| Boxed warning | Both: risk of thyroid C-cell tumors | |
SURMOUNT-5, published in the New England Journal of Medicine in 2025, compared the two medicines directly. It enrolled 751 adults with obesity who did not have type 2 diabetes. Each person was randomly assigned to weekly tirzepatide at the highest dose they could tolerate (10 or 15 mg) or weekly semaglutide at the highest dose they could tolerate (1.7 or 2.4 mg), for 72 weeks.
| SURMOUNT-5 at 72 weeks | Result |
|---|---|
| Average weight change | Tirzepatide: down 20.2 percent. Semaglutide: down 13.7 percent. |
| Average waist change | Tirzepatide: down 18.4 cm (about 7.2 inches). Semaglutide: down 13.0 cm (about 5.1 inches). |
| Losing at least 10, 15, 20 or 25 percent of body weight | More likely with tirzepatide at every one of these levels |
| Most common side effects | Digestive in both groups, mostly mild to moderate, and mainly while the dose was going up |
Two honest caveats. First, the trial was open label, meaning participants and their doctors knew which medicine each person was taking, and it was funded by Eli Lilly, the maker of Zepbound. The difference was still statistically significant, but both points are worth knowing. Second, the trial tested semaglutide up to 2.4 mg a week.
Wegovy’s label now also allows up to 7.2 mg a week for some adults, and SURMOUNT-5 did not include that dose. In a separate 72-week trial in Wegovy’s label, adults with obesity and no diabetes lost 18.8 percent of their body weight on average with 7.2 mg, 15.5 percent with 2.4 mg, and 3.9 percent with placebo. That trial enrolled different people under different conditions, so its numbers should not be lined up against SURMOUNT-5 as if the two were one study.
On average weight loss, the head-to-head evidence favors Zepbound. But better has more parts than one number, and averages hide a wide range of individual results. Here is how the choice tends to break down.
Side effects, cost and how you respond all count too. And neither one is a short course. The NIH notes that you can keep taking these medicines as long as they are helping, and that you will probably regain some weight after you stop. Plan for months of treatment and regular check-ins, whichever one you choose.
Beyond weight, the two labels have grown in different directions. Zepbound added an approval in December 2024 to treat moderate to severe obstructive sleep apnea in adults with obesity. Its label lists a maintenance dose of 10 or 15 mg a week for that use.
Wegovy’s label covers three things Zepbound’s does not. It is approved to lower the risk of heart attack, stroke and heart-related death in adults with established heart disease and either obesity or overweight. The shot is approved for weight management in children 12 and older with obesity. And it is approved, under the FDA’s accelerated pathway, for MASH, a fatty liver disease, in adults with moderate to advanced liver scarring but not cirrhosis.
Each of these approvals rests on trials in that condition. The MASH approval is an accelerated one: it is based on improvement in MASH and liver scarring, and keeping it may depend on a confirmatory trial that shows a clinical benefit. These differences are also a good reason to tell your doctor about every diagnosis you have, not only your weight.
Zepbound starts at 2.5 mg once a week for four weeks. The dose then rises in 2.5 mg steps, at least four weeks apart. The maintenance dose for weight is 5, 10 or 15 mg a week, and 15 mg is the maximum.
The Wegovy shot starts at 0.25 mg once a week. It then steps up every four weeks, to 0.5 mg, 1 mg and 1.7 mg, before reaching a maintenance dose from week 17. For weight loss in adults, that dose is 2.4 mg a week (the recommended dose) or 1.7 mg. Adults who tolerate 2.4 mg for at least four weeks and need more weight loss can go up to 7.2 mg. The Wegovy tablet is a separate form: one tablet each morning on an empty stomach, starting at 1.5 mg and building to 25 mg a day.
Because the milligram scales differ, the numbers cannot be compared directly. For example, 2.5 mg is Zepbound’s starting dose, while 2.4 mg is Wegovy’s usual maintenance dose. If you are already on one and wondering about the other, our guide to switching from semaglutide to tirzepatide explains how prescribers approach the change.
Their side effects are more alike than different. On both labels, the most common ones are digestive: nausea, diarrhea, vomiting, constipation, stomach pain, indigestion, burping and reflux. Both also list fatigue and hair loss. Wegovy’s list adds headache, dizziness, bloating, gas, stomach flu, unusual skin sensations, and low blood sugar in people with type 2 diabetes. Zepbound’s list adds injection site reactions and allergic-type reactions.
Both carry a boxed warning about thyroid C-cell tumors seen in rodents, and neither is used by people with a personal or family history of medullary thyroid cancer or MEN 2. Both caution about pancreatitis, gallbladder problems, kidney injury from dehydration, severe stomach side effects, and the risk of inhaling stomach contents during anesthesia. Wegovy’s label lists a faster heart rate as a precaution. Zepbound’s label reports an average heart rate rise of 1 to 3 beats per minute in its weight-loss trials.
Planning a pregnancy changes the details. Wegovy’s label advises stopping at least two months before a planned pregnancy because semaglutide stays in the body for a long time. Zepbound’s label advises switching from birth control pills to another method, or adding a barrier method, for four weeks after starting and after each dose increase. Our guides to tirzepatide side effects and semaglutide side effects go deeper on each medicine.
MeliOra Elite Wellness is a physician-led practice based in Lutz. Dr. Melanie Espinet, a board-certified family physician, prescribes semaglutide or tirzepatide and explains your medication at your visit. She weighs the same things this guide covers: your health history, your other diagnoses, your goals, how you have done on any past GLP-1 medicine, and your budget. Then she sets your dose and adjusts it herself.
Semaglutide at MeliOra is $150/month at starting doses and $240/month for higher dosing. Tirzepatide is $230/month at starting doses and $320/month for higher dosing. Each monthly price includes physician visits, lab work, your medication and supplies, and dose adjustments and check-ins, with no separate consultation fee. Dr. Espinet makes house calls across Tampa Bay with no travel fee, sees select patients at the Lutz office, and offers telehealth weight loss visits anywhere in Florida at the same price. See semaglutide weight loss in Lutz or tirzepatide weight loss in Lutz for the details of each plan.
These medicines are generally considered for adults with a BMI of 30 or higher, or 27 or higher with a weight-related problem such as high blood pressure or type 2 diabetes. Our guide on how to get a semaglutide prescription walks through who qualifies and what the first visit looks like.
For average weight loss, Zepbound came out ahead in the head-to-head SURMOUNT-5 trial. Wegovy has a longer track record and approvals Zepbound does not have, including lowering heart risk in adults with heart disease. The better choice for you depends on your health history, goals, side effects and cost.
On average, people lost more weight on tirzepatide, the medicine in Zepbound. In SURMOUNT-5, average weight loss at 72 weeks was 20.2 percent of body weight with tirzepatide and 13.7 percent with semaglutide, the medicine in Wegovy. Individual results vary widely around those averages.
For weight loss, yes on average: in the head-to-head SURMOUNT-5 trial, tirzepatide, the medicine in Zepbound, led to more weight loss than semaglutide, the medicine in Wegovy. The milligram numbers do not show strength, because the two medicines use different dose scales. What matters is the effect of the dose you tolerate.
No. Zepbound contains tirzepatide from Eli Lilly, and Wegovy contains semaglutide from Novo Nordisk. Both act on the GLP-1 receptor, and tirzepatide also acts on a second hormone receptor, GIP.
No. Zepbound’s label says not to combine it with any GLP-1 medicine, and Wegovy’s label says not to combine it with any other GLP-1 medicine. Any move from one to the other should be planned by your prescriber.
Wegovy now comes as a once-daily tablet as well as a weekly shot, while Zepbound’s label lists only injections. The Wegovy tablet is taken each morning on an empty stomach with up to 4 ounces of water, and you wait at least 30 minutes before eating or drinking anything else. MeliOra’s weight loss plans use a weekly injection.
Their side effects are similar. Both most often cause nausea, diarrhea, vomiting, constipation and other digestive effects, and in SURMOUNT-5 these were mostly mild to moderate and mainly occurred while the dose was rising. How you personally tolerate each one matters more than the averages.
Dr. Espinet prescribes semaglutide or tirzepatide and explains your medication at your visit. At MeliOra, semaglutide starts at $150/month and tirzepatide starts at $230/month, with physician visits, lab work, medication and supplies, and dose adjustments and check-ins included.
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