Tirzepatide and semaglutide are the two most prescribed GLP-1 medications in the world. Both work — but they work differently, cost differently, and suit different patients.
Full Comparison
Side-by-side breakdown
Based on published clinical trial data and FDA prescribing information as of 2026.
| Category | Tirzepatide | Semaglutide |
|---|---|---|
| Mechanism | Dual GIP + GLP-1 receptor agonist | GLP-1 receptor agonist only |
| Average weight loss | ~20–22% body weight (SURMOUNT) | ~15% body weight (STEP) |
| FDA approval | Diabetes (Mounjaro) · Obesity (Zepbound) | Diabetes (Ozempic) · Obesity (Wegovy) · CV risk (Wegovy) |
| Dosing frequency | Once weekly | Once weekly |
| Starting dose | 2.5 mg | 0.25 mg |
| Maximum dose | 15 mg | 2.4 mg (Wegovy) / 2.0 mg (Ozempic) |
| Brand-name cost | ~$1,060/month (Zepbound) | ~$935–1,349/month |
| Compounded cost | ~$200–400/month | ~$150–350/month |
| Insurance coverage | Growing — check your plan | More established |
| Years on market | Since 2022 | Since 2017 (Ozempic) |
| Cardiovascular data | Emerging | Strong CV outcome data (SELECT) |
| Nausea / GI side effects | Comparable | Comparable |
| Injection form | Auto-injector pen or compounded vial | Auto-injector pen or compounded vial |
Scenario-Based Guide
Who should consider which
These are general considerations — always discuss with your prescribing provider.
You want maximum weight loss
Clinical trials show tirzepatide produces greater average weight loss — around 20–22% vs 15% for semaglutide. For patients whose primary goal is significant weight reduction, tirzepatide may be the stronger option.
Consider TirzepatideYou have type 2 diabetes
Both are effective for blood sugar control. Semaglutide (Ozempic) has a longer track record and stronger cardiovascular outcome data; tirzepatide (Mounjaro) also has strong glycemic data. Your provider will weigh your specific cardiac risk profile.
Discuss with your providerYou have cardiovascular disease
Semaglutide has SELECT trial data showing a significant reduction in major cardiovascular events in people with obesity and established cardiovascular disease. Tirzepatide's CV trial data is still emerging. For high cardiac risk, semaglutide currently has stronger evidence.
Lean toward SemaglutideCost is your primary concern
Compounded semaglutide is generally slightly less expensive than compounded tirzepatide, and semaglutide has more established insurance pathways. If cost is the deciding factor, semaglutide may be more accessible.
Lean toward SemaglutideYou've tried semaglutide and plateaued
Some patients who plateau on semaglutide see additional results switching to tirzepatide due to its dual mechanism. This is a clinical decision — discuss with your provider before switching.
Ask about TirzepatideYou're new to GLP-1 medications
Both are appropriate starting points. Semaglutide has more published long-term data; tirzepatide has shown stronger weight loss results. Your provider will consider your full medical history, goals, and insurance.
Discuss with your providerThis content is for educational and informational purposes only and does not constitute medical advice. Clinical data referenced reflects published trial results as of early 2026. Always consult a licensed healthcare provider before starting, stopping, or switching any prescription medication.