Tirzepatide and semaglutide are medications developed for type 2 diabetes that are increasingly used to aid weight reduction. Tirzepatide tends to be less costly and might produce larger weight loss, but it’s a newer treatment and requires further study.
Prescribing medications to promote weight loss has become more widespread. Clinicians sometimes use newer type 2 diabetes drugs off-label to help patients manage weight. “Off-label” means the medication is being used for a purpose that differs from the indication approved by the Food and Drug Administration (FDA).
Two medications frequently used this way are tirzepatide and semaglutide. Both can reduce appetite by acting on brain pathways, yet they differ in important ways that should be discussed with a clinician. Current evidence has not definitively settled which of the two is superior for weight loss.
How tirzepatide and semaglutide work
When you eat, the gut releases glucagon-like peptide-1 (GLP-1), a hormone that stimulates insulin release and signals fullness to the brain. Semaglutide is a GLP-1 receptor agonist that imitates this hormone, helping to curb hunger.
Semaglutide is FDA-approved to treat type 2 diabetes under brand names such as Ozempic and Rybelsus. Wegovy is the only semaglutide formulation specifically approved for weight management, but clinicians may prescribe other semaglutide brands off-label to support weight loss.
Tirzepatide acts as an agonist at both glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptors, mimicking the effects of both hormones. GIP also promotes insulin secretion and contributes to feelings of satiety.
Tirzepatide is marketed as Mounjaro for type 2 diabetes. It may also be prescribed under the Zepbound name for weight loss in some contexts.
Note that semaglutide comes in both oral tablet and injectable forms, while tirzepatide is available only as an injection.
Which produces greater weight loss?
A number of recent comparisons have examined tirzepatide versus semaglutide for weight reduction. Studies from 2024, 2023, and 2021 indicate that tirzepatide may lead to larger reductions in weight than semaglutide.
However, those studies have limitations.
The dosages of semaglutide and tirzepatide administered were not identical. Because the agents act via different mechanisms, researchers selected dose regimens they considered comparable, yet the tirzepatide doses were higher, which could have influenced outcomes.
Tirzepatide has received FDA approval for chronic weight management in people with overweight or obesity, regardless of diabetes status.
Still, evidence supports semaglutide as an effective weight-loss option for people without diabetes as well.
Side effects to consider
Tirzepatide and semaglutide share many side effects. Common, moderate adverse effects can include:
- constipation or diarrhea
- nausea, upset stomach, and vomiting
- headache
- abdominal discomfort
- fatigue
- hypoglycemia (low blood sugar)
More serious potential complications include:
- vision disturbances
- pancreatitis
- kidney injury
- gallbladder disease
- allergic responses
Both medications carry boxed warnings regarding the risk of thyroid C‑cell tumors. A boxed warning is the FDA’s most prominent caution.
Concerns specific to tirzepatide
There remain uncertainties about tirzepatide’s long-term side effects, particularly when used in people without type 2 diabetes. Using these agents for weight loss is relatively recent, and additional risks or limitations may emerge as more data accrue.
Your clinician and care team are the best resources for advice on these drugs and for evaluating any symptoms you experience while using Mounjaro in particular.
Dosage comparison
The table below outlines dosing for Zepbound and Wegovy, the brand-name products approved for weight management. Because the medications work differently, their titration schedules and target doses differ.
Your prescribed dose might vary according to your clinician’s judgment and whether another brand is used off-label.
Doses are shown in milligrams (mg).
| Medication | Weeks 1–4 | Weeks 5–7 | Week 8 and beyond | Maintenance doses |
|---|---|---|---|---|
| Zepbound | 2.5 mg once weekly | 5 mg once weekly | may be increased by 2.5 mg every 4 weeks up to 15 mg once weekly | 5 mg, 10 mg, or 15 mg once weekly |
| Wegovy | 0.25 mg once weekly | 0.5 mg once weekly | • Weeks 9–12: 1 mg once weekly • Weeks 13–16: 1.7 mg once weekly | 1.7 mg or 2.4 mg once weekly |
Frequently asked questions
How much do semaglutide and tirzepatide cost?
Your personal cost depends on insurance coverage. Retail prices for three packages of Zepbound are roughly $3,000, while three packages of Wegovy run about $4,000. Prices vary by pharmacy.
A 2023 analysis estimated that 72 weeks of tirzepatide therapy cost approximately $17,527, whereas 68 weeks of semaglutide cost around $22,878. The study suggested tirzepatide could be more cost-effective due to greater weight-loss effects.
Can I switch from semaglutide to tirzepatide?
Switching from semaglutide to tirzepatide is generally considered safe. Some research indicates that changing to tirzepatide may improve weight-loss outcomes. Always consult your clinician and make such changes under medical supervision.
What are the downsides of tirzepatide?
As with other GLP‑1–based therapies, tirzepatide can produce adverse effects.
How quickly do people lose weight on tirzepatide?
Results vary by individual, but a 2022 study found that weight loss can begin within a few weeks.
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Takeaway
Tirzepatide and semaglutide are diabetes medications commonly prescribed for weight reduction. Tirzepatide may produce greater weight loss due to its dual GIP and GLP‑1 actions, but the evidence is not definitive. More research is needed, especially in people without diabetes, to determine if one agent is clearly superior.
Multiple studies suggest tirzepatide could offer larger weight-loss benefits for people with type 2 diabetes, but results are not conclusive. Discuss options with your clinician to determine which treatment—if any—is appropriate for your situation.
Also see semaglutide drugs ozempic wegovy mental health side effects for information on related concerns.
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