Two prescription medicines, two makersZepbound is tirzepatide from Eli Lilly; Wegovy is semaglutide from Novo Nordisk. Both labels say not to combine them with other GLP-1 receptor agonists.[1][2] Figures below are quoted from each FDA label, the trials and each maker's published prices, with dates.
Zepbound vs Wegovy at a glance
Zepbound acts on two hormone receptors and Wegovy on one; Wegovy has been approved longer and for more uses.[1][2]
| Zepbound | Wegovy | |
|---|---|---|
| Active ingredient | Tirzepatide (GIP and GLP-1 receptor agonist) | Semaglutide (GLP-1 receptor agonist) |
| First U.S. approval | November 8, 2023[7] | June 4, 2021[8] |
| Weight management | Adults | Adults and children 12 and older |
| Other approved uses | Moderate to severe sleep apnea with obesity | Lowering heart-attack and stroke risk in people with heart disease; MASH liver disease (accelerated approval) |
| Forms | Single-dose pen and vial; KwikPen and multi-dose vial (4 doses) | Single-dose pen and syringe; 4-dose FlexTouch pen; daily tablets (approved Dec 22, 2025)[9] |
| Starting dose | 2.5 mg weekly | 0.25 mg weekly (tablets: 1.5 mg daily) |
| Maintenance for weight | 5, 10 or 15 mg weekly | 2.4 mg (recommended) or 1.7 mg weekly; up to 7.2 mg in adults |
| Half-life | About 5–6 days | About 1 week |
| Boxed warning | Thyroid C-cell tumors in rodents | Thyroid C-cell tumors in rodents |
Sources: Zepbound and Wegovy prescribing information.[1][2] The 7.2 mg Wegovy dose (“Wegovy HD”) was approved on March 19, 2026, for adults who have tolerated 2.4 mg for at least 4 weeks.[10][2]
Wegovy vs Zepbound for weight loss
Zepbound produced more weight loss in the one trial that compared them directly. SURMOUNT-5 randomized 751 adults with obesity, without diabetes, to the highest tolerated dose of each drug for 72 weeks; it was open-label and funded by Eli Lilly.[3]
- −20.2%Zepbound (10 or 15 mg), 72 weeks
- −13.7%Wegovy (1.7 or 2.4 mg), 72 weeks
- −18.4 cmwaist, Zepbound
- −13.0 cmwaist, Wegovy
| Trial | Drug and dose | Weeks | Weight change | Placebo |
|---|---|---|---|---|
| SURMOUNT-1[4] | Zepbound 15 mg | 72 | −20.9% | −3.1% |
| STEP 1[5] | Wegovy 2.4 mg | 68 | −14.9% | −2.4% |
| STEP UP (label)[2] | Wegovy 7.2 mg | 72 | −18.8% | −3.9% |
| OASIS 4 (label)[2] | Wegovy tablets 25 mg | 64 | −13.6% | −2.4% |
The separate trials differ in length and population, so only SURMOUNT-5 is a fair comparison; it did not test Wegovy 7.2 mg or the tablets. Results at each Zepbound dose are on tirzepatide for weight loss.
Wegovy pill vs Zepbound
The Wegovy pill is a once-daily semaglutide tablet taken on an empty stomach, while Zepbound is a once-weekly injection; in separate trials, weight fell 13.6% at 64 weeks on the 25 mg tablet and 20.9% at 72 weeks on Zepbound 15 mg.[2][4]
| Wegovy pill | Zepbound | |
|---|---|---|
| How often | Once daily, tablet | Once weekly, injection |
| Doses | 1.5, 4, 9 and 25 mg tablets | 2.5 to 15 mg |
| How it is taken | Empty stomach in the morning with up to 4 oz of water; wait 30 minutes before food, drink or other pills | Any time of day, with or without meals |
| Trial weight change | −13.6% vs −2.4% placebo (64 weeks, 25 mg) | −20.9% vs −3.1% placebo (72 weeks, 15 mg) |
| Maker self-pay price | $149 to $299 per 30 tablets | $299 to $449 per 4 doses with on-time refills |
| Medicare GLP-1 Bridge | Included | KwikPen only |
Sources: Wegovy and Zepbound labels, SURMOUNT-1, NovoCare and LillyDirect.[2][1][4][13][11] The two have not been compared head to head. Coverage details are on Zepbound insurance coverage, and Lilly's own pill on Foundayo vs Zepbound.
Dose schedules side by side
Both drugs start low and rise every 4 weeks, but the milligram numbers are not comparable between the two molecules.[1][2]
| Weeks | Zepbound | Wegovy |
|---|---|---|
| 1–4 | 2.5 mg | 0.25 mg |
| 5–8 | 5 mg | 0.5 mg |
| 9–12 | 7.5 mg | 1 mg |
| 13–16 | 10 mg | 1.7 mg |
| 17–20 | 12.5 mg | 2.4 mg (maintenance) |
| 21 onward | 15 mg (maximum) | 2.4 mg, or 7.2 mg in adults after ≥4 weeks on 2.4 mg |
Missed doses are handled differently. Zepbound may be taken up to 4 days late.[1] Wegovy injection is taken as soon as possible if the next dose is more than 2 days away, and after 2 or more missed doses in a row the label restarts the escalation at a lower dose.[2] See the tirzepatide dosage chart and missed Zepbound dose.
Switching from Wegovy to Zepbound, or from Zepbound to Wegovy
No: neither label contains a conversion chart between the two drugs. The Zepbound label starts every patient at 2.5 mg once weekly, and both labels say not to use the drug together with another GLP-1 receptor agonist.[1][2] A 2.4 mg Wegovy dose and a 2.5 mg Zepbound dose are not equivalent: they are different molecules with different strengths per milligram. Going the other way, the Wegovy label's escalation starts at 0.25 mg weekly and gives no conversion from tirzepatide either; its only switching rules cover moving between Wegovy injection and Wegovy tablets.[2] The timing and starting dose of any switch are the prescriber's decision.
Zepbound vs Wegovy side effects
Both cause mainly stomach side effects; in SURMOUNT-5 they were the most common in both groups, mostly mild to moderate and mainly during dose increases.[3] Each label's own trials show:
| Side effect | Zepbound 5–15 mg | Its placebo | Wegovy 2.4 mg | Its placebo |
|---|---|---|---|---|
| Nausea | 25–29% | 8% | 44% | 16% |
| Diarrhea | 19–23% | 8% | 30% | 16% |
| Vomiting | 8–13% | 2% | 24% | 6% |
| Constipation | 11–17% | 5% | 24% | 11% |
| Abdominal pain | 9–10% | 5% | 20% | 10% |
| Fatigue | 5–7% | 3% | 11% | 5% |
| Hair loss | 4–5% | 1% | 3% | 1% |
| Stopped for side effects | 4.8–6.7% | 3.4% | 6.8% | 3.2% |
The placebo columns differ (nausea 8% vs 16%), which shows how much trial design affects these numbers; compare each drug with its own placebo, not with the other drug.[1][2] Full Zepbound data: Zepbound side effects.
Zepbound vs Wegovy cost
At each maker's published self-pay prices in November 2026, Wegovy injection costs $349 a month at every standard dose, which sits between Zepbound's $299 (2.5 mg) and $399 (5 mg) and below its $449 for 7.5–15 mg with on-time refills.[11][13]
| Zepbound (Lilly) | Wegovy (Novo Nordisk) | |
|---|---|---|
| Self-pay, starting doses | $299 (2.5 mg) · $399 (5 mg) per 4 doses | $349 per month, 0.25–2.4 mg |
| Self-pay, higher doses | $449 (7.5–15 mg, on-time refills); $499–$699 otherwise | $399 per month for 7.2 mg |
| Self-pay, tablets | No tablet form | $149 (1.5 mg) · $199 (4 mg) · $299 (9 and 25 mg) per month |
| List price | $1,059.87 per month at 2023 launch | $1,349.02 per package; announced $675 from Jan 1, 2027 |
| A year at a typical maintenance dose (self-pay) | $5,837 (15 mg, 13 fills) | $4,537 (2.4 mg, 13 boxes of 4 pens) |
Sources: Lilly and Novo Nordisk price pages and releases.[11][12][13][14] We list only prices the makers publish; what an insured person pays depends on the plan. More on Zepbound cost.
Zepbound vs Ozempic
Ozempic is the same drug as Wegovy, semaglutide, but it is approved for type 2 diabetes, not for weight management. Its label covers blood-sugar control, lowering cardiovascular risk in type 2 diabetes with heart disease, and protecting kidney function in type 2 diabetes with chronic kidney disease.[15]
| Zepbound | Ozempic | |
|---|---|---|
| Drug | Tirzepatide | Semaglutide |
| Approved for weight management | Yes | No |
| Approved for type 2 diabetes | No (that is Mounjaro) | Yes |
| Dose steps | 2.5 → 5 → 7.5 → 10 → 12.5 → 15 mg | 0.25 → 0.5 → 1 → 2 mg |
| Missed dose | Within 4 days | Within 5 days |
The like-for-like comparison is Mounjaro vs Ozempic, both for type 2 diabetes: in SURPASS-2, tirzepatide 5–15 mg lowered HbA1c by 2.01–2.30 points versus 1.86 for semaglutide 1 mg.[17][16] See tirzepatide vs semaglutide.
Which is better, Zepbound or Wegovy?
For average weight loss, Zepbound did better head to head, but each has approved uses the other lacks.
- Weight: −20.2% vs −13.7% in SURMOUNT-5.[3]
- Heart outcomes: Wegovy is approved to lower major cardiovascular events after SELECT, where risk fell by 20% (hazard ratio 0.80) in people with heart disease and overweight.[6][2]
- Sleep apnea: only Zepbound is approved for it; see Zepbound for sleep apnea.[1]
- Teenagers and pills: only Wegovy is approved from age 12 and as a daily tablet.[2][9]
Which suits a person is a decision for them and their prescriber. The molecules themselves are compared on tirzepatide vs semaglutide.
Related
- Tirzepatide vs semaglutideMechanism and diabetes trial
- Zepbound vs MounjaroSame molecule, two labels
- Zepbound costPer dose, per mg and per year
Frequently asked questions
Which is better for weight loss, Zepbound or Wegovy?
In the head-to-head SURMOUNT-5 trial, Zepbound users lost 20.2% of body weight on average versus 13.7% with Wegovy over 72 weeks.[3]
Is there a dosage chart for switching from Wegovy to Zepbound?
Is Zepbound or Wegovy cheaper?
Is the Wegovy pill better than Zepbound?
Do Zepbound and Wegovy have generic versions?
What is the difference between Zepbound and Ozempic?
Sources
- Zepbound (tirzepatide) injection: prescribing information, Medication Guide and Instructions for Use
- Wegovy (semaglutide) injection and tablets: prescribing information
- Aronne LJ et al. Tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5)
- Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1)
- Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1)
- Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT)
- Drugs@FDA: NDA 217806 (Zepbound) approval history and supplement letters
- Drugs@FDA: NDA 215256 (Wegovy injection) approval history
- NDA 218316 approval letter: Wegovy tablets
- FDA approves fourth product under National Priority Voucher program, higher dose semaglutide
- Zepbound on LillyDirect: formats and self-pay prices
- FDA approves Lilly's Zepbound (tirzepatide) for chronic weight management
- Wegovy cost, coverage and self-pay prices (NovoCare)
- Wegovy and Ozempic list price reduction
- Ozempic (semaglutide) injection: prescribing information
- Mounjaro (tirzepatide) injection: prescribing information and Instructions for Use
- Frías JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes (SURPASS-2)