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Tirzepatide vs semaglutide: which is better for weight loss?

By the NexLife Medical Team · Medically reviewed by Adam Kennah, MD · Updated

In SURMOUNT-5, the head-to-head trial, tirzepatide led to more weight loss than semaglutide: 20.2% versus 13.7% on average over 72 weeks (The New England Journal of Medicine, 2025). It studied FDA-approved Zepbound and Wegovy; compounded versions weren’t studied. Tirzepatide acts on GIP and GLP-1, semaglutide on GLP-1.

  • How they work: GIP and GLP-1 vs. GLP-1 only
  • Side effects: similar, mostly stomach-related
  • Brand self-pay: Zepbound $299 to $449 ($449, at 7.5 to 15 mg, needs a refill within 45 days; otherwise $499 to $699), Wegovy $149 to $399
Published by NexLifeLegitScript-certifiedUpdated By the NexLife Medical Team · Medically reviewed by Adam Kennah, MD (NPI 1144260043)

Tirzepatide vs. semaglutide at a glance

Also approved for
Sleep apnea with obesity (Zepbound) vs. lowering heart risk (Wegovy)
How they work
GIP + GLP-1 vs. GLP-1 only
Weekly dose range
2.5 to 15 mg vs. 0.25 to 2.4 mg (Wegovy also has a 7.2 mg dose)
Common side effects
Nausea, diarrhea, vomiting, constipation, for both

Torn between the two? Call or text (949) 818-8000. A provider helps you decide.

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Compounded medicines aren’t FDA-approved. A NexLife provider prescribes one only if it offers a significant difference for you compared with an FDA-approved medicine.

The evidence

Which works better for weight loss, tirzepatide or semaglutide?

What the trials found
TrialWhat was comparedAverage weight loss
SURMOUNT-5 (2025)Tirzepatide vs. semaglutide, head to head, 72 weeks20.2% with tirzepatide vs. 13.7% with semaglutide
SURMOUNT-1 (2022)Tirzepatide vs. placebo, 72 weeks20.9% at the highest dose (15 mg)
STEP 1 (2021)Semaglutide 2.4 mg vs. placebo, 68 weeks14.9%

Published in The New England Journal of Medicine. These trials used the FDA-approved medicines; compounded versions weren’t studied.

“…compounded drugs are not FDA approved. This means the agency does not review compounded drugs for safety, effectiveness or quality before they are marketed.”

U.S. Food and Drug Administration, FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss
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Key takeaways

  • Tirzepatide led to more weight loss: 20.2% versus 13.7% for semaglutide, on average over 72 weeks in SURMOUNT-5, the head-to-head trial.
  • That trial used FDA-approved Zepbound and Wegovy. Compounded versions weren’t studied, and compounded drugs aren’t FDA-approved.
  • They work differently. Tirzepatide acts on GIP and GLP-1, semaglutide on GLP-1 only. Side effects are similar, mostly stomach-related.
  • Other approved uses: Zepbound for sleep apnea with obesity; Wegovy for lowering heart risk in people with heart disease and excess weight.
  • Semaglutide costs less. Self-pay, Wegovy is $149 to $399 a month and Zepbound $299 to $699 (checked November 1, 2026).
  • At NexLife, compounded semaglutide is $119 a month and tirzepatide $139 on the 12-month plan, at every dose.
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One of the most affordable, at every dose. Tirzepatide $139/mo on 12 months, or $169 month to month, all in. Pay less elsewhere? We match it.†About 3 minutes of health questions, no insurance needed. Compounded, not FDA-approved. A licensed provider prescribes it only when it offers a significant difference for you.

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The details

How do tirzepatide and semaglutide compare, side by side?

Tirzepatide vs. semaglutide, side by side
TirzepatideSemaglutide
How it worksActs on two hormone pathways, GIP and GLP-1Acts on one, GLP-1
Brand namesZepbound (weight), Mounjaro (type 2 diabetes)Wegovy (weight), Ozempic and Rybelsus (type 2 diabetes)
Weekly dose range2.5 mg up to 15 mg0.25 mg up to 2.4 mg (Wegovy also has a 7.2 mg dose)
Also approved forSleep apnea with obesity (Zepbound)Lowering heart risk in people with heart disease and excess weight (Wegovy)
Brand self-pay price$299 to $449 a month (Zepbound at LillyDirect; at 7.5 to 15 mg, $449 needs a refill within 45 days; otherwise $499 to $699)$149 to $399 a month (Wegovy pill or pen)
Compounded at NexLife$139 a month on a 12-month plan, or $169 month to month, at every dose Pay less elsewhere? Matched†$119 a month on a 12-month plan, or $139 month to month, at every dose

From the Zepbound and Wegovy prescribing information and self-pay prices, checked November 1, 2026.

“Tirzepatide is a GIP receptor and GLP-1 receptor agonist.”

Eli Lilly and Company, Zepbound (tirzepatide) prescribing information, section 12.1

How are tirzepatide and semaglutide different?

Tirzepatide and semaglutide work differently, cost differently and suit different people. Your provider helps you decide.

  • Two pathways. Tirzepatide acts on GIP and GLP-1; semaglutide acts on GLP-1.
  • Different doses. Tirzepatide runs 2.5 to 15 mg a week; semaglutide 0.25 to 2.4 mg, and Wegovy also has a 7.2 mg dose.
  • Different prices. At NexLife, $139 and $119 a month on 12-month plans ($169 and $139 month to month), each flat at every dose.

Who decides between tirzepatide and semaglutide?

  • A provider helps you choose. Based on your history, your goals and how you respond.
  • One price each. $139 a month for tirzepatide or $119 for semaglutide on 12-month plans ($169 or $139 month to month), at every dose.
  • Room to adjust. Your provider can change your plan as you go.

Real people who know both. Licensed providers who prescribe both and follow your dose. Call or text (949) 818-8000, 24/7.
Check my eligibilityCompounded, not FDA-approved: a licensed provider prescribes it only when it offers a significant difference for you.

Your call

Is tirzepatide or semaglutide the better fit for you?

Semaglutide may suit you if…

  • You want the lower price: semaglutide costs less, brand-name or compounded
  • You have heart disease and want Wegovy’s heart-risk benefit
  • You’d like the medicine with the longer track record

Tirzepatide may suit you if…

  • You want the larger average weight loss seen in the head-to-head trial of Zepbound and Wegovy
  • Your weight loss stalled on semaglutide
  • You have obstructive sleep apnea with obesity

Your provider decides which is right for you, and can switch you later if needed. You take one or the other, not both.

“ZEPBOUND contains tirzepatide. Coadministration with other tirzepatide-containing products or with any glucagon-like peptide-1 (GLP-1) receptor agonist is not recommended.”

Eli Lilly and Company, Zepbound (tirzepatide) prescribing information, section 1

Step by step

How do you choose between tirzepatide and semaglutide?

Start with the head-to-head trial, then weigh your health, side effects, price and how semaglutide has worked for you.

  1. Look at the head-to-head result. In SURMOUNT-5, tirzepatide led to 20.2% average weight loss over 72 weeks, against 13.7% on semaglutide. It studied FDA-approved Zepbound and Wegovy; compounded versions weren’t studied.
  2. Match the other approved uses to your health. Zepbound is also approved for sleep apnea with obesity. Wegovy is also approved to lower heart risk in people with heart disease and excess weight.
  3. Compare side effects. Both most often cause nausea, diarrhea, vomiting and constipation, usually while the dose is going up, and your provider can slow the pace. Don’t use either if you or a family member has had medullary thyroid carcinoma or MEN 2.
  4. Compare the price. Self-pay, Wegovy is $149 to $399 a month and Zepbound $299 to $449 (checked November 1, 2026); Zepbound’s $449 (7.5 to 15 mg) needs a refill within 45 days, or it’s $499 to $699. Semaglutide costs less, brand-name or compounded.
  5. Know how switching works. If your weight loss stalled on semaglutide, tirzepatide may suit you. Switching takes a new prescription, and with no official dose conversion, your provider decides where you start.
  6. Let your provider decide. Both labels advise against taking them together. Your provider decides which is right for you, based on your history, your goals and how you respond, and can switch you later if needed.

Compounded tirzepatide and semaglutide aren’t FDA-approved; a licensed provider prescribes one only when it offers a significant difference for you.

Vial math

How many units is your semaglutide dose?

It depends on your vial’s strength. Here are the Wegovy label’s dose steps at two example strengths.

Semaglutide dose steps from the Wegovy label, with the volume and units on a U-100 syringe at two example strengths, 2.5 mg/mL and 5 mg/mL
WeeksWeekly doseAt 2.5 mg/mLAt 5 mg/mL
1 to 40.25 mg0.1 mL (10 units)0.05 mL (5 units)
5 to 80.5 mg0.2 mL (20 units)0.1 mL (10 units)
9 to 121 mg0.4 mL (40 units)0.2 mL (20 units)
13 to 161.7 mg0.68 mL (68 units)0.34 mL (34 units)
17 onward2.4 mg0.96 mL (96 units)0.48 mL (48 units)

The math: mL = dose ÷ strength (mg per mL); units = mL × 100. At 2.5 mg/mL, 1 mg is 1 ÷ 2.5 = 0.4 mL, or 40 units. At 5 mg/mL, the same 1 mg is 0.2 mL, or 20 units.

Both strengths are examples only. The same dose is a different number of units at a different strength, so read the strength on your own vial’s label. Your prescription sets your dose and schedule, which may differ from these label steps. Every step: the semaglutide dosage chart.

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Prices from each provider’s own site, checked November 1, 2026. Brand-name and compounded medications are different products: compounded medications aren’t FDA-approved, and a provider prescribes one only when it offers a significant difference for you. Price Match Guarantee† terms apply.

What does NexLife cost?
One flat price at every dose.

No membership fee. Provider care, a nutrition plan, coaching and shipping are included. Paying less with another licensed provider? We match your regular monthly price.†

Illustration of a compounded tirzepatide vialGIP + GLP-1

12-month plan $139/mo

Tirzepatide

Weekly and dual-action. Care, coaching and shipping included. On a 12-month plan; $169/mo month to month.

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Compounded, not FDA-approved · Not prescribed? No charge for medication

Illustration of a compounded semaglutide vialGLP-1

12-month plan $119/mo

Semaglutide

Weekly GLP-1. Care, coaching and shipping included. On a 12-month plan; $139/mo month to month.

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Compounded, not FDA-approved · Not prescribed? No charge for medication

Compounded, not FDA-approved. A licensed provider prescribes it only when it offers a significant difference for you. Vials shown are illustrations. Always use the strength on your pharmacy’s label. Every plan and price · Price Match Guarantee† terms

The NexLife Price Match Guarantee†

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†Terms: see the Price Match Guarantee† details below. Compounded medications aren’t FDA-approved; a provider prescribes one only when it offers a significant difference for you.

Tirzepatide vs. semaglutide: your questions

Fair questions about NexLife

Will my price go up with my dose?
No. You pay the same at every dose.
What if I’m not prescribed?
You aren’t charged for medication.
Can I cancel?
Yes, by email. It takes effect 30 days after we receive it. Plans renew until you cancel; our cancellation policy has the details.
Do I need insurance?
No. Pay with an HSA or FSA card, or with Affirm, Klarna or Afterpay at checkout.

Which is better for weight loss, tirzepatide or semaglutide?

Tirzepatide, on average. In the SURMOUNT-5 head-to-head trial, people on it lost an average of 20.2% of their body weight over 72 weeks, compared with 13.7% on semaglutide. The trial studied FDA-approved Zepbound and Wegovy; compounded versions weren’t studied. Which is better for you depends on your health, your budget and how you respond.

Is tirzepatide stronger than semaglutide?

By average weight loss, yes. In SURMOUNT-5, the head-to-head trial of FDA-approved Zepbound and Wegovy, average weight loss over 72 weeks was 20.2% on tirzepatide and 13.7% on semaglutide. Tirzepatide also acts on two hormone pathways, GIP and GLP-1, instead of one. Compounded versions weren’t studied.

Were compounded versions tested in SURMOUNT-5?

No. The trial used FDA-approved Zepbound and Wegovy. Compounded tirzepatide and semaglutide aren’t FDA-approved and weren’t studied, and the FDA hasn’t reviewed them for safety, effectiveness or quality. A NexLife provider prescribes one only if it offers a significant difference for you compared with an FDA-approved medicine.

Which has fewer side effects?

Neither stands out. Both most often cause nausea, diarrhea, vomiting and constipation, usually while the dose is going up, and your provider can slow the pace. Both may also cause thyroid tumors, including cancer: don’t use either if you or a family member has had medullary thyroid carcinoma (MTC) or MEN 2.

What’s the difference between how they work?

Semaglutide activates one hormone receptor, GLP-1; tirzepatide activates two, GLP-1 and GIP, so it’s dual-action. Semaglutide is sold as Wegovy for weight and as Ozempic and Rybelsus for type 2 diabetes. Tirzepatide is sold as Zepbound for weight and as Mounjaro for type 2 diabetes.

Can I switch from semaglutide to tirzepatide?

Yes, with a new prescription. There’s no official dose conversion between them, so your provider decides where you start. Tirzepatide may suit you if your weight loss stalled on semaglutide. It can make birth control pills less effective: switch to a non-oral method or add a barrier one for 4 weeks after starting and after each dose increase.

Can you take tirzepatide and semaglutide together?

No. Both labels advise against it: taking Zepbound with any GLP-1 receptor agonist, semaglutide included, is “not recommended,” and Wegovy’s label says the same about other GLP-1 medicines. You take one or the other. If you switch, your provider writes a new prescription and picks your starting dose; there’s no official dose conversion.

Which is cheaper?

Semaglutide, brand-name or compounded. Self-pay, checked November 1, 2026: Wegovy $149 to $399 a month; Zepbound $299 to $449 (at 7.5 to 15 mg, $449 needs a refill within 45 days, or it’s $499 to $699). Our price index’s month-to-month medians: $199 for compounded semaglutide, $237 for tirzepatide. NexLife’s 12-month plan: $119 a month for semaglutide, $139 for tirzepatide.

Which is better for sleep apnea or heart disease, tirzepatide or semaglutide?

They’re approved for different extras. Zepbound, a tirzepatide, is also approved for sleep apnea with obesity. Wegovy, a semaglutide, is also approved to lower heart risk in people with heart disease and excess weight. Compounded tirzepatide and semaglutide aren’t FDA-approved.

What are the doses of tirzepatide and semaglutide?

Both are weekly. Tirzepatide runs 2.5 to 15 mg a week; semaglutide runs 0.25 to 2.4 mg, and Wegovy also has a 7.2 mg dose. There’s no official dose conversion between them, so if you switch, your provider decides where you start.

Can I switch from tirzepatide to semaglutide?

Yes, if your provider decides it’s right: they can switch you later if needed, and you take one or the other, not both. Switching takes a new prescription, and with no official dose conversion, your provider decides where you start.

Important safety information

Compounded tirzepatide and semaglutide are not FDA-approved, and the FDA hasn’t reviewed them for safety, effectiveness or quality. A provider prescribes them only when they offer a significant difference for you compared with an FDA-approved product. Both medicines may cause thyroid tumors, including cancer: don’t use either if you or a family member has had medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).

Read the full safety information

In studies with rodents, both medicines caused thyroid tumors; it isn’t known whether they cause them in people. Tell your provider if you notice a lump or swelling in your neck, hoarseness, trouble swallowing or shortness of breath. Serious side effects can include inflammation of the pancreas (pancreatitis), gallbladder problems, low blood sugar (especially with insulin or sulfonylureas), kidney problems from dehydration, severe stomach problems, serious allergic reactions, vision changes in people with type 2 diabetes, and a faster heart rate. Tell your care team before any surgery or procedure that uses anesthesia or deep sedation. Don’t combine either medicine with other GLP-1 medicines.

Tirzepatide can make birth control pills less effective: switch to a non-oral method, or add a barrier method such as condoms, for 4 weeks after you start and for 4 weeks after each dose increase. Both medicines may harm an unborn baby. Semaglutide should be stopped at least 2 months before a planned pregnancy. Tell your provider right away if you’re pregnant, planning to be, or breastfeeding.

This is a summary, not the complete safety information. Read the full Prescribing Information for FDA-approved tirzepatide (Zepbound) and semaglutide (Wegovy), and talk with your provider. You can report side effects to the FDA at 1-800-FDA-1088 or fda.gov/medwatch.

† NexLife Price Match Guarantee: for new NexLife members switching from a licensed U.S. telehealth provider or clinic with an active prescription for compounded tirzepatide or semaglutide. We match your regular all-in monthly price there (medication plus any required membership, program or visit fee, on a month-to-month plan); first-month offers, coupons, referral credits and prepaid multi-month rates aren’t matched. Proof from the last 60 days required. A licensed provider must determine that treatment is right for you. Not open to people with Medicare, Medicaid or TRICARE coverage. Full terms.

About NexLife. NexLife is a telehealth and care-coordination platform. Care is delivered through affiliated, physician-owned medical groups, and licensed providers decide whether treatment is right for you. NexLife doesn’t make or compound medication: state-licensed partner pharmacies fill each prescription, and we coordinate the rest. Available only in states where our affiliated providers are licensed.

“No. A generic drug is approved by FDA under 505(j) of the FD&C Act and meets all of the requirements of that section (including establishing therapeutic equivalence to a brand name drug, among others), while a compounded drug is not approved by FDA.”

U.S. Food and Drug Administration, Compounding and the FDA: Questions and Answers

Who wrote and medically reviewed this page?

Adam Kennah, MDMedical Director, NexLife · Board-certified in emergency medicine (American Board of Emergency Medicine) · NPI 1144260043

Leads the NexLife Medical Team, which writes and medically reviews NexLife’s guides, including this one.

NexLife Medical TeamWrites and updates NexLife’s guides

Checked the SURMOUNT-5, SURMOUNT-1 and STEP 1 results, the Zepbound and Wegovy labels and current self-pay prices.

  • Every fact, sourced. Each price and rule links to the page it comes from.
  • How we make money. NexLife is a telehealth and care-coordination platform. We earn revenue when people join NexLife.
  • Corrections, fast. See something wrong or out of date? Email care@nexlife.us and we’ll fix it.

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Sources

  1. The New England Journal of Medicine. Tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5), 2025.
  2. The New England Journal of Medicine. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1), 2022.
  3. The New England Journal of Medicine. Once-weekly semaglutide in adults with overweight or obesity (STEP 1), 2021.
  4. Eli Lilly and Company. Zepbound (tirzepatide) prescribing information.
  5. Novo Nordisk. Wegovy (semaglutide) prescribing information.
  6. U.S. Food and Drug Administration. FDA’s concerns with unapproved GLP-1 drugs used for weight loss.
  7. NexLife. Compounded tirzepatide plans.
  8. NexLife. Compounded semaglutide plans.
  9. LegitScript. LegitScript certification record for NexLife.us.
  10. Ro: weight loss program pricing. Checked November 1, 2026.
  11. Hims: Zepbound KwikPen. Checked November 1, 2026.
  12. Hims: Wegovy pill and pen, with membership. Checked November 1, 2026.
  13. Mochi Health: FAQs (membership and medication prices). Checked November 1, 2026.
  14. Embody: compounded tirzepatide, one-month supply. Checked November 1, 2026.
  15. Embody: compounded semaglutide, one-month supply. Checked November 1, 2026.