Zepbound vs Wegovy: Which Weight Loss Medication Is Better?

Choosing between Zepbound and Wegovy feels overwhelming when you’re researching weight loss medications. Both have FDA approval specifically for weight management. Both require weekly injections. Both produce results that far exceed what most people achieve through diet and exercise alone. So which one actually works better?

Here’s the straightforward answer: Zepbound produces higher average weight loss in clinical trials. People taking the highest dose lost an average of 22.5% of their body weight over 72 weeks, compared to 14.9% with Wegovy over 68 weeks. That difference is real and substantial. However, Wegovy still delivers excellent results for many people, costs less in compounded form, and some people tolerate it better.

This guide compares everything from how each medication works to what you’ll pay, helping you make an informed decision based on your goals, budget, and individual needs.

Key Takeaways: Zepbound vs Wegovy

• Zepbound shows higher average weight loss: 22.5% vs 14.9% at maximum doses
• Zepbound (tirzepatide) acts on two hormone receptors, Wegovy (semaglutide) acts on one
• Both are FDA-approved specifically for chronic weight management
• Side effects similar but Zepbound may cause slightly more gastrointestinal issues
• Brand prices: Zepbound $1,069/month, Wegovy $1,349/month
• Compounded options: tirzepatide $349/month, semaglutide $199/month through TrimRx
• Insurance coverage inconsistent for both, many plans exclude weight loss medications
• Both require weekly self-injections using pre-filled pens

Understanding Zepbound and Wegovy

Both medications belong to a class called GLP-1 receptor agonists, though Zepbound technically goes beyond this single classification. They mimic hormones your gut produces after eating that affect appetite and metabolism.

Wegovy contains semaglutide and received FDA approval in 2021 for chronic weight management. Manufactured by Novo Nordisk, it’s the same medication sold as Ozempic for diabetes but formulated at a higher maximum dose specifically for weight loss. Wegovy represented a major breakthrough when it launched, offering the first highly effective weight loss medication in decades.

Zepbound contains tirzepatide and got FDA approval in 2023 for weight management. Made by Eli Lilly, it’s the same medication as Mounjaro (approved for diabetes) but marketed specifically for obesity treatment. Zepbound’s clinical trials showed even better weight loss results than Wegovy, making it the newest and most powerful option currently available.

Both require weekly injections that you give yourself at home using pre-filled pen devices. Neither comes as a daily pill, though oral versions are being developed.

How They Work: Mechanism of Action

The key difference between these medications lies in how many hormone receptors they activate.

Wegovy (Semaglutide): GLP-1 Activation

Wegovy mimics GLP-1, a hormone your intestines release after you eat. When you inject semaglutide weekly, it activates GLP-1 receptors throughout your body, creating several weight loss effects.

Your brain receives stronger signals that you’re full and satisfied. The constant mental chatter about food, what many call “food noise,” often decreases dramatically. Your stomach empties more slowly after meals, keeping you fuller for extended periods. Your pancreas secretes insulin more effectively when blood sugar rises, and your liver produces less glucose between meals.

These combined effects make it significantly easier to eat less without feeling hungry or deprived. Most people naturally reduce their daily calorie intake by 500 to 1,000 calories without conscious restriction or willpower battles.

Zepbound (Tirzepatide): Dual GLP-1 and GIP Activation

Zepbound activates both GLP-1 receptors (like Wegovy) and adds GIP receptors into the equation. GIP stands for glucose-dependent insulinotropic polypeptide, another gut hormone that influences how your body handles nutrients and regulates metabolism.

The dual activation appears to create additive benefits. You get all the appetite suppression and metabolic improvements from GLP-1, plus additional effects from GIP. The GIP component may enhance insulin secretion, improve fat metabolism, and provide extra appetite reduction beyond GLP-1 alone.

Think of Zepbound as using two complementary approaches simultaneously rather than relying on one very effective approach. The result typically means more weight loss and better metabolic improvements, though sometimes with slightly more side effects.

Weight Loss Results: Clinical Trial Data

Let’s examine the actual numbers from the pivotal clinical trials that led to FDA approval for each medication.

Zepbound Results (SURMOUNT-1 Trial)

The SURMOUNT-1 trial studied 2,539 adults with obesity or overweight (without diabetes) over 72 weeks. At the highest Zepbound dose of 15 mg weekly, results showed:

Average weight loss: 22.5% of body weight

Breaking down the success rates:

• 96% lost at least 5% of body weight
• 89% lost at least 10% of body weight
• 78% lost at least 15% of body weight
• 63% lost at least 20% of body weight

For someone weighing 220 pounds, losing 22.5% means dropping about 50 pounds to reach 170 pounds. Even at lower Zepbound doses, results remained impressive. The 10 mg dose produced 20.9% average weight loss, and the 5 mg dose achieved 15% average loss.

Wegovy Results (STEP-1 Trial)

The STEP-1 trial examined 1,961 adults with obesity or overweight over 68 weeks. Participants took semaglutide at 2.4 mg weekly. Results demonstrated:

Average weight loss: 14.9% of body weight

Success rate breakdown:

• 86.4% lost at least 5% of body weight
• 69.1% lost at least 10% of body weight
• 50.5% lost at least 15% of body weight
• 32% lost at least 20% of body weight

That same 220-pound person losing 14.9% would drop about 33 pounds to reach 187 pounds.

Direct Comparison

Zepbound shows a clear advantage in average weight loss, producing roughly 7.6 percentage points more loss than Wegovy. For a 200-pound person, that translates to about 15 additional pounds lost with Zepbound versus Wegovy.

However, context matters here. Both medications produce substantial, clinically significant results that dramatically exceed traditional weight loss methods. Losing 15% of your body weight improves virtually every health marker, from blood pressure and cholesterol to blood sugar and joint health. Both medications achieve outcomes that approach bariatric surgery results without requiring invasive procedures.

Individual variation also plays a major role. Some people respond exceptionally well to Wegovy and lose 20% or more of their weight. Others might see only modest results with Zepbound. Clinical trial averages don’t perfectly predict your personal outcome.

For detailed timelines of what to expect month by month, see our semaglutide weight loss results guide for Wegovy and our tirzepatide results guide for Zepbound.

Dosing Schedules and Administration

Both medications follow gradual dose escalation to minimize side effects, but the schedules differ in timeline and complexity.

Wegovy Dosing Schedule

Month 1 (Weeks 1-4): 0.25 mg weekly Month 2 (Weeks 5-8): 0.5 mg weekly
Month 3 (Weeks 9-12): 1 mg weekly Month 4 (Weeks 13-16): 1.7 mg weekly Month 5+ (Week 17+): 2.4 mg weekly (maintenance dose)

You’ll reach the maximum dose after about 16-20 weeks. The progression is straightforward with clear monthly increases. Each pen is pre-filled for a single dose, so you use a new pen each week.

Zepbound Dosing Schedule

Month 1 (Weeks 1-4): 2.5 mg weekly Month 2 (Weeks 5-8): 5 mg weekly Month 3 (Weeks 9-12): 7.5 mg weekly Month 4 (Weeks 13-16): 10 mg weekly Month 5 (Weeks 17-20): 12.5 mg weekly Month 6+ (Week 21+): 15 mg weekly (maximum dose)

Zepbound takes longer to reach maximum dose, around 20-24 weeks. The schedule includes more intermediate steps, allowing for finer dose adjustments. Like Wegovy, each pen delivers a single weekly dose.

Injection Process

Both medications use similar injection techniques. You’ll inject once weekly into your abdomen, thigh, or upper arm. The pens make the process straightforward. After cleaning the injection site with an alcohol pad, you press the pen against your skin and click a button to deliver the dose. Most people find injections quick and relatively painless after the first few times.

Pick the same day each week for your injection. The specific day doesn’t matter, just consistency. Many people choose Friday or Saturday evenings so they can rest over the weekend if side effects occur.

Side Effects Comparison

Since both medications affect gut hormones and slow gastric emptying, they cause similar side effects. The main difference is frequency and severity.

Common Side Effects (Both Medications)

Nausea ranks as the most frequent complaint. Roughly 30-44% of people experience nausea with Wegovy, while 40-45% report it with Zepbound. It typically peaks during the first few days after your injection and improves before your next dose. Most people find nausea lessens significantly after the first 2-3 weeks at each new dose level.

Diarrhea affects about 30% of users of both medications. Usually mild and temporary, improving as your digestive system adjusts.

Constipation hits approximately 24% of Wegovy users and 20-25% of Zepbound users. The slowed gastric emptying and reduced food intake both contribute. Increasing water and fiber intake helps manage this.

Vomiting occurs less frequently, around 9-15% depending on the medication. More common if you eat too much too quickly despite reduced appetite.

Abdominal pain or discomfort affects roughly 20-25% of people, typically mild and temporary.

Reduced appetite is the intended effect, though it sometimes feels too extreme. Some people need to consciously remind themselves to eat adequate nutrition.

Fatigue and headaches occur in some people during initial adjustment periods.

Zepbound Specific Considerations

Clinical trials suggest Zepbound causes gastrointestinal side effects slightly more frequently than Wegovy. The dual-receptor action appears to create somewhat stronger gut effects. The differences aren’t dramatic, perhaps 3-5 percentage points higher for nausea and diarrhea, but they’re noticeable in the data.

Some people who struggled with Zepbound’s side effects switch to Wegovy and tolerate it better. Others who tried Wegovy first and couldn’t manage the nausea find Zepbound equally challenging or sometimes easier. Individual body chemistry determines tolerance more than the medication choice.

Managing Side Effects

These strategies work well for both medications:

Eat smaller, more frequent meals instead of three large ones. Your stomach empties slowly, making big portions uncomfortable.

Avoid fatty, greasy, or spicy foods, especially in the first few months. These often worsen nausea.

Stay well hydrated throughout the day. Aim for 64 ounces or more of water.

Take your injection on a convenient day when you can rest if needed.

Stop eating when you feel satisfied, even if food remains on your plate. Don’t force yourself to finish meals.

Give side effects time to improve. Most decrease substantially after 2-3 weeks at each new dose.

Serious Side Effects (Both Medications)

Both medications carry small risks of pancreatitis, gallbladder problems, and kidney issues (usually related to dehydration from vomiting or diarrhea). Thyroid tumors appeared in animal studies but haven’t been confirmed in human use.

Don’t use either medication if you have a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2.

Cost Comparison and Insurance Coverage

Here’s where practical considerations often override clinical effectiveness. Both medications are extremely expensive at retail prices.

Brand-Name Costs

Wegovy: $1,349 per month without insurance Zepbound: $1,069 per month without insurance

Surprisingly, Zepbound costs $280 less per month than Wegovy despite showing better results in trials. That’s $3,360 less annually. However, both prices remain prohibitively expensive for most people without insurance coverage.

Insurance Coverage Realities

Insurance companies approach both medications similarly, and unfortunately coverage remains inconsistent at best.

Many insurance plans specifically exclude weight loss medications regardless of FDA approval. Even plans that do cover obesity treatment often require extensive documentation including BMI records, documentation of previous weight loss attempts, evidence of weight-related health conditions, and detailed justification from your physician.

Some plans cover these medications but only for patients with specific comorbidities like diabetes, heart disease, or sleep apnea. Others approve coverage but charge copays of $100-$300 monthly.

Medicare doesn’t cover weight loss medications due to federal regulations, though this may change in the future. State Medicaid programs vary, with some beginning to cover GLP-1 medications for obesity while others maintain exclusions.

Both manufacturers offer savings programs. Eli Lilly provides savings cards that can reduce Zepbound copays to $25 monthly for eligible patients with commercial insurance. Novo Nordisk offers similar programs for Wegovy. These programs don’t work with government insurance like Medicare or Medicaid.

Compounded Alternatives

Compounded versions of both medications provide the same active ingredients at dramatically lower prices.

TrimRx offers compounded tirzepatide at $349 per month and compounded semaglutide at $199 per month. Both prices are all-inclusive, covering consultations with licensed providers, the medication itself, all injection supplies, cold-chain shipping, and ongoing medical support. No hidden fees, membership charges, or surprise costs.

Compounded medications use the same active ingredients as brand-name versions, prepared by FDA-registered compounding pharmacies following strict quality standards. They work identically to Zepbound and Wegovy but without the branded packaging and associated costs.

The $150 monthly difference between compounded semaglutide and tirzepatide matters for long-term affordability. Over a year, that’s $1,800. Some people achieve excellent results with semaglutide and see no reason to spend extra for tirzepatide. Others prioritize maximizing weight loss and choose tirzepatide despite the higher cost.

Which Medication Should You Choose?

The better medication depends on your specific goals, budget, and medical situation.

Choose Zepbound If:

You want maximum weight loss results. Clinical data shows tirzepatide produces the highest average weight loss of any medication currently available, making it ideal if you’re prioritizing total pounds lost.

You can manage the higher cost. Whether through insurance coverage or compounded options, the price difference is feasible for your budget.

You tried Wegovy and plateaued. Some people switch from semaglutide to tirzepatide when weight loss stalls, often restarting progress.

You have related health conditions like type 2 diabetes or cardiovascular disease. Zepbound shows excellent benefits for metabolic health beyond just weight loss.

Choose Wegovy If:

You want excellent results at lower cost. Semaglutide produces substantial weight loss (14.9% average) while costing $150/month less than tirzepatide in compounded form.

You’re concerned about side effects. While both cause similar issues, clinical trials show slightly lower rates of gastrointestinal problems with semaglutide.

Your insurance covers Wegovy but not Zepbound. Take advantage of whatever your plan will cover.

You tried Zepbound and couldn’t tolerate side effects. Some people who struggle with tirzepatide do fine on semaglutide.

Consider Starting Points

Many healthcare providers suggest starting with semaglutide given its excellent effectiveness and lower cost. If you achieve good results and tolerate it well, there’s no compelling reason to switch. If weight loss plateaus after 6-8 months or you want to maximize results, tirzepatide becomes a logical next step.

This approach lets you experience GLP-1 medication effects without immediately committing to the most expensive option. You can always escalate to tirzepatide later if needed.

How to Access Zepbound or Wegovy

Getting prescribed either medication has become more straightforward through telehealth platforms.

Traditional Healthcare Route

Schedule an appointment with your primary care doctor, endocrinologist, or weight management specialist. They’ll evaluate your BMI, weight-related health conditions, previous weight loss attempts, and overall health status. If they prescribe, you’ll need to navigate insurance authorization processes and fill the prescription at a pharmacy.

This works well if you have established care with a provider comfortable prescribing these medications and if your insurance provides reasonable coverage. However, many doctors remain hesitant about prescribing expensive weight loss medications, and insurance battles can be frustrating and time-consuming.

Telehealth Route

Platforms specializing in weight management offer a more streamlined process. Through TrimRx, the process works like this:

Complete an online medical assessment covering your health history, current medications, weight loss goals, and relevant health conditions. Takes about 10-15 minutes.

Consult with a licensed healthcare provider via telehealth. You’ll typically receive a response within 24-48 hours.

Receive medication at home if approved. Compounded tirzepatide or semaglutide ships directly to you with all necessary supplies and detailed instructions.

Begin treatment with ongoing support. Monthly follow-ups track your progress, manage any side effects, and adjust dosing as appropriate.

Everything happens remotely without requiring in-person visits. Learn more about accessing weight loss prescriptions online through telehealth.

Comparison to Related Medications

Understanding where Zepbound and Wegovy fit among other options helps contextualize their benefits.

Zepbound/Wegovy vs Mounjaro/Ozempic

Mounjaro and Ozempic are the diabetes versions of Zepbound and Wegovy respectively. They contain the same active ingredients but carry FDA approval for type 2 diabetes rather than weight loss.

Mounjaro contains tirzepatide (like Zepbound) with a maximum dose of 15 mg weekly, identical to Zepbound’s maximum. Ozempic contains semaglutide (like Wegovy) but maxes out at 2 mg weekly compared to Wegovy’s 2.4 mg maximum.

For detailed comparison of the diabetes versions, see our Mounjaro vs Ozempic guide.

GLP-1 Medications vs Traditional Weight Loss Drugs

Older weight loss medications like phentermine, orlistat, or naltrexone-bupropion typically produce 5-10% weight loss compared to 15-22% with GLP-1 medications. The newer drugs represent a genuine breakthrough, offering results that approach bariatric surgery outcomes without requiring invasive procedures.

For comprehensive overview of all options, check our comparison of weight loss medications in 2026.

Maximizing Results on Either Medication

While both medications work even without dramatic lifestyle changes, certain strategies optimize your outcomes.

Focus on protein consumption. Aim for 0.7-1 gram of protein per pound of your goal body weight daily. When appetite drops dramatically, many people naturally reduce protein intake, which can lead to muscle loss alongside fat loss. Prioritizing protein preserves lean muscle mass.

Maintain consistent dosing schedule. Take your injection the same day each week without skipping doses. Set phone reminders if needed. Consistency keeps medication levels stable and optimizes effectiveness.

Incorporate resistance training. While cardio exercise burns calories, strength training preserves muscle mass and maintains metabolic rate during weight loss. Even two 30-minute resistance sessions weekly make a substantial difference.

Track multiple metrics. Take body measurements, progress photos, and note how clothes fit. Sometimes body composition improves without dramatic scale changes. These additional metrics help you see progress the scale might not reflect.

Prioritize sleep quality. Poor sleep disrupts hunger hormones (ghrelin and leptin) and can slow weight loss. Aim for 7-9 hours of quality sleep nightly.

Stay properly hydrated. Adequate water intake supports metabolism, helps manage side effects, and prevents constipation. Target at least 64 ounces daily, more if you’re physically active.

Work closely with your provider. Regular check-ins allow for dose optimization, side effect management, and ongoing support throughout your journey.

Frequently Asked Questions

Which medication causes more weight loss, Zepbound or Wegovy?

Zepbound produces higher average weight loss based on clinical trial data. People taking the maximum dose (15 mg) lost an average of 22.5% of their body weight over 72 weeks, compared to 14.9% with Wegovy’s maximum dose (2.4 mg) over 68 weeks. This makes Zepbound objectively more effective on average, though both deliver substantial results.

Is Zepbound worth the extra cost compared to Wegovy?

That depends on your priorities and budget. In compounded form through TrimRx, tirzepatide costs $349 monthly versus $199 for semaglutide, a difference of $150 monthly or $1,800 annually. Zepbound produces roughly 50% more weight loss but costs about 75% more. If maximizing results is your priority and budget allows, Zepbound makes sense. If you achieve good results with Wegovy, the lower cost may be more practical for long-term use.

Do Zepbound and Wegovy have the same side effects?

They cause very similar side effects since both affect gut hormones and slow gastric emptying. The most common issues include nausea, diarrhea, constipation, and reduced appetite. Clinical trials suggest Zepbound causes gastrointestinal side effects slightly more frequently than Wegovy, likely due to its dual-receptor action, but the differences aren’t dramatic. Individual tolerance varies more than the medication choice.

Can I switch from Wegovy to Zepbound?

Yes, switching is common and straightforward. Some people start with Wegovy, see good results, then switch to Zepbound if they plateau or want to maximize weight loss. Your provider will guide the transition, typically starting Zepbound at a lower dose even if you’re on high-dose Wegovy, then gradually increasing. The reverse switch (Zepbound to Wegovy) also works if side effects become problematic.

How long do results take with Zepbound vs Wegovy?

Both follow similar timelines. You’ll notice reduced appetite within 1-2 weeks of starting either medication. Visible weight loss typically begins around week 4-8. More substantial results accumulate over months, with maximum weight loss usually occurring around month 14-18. Zepbound’s longer titration schedule (5-6 months to maximum dose) means you might reach peak effectiveness slightly later than with Wegovy.

Will insurance cover Zepbound or Wegovy?

Insurance coverage varies dramatically by plan and remains inconsistent. Many plans specifically exclude weight loss medications regardless of FDA approval. Others cover these medications but require extensive documentation and prior authorization. Some plans approve coverage but charge substantial copays. Medicare generally doesn’t cover weight loss medications. Check your specific plan’s formulary and obesity treatment coverage policies.

Are compounded versions as effective as brand-name?

Compounded tirzepatide and semaglutide contain the same active ingredients as brand-name Zepbound and Wegovy. When sourced from reputable FDA-registered compounding pharmacies, they work identically. The main differences are price and packaging. Compounded versions don’t come in branded pen devices but use standard syringes. Effectiveness is equivalent with proper sourcing and administration.

What happens if I stop taking these medications?

Most people regain significant weight after stopping either Zepbound or Wegovy. Research shows patients typically regain 50-80% of lost weight within 6-12 months after discontinuing treatment. These medications don’t permanently reset your metabolism or appetite regulation. Many people stay on maintenance doses indefinitely, treating obesity as a chronic condition requiring ongoing management.

Which medication has fewer side effects?

Clinical data suggests Wegovy causes slightly lower rates of gastrointestinal side effects compared to Zepbound. However, the differences are modest, and individual variation matters more than medication choice. Some people tolerate one better than the other for reasons that vary individually. Neither is dramatically easier on side effects. Most people on either medication experience side effects that improve significantly after initial adjustment periods.

Can I use these medications without changing my diet?

Both medications produce weight loss even without significant dietary changes due to their powerful appetite suppression effects. However, clinical trials combined the medications with reduced calorie intake (500-calorie deficit) and moderate physical activity (150 minutes weekly). People who combine medication with healthier eating patterns and increased activity typically see better results and establish sustainable habits for long-term weight maintenance.

Making Your Final Decision

Both Zepbound and Wegovy represent major advances in obesity treatment, producing weight loss results that seemed impossible just a few years ago. Zepbound shows higher average weight loss in clinical trials, making it the more powerful option if you’re prioritizing maximum results. Wegovy delivers excellent outcomes at a lower price point, making it more accessible for long-term use.

The right choice depends on your individual situation. Consider your weight loss goals, budget for ongoing treatment, tolerance for potential side effects, and what your insurance covers. Both medications work remarkably well when used consistently with appropriate medical oversight.

TrimRx offers compounded tirzepatide at $349 monthly and compounded semaglutide at $199 monthly, providing affordable access to these medications with comprehensive support throughout your weight loss journey. Get started with a simple online consultation and begin working toward the results you’ve been seeking.