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Wegovy or Zepbound?

Different molecule, different approvals, same weekly shot. Here's what the head-to-head trial actually found — weight loss, side effects, approvals, cost.

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THE SHORT ANSWER

In the SURMOUNT-5 head-to-head trial, Zepbound (tirzepatide) produced 20.2% average weight loss at 72 weeks, versus 13.7% for Wegovy (semaglutide). But Wegovy carries FDA approvals Zepbound doesn't — cardiovascular risk reduction and MASH — and now comes as a pill too.

Per SURMOUNT-5 head-to-head trial results, Eli Lilly. Not medical advice — individual response varies; talk to your prescriber before switching.

SEC. 01

Side by side

Feature
Wegovy
Zepbound
Active ingredient
SEMAGLUTIDE (GLP-1 ONLY)
TIRZEPATIDE (DUAL GIP/GLP-1)
Manufacturer
NOVO NORDISK
ELI LILLY
FDA-approved for
WEIGHT MGMT · CV RISK REDUCTION · MASH
WEIGHT MGMT · SLEEP APNEA (OSA)
Injection frequency
ONCE WEEKLY
ONCE WEEKLY
Maintenance dose
2.4 MG
5, 10, OR 15 MG
Oral pill available
YES (25MG, FDA-APPROVED DEC 2025)
NOT YET APPROVED
Self-pay, no insurance (approx.)
~$349–$1,349/MO
~$299–$449/MO

Per official prescribing information and manufacturer pricing pages · not medical advice — confirm current pricing with your prescriber and pharmacy

SEC. 02

What the trial found

Outcome (72 weeks)
Result
Wegovy — average weight loss
13.7%
Zepbound — average weight loss
20.2%
Wegovy — nausea reported
~24%
Zepbound — nausea reported
~44%
Wegovy — vomiting reported
~12%
Zepbound — vomiting reported
~24%

SURMOUNT-5 was the first head-to-head trial directly comparing tirzepatide (Zepbound) and semaglutide (Wegovy) for weight management. Zepbound produced greater average weight loss, but also more frequent GI side effects. Individual results vary.

SEC. 03

Which one fits you?

W—01

Cardiovascular risk

Wegovy has an FDA approval specifically for reducing cardiovascular risk — Zepbound doesn't yet.

W—02

Sleep apnea

Zepbound has an FDA approval for moderate-to-severe obstructive sleep apnea — Wegovy doesn't.

W—03

Want a pill option

Wegovy now comes as an oral pill (25mg). No FDA-approved tirzepatide pill exists yet.

W—04

Maximize average weight loss

Zepbound showed a larger average weight loss in the head-to-head trial, though results vary by person.

W—05

Sensitive to GI side effects

Wegovy had a lower rate of nausea and vomiting than Zepbound in the head-to-head trial.

W—06

Already on one of them

Switching is a conversation for your prescriber, not a decision to make solo.

SEC. 04

Q & A

Which causes worse nausea, Wegovy or Zepbound?Q—01 +
In the SURMOUNT-5 head-to-head trial, nausea was more common with Zepbound (about 44%) than Wegovy (about 24%); vomiting was about 24% versus 12%.
Is Zepbound always the better choice since it produced more weight loss?Q—02 +
Not necessarily. Zepbound showed a larger average weight loss in the head-to-head trial, but Wegovy has FDA approvals Zepbound doesn't yet have — cardiovascular risk reduction and MASH — and is available as a pill. The right choice depends on your health history and goals.
Can I switch from Wegovy to Zepbound or vice versa?Q—03 +
Yes, under a prescriber's supervision. There's no single switching protocol — your prescriber will factor in your current dose, tolerability, and reason for switching.
Does Zepbound have an FDA approval Wegovy doesn't?Q—04 +
Yes — Zepbound is FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity, an approval Wegovy doesn't currently have.
Is there a Zepbound pill like the Wegovy pill?Q—05 +
Not yet. As of the Wegovy pill's December 2025 approval, there was no FDA-approved oral tirzepatide (Zepbound) product on the market.

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