Wegovy vs Zepbound: Weight Loss, Side Effects and Cost Compared

Wegovy and Zepbound are the two leading prescription injections approved by the FDA for chronic weight management. Wegovy is semaglutide; Zepbound is tirzepatide. In SURMOUNT-5, the only randomized trial to compare them directly, people on Zepbound lost an average of 20.2% of their body weight over 72 weeks and people on Wegovy lost 13.7%. Wegovy answers with a wider label: it is approved to lower the risk of heart attack and stroke, for teenagers 12 and older, and for the liver disease MASH, and since 2026 it comes in a higher 7.2 mg dose and as a daily pill. Zepbound is the one approved for obstructive sleep apnea.

Which is "better" depends on what you are treating, what your plan covers and what you can tolerate. Below is the evidence, the label differences and the October 2026 prices, so you can have a specific conversation with your prescriber.

Wegovy vs Zepbound at a glance

	Wegovy	Zepbound
Active ingredient	Semaglutide (GLP-1 agonist)	Tirzepatide (GIP and GLP-1 agonist)
Maker	Novo Nordisk	Eli Lilly
Weight management	Adults with obesity, adults with overweight plus a weight-related condition, and children 12 and older with obesity	Adults with obesity, or with overweight plus a weight-related condition
Other FDA-approved uses	Lowering risk of major cardiovascular events in adults with established cardiovascular disease and obesity or overweight; MASH with moderate to advanced liver fibrosis (accelerated approval)	Moderate to severe obstructive sleep apnea in adults with obesity
Forms	Weekly injection; once-daily tablet	Weekly injection (single-dose pen, vial, four-dose KwikPen)
Maintenance dose	2.4 mg weekly (or 1.7 mg); up to 7.2 mg weekly for adults who need more; tablets 25 mg daily	5 mg, 10 mg or 15 mg weekly
Average weight loss, head to head	13.7% at 72 weeks	20.2% at 72 weeks
Manufacturer self-pay price	$199 to $399 a month (injection); $149 to $299 (tablets)	$299 to $449 a month with timely refills
Medicare GLP-1 Bridge ($50 copay)	Covered, injection and tablets	Covered, KwikPen only

Which causes more weight loss

The head-to-head trial

SURMOUNT-5 enrolled 751 adults with obesity, or overweight with a weight-related condition, and without type 2 diabetes. Each was assigned to the maximum dose they could tolerate of Zepbound (10 or 15 mg) or Wegovy (1.7 or 2.4 mg) for 72 weeks, alongside diet and activity counseling. The results were published in the New England Journal of Medicine in 2025.

Result at 72 weeks	Wegovy	Zepbound
Average weight change	-13.7%	-20.2%
Average pounds lost	33.1 lb (15.0 kg)	50.3 lb (22.8 kg)
Waist circumference	-13.0 cm (about 5.1 in)	-18.4 cm (about 7.2 in)
Lost at least 25% of body weight	16.1%	31.6%

Two caveats. Eli Lilly paid for the study, and it was open-label, meaning participants knew which drug they were injecting. Neither point erases a difference this large, but both are worth knowing.

What the higher Wegovy dose changes

SURMOUNT-5 tested Wegovy at 2.4 mg, its top dose at the time. On March 19, 2026, the FDA approved a 7.2 mg dose, sold as Wegovy HD, for adults who have tolerated 2.4 mg for at least four weeks and need additional weight reduction. In the STEP UP trial, average weight loss at 72 weeks was 18.7% on 7.2 mg, compared with 15.6% on 2.4 mg and 3.9% on placebo. That puts high-dose Wegovy close to Zepbound's range on paper. The two have not been tested against each other, and the higher dose brought more side effects, including a skin-sensitivity reaction discussed below.

Each drug against placebo

Drug and dose	Trial	Average weight change	Lost 5% or more	Lost 15% or more
Wegovy 2.4 mg	STEP 1, 68 weeks	-14.9%	83.5%	47.9%
Zepbound 5 mg	SURMOUNT-1, 72 weeks	-15.0%	85.1%	48.0%
Zepbound 10 mg	SURMOUNT-1, 72 weeks	-19.5%	88.9%	66.6%
Zepbound 15 mg	SURMOUNT-1, 72 weeks	-20.9%	90.9%	70.6%

Figures are from the FDA labels. One detail stands out: Zepbound's lowest maintenance dose, 5 mg, performed about as well as Wegovy 2.4 mg in their separate trials. A meaningful minority on either drug loses less than 5%, and nobody can tell you in advance which group you will be in.

Approved uses: where the labels differ

Weight is not the only reason these drugs are prescribed, and the differences can decide both the medical choice and the insurance approval.

• Heart disease. In the SELECT trial of 17,604 adults with established cardiovascular disease and overweight or obesity but no diabetes, Wegovy lowered the rate of heart attack, stroke or cardiovascular death from 8.0% to 6.5% (hazard ratio 0.80). That indication is on Wegovy's label. Zepbound has no cardiovascular indication. Tirzepatide's cardiovascular approval sits on the Mounjaro label and applies to adults with type 2 diabetes.
• Sleep apnea. Zepbound is approved to treat moderate to severe obstructive sleep apnea in adults with obesity, at 10 or 15 mg. In the SURMOUNT-OSA trials, breathing interruptions fell by about 25 to 29 events per hour on tirzepatide and about 5 on placebo. Wegovy has no sleep apnea indication.
• Liver disease. Wegovy injection has accelerated approval for noncirrhotic MASH with moderate to advanced fibrosis in adults. Zepbound does not.
• Teenagers. Wegovy injection is approved for weight management from age 12. Zepbound's label says its safety and effectiveness have not been established in pediatric patients.

These indications matter for coverage. Medicare Part D, for example, can cover Wegovy for cardiovascular risk reduction and Zepbound for sleep apnea under the regular drug benefit, separate from any weight-management program.

Side effects of Wegovy vs Zepbound

Both drugs most often cause stomach and bowel symptoms, concentrated in the weeks after each dose increase. Rates below are from each label's placebo-controlled weight-management trials.

Side effect	Wegovy 2.4 mg	Zepbound 5 mg	Zepbound 10 mg	Zepbound 15 mg
Nausea	44%	25%	29%	28%
Diarrhea	30%	19%	21%	23%
Vomiting	24%	8%	11%	13%
Constipation	24%	17%	14%	11%
Abdominal pain	20%	9%	9%	10%
Headache	14%	not in the common list	not in the common list	not in the common list
Fatigue	11%	5%	6%	7%
Injection-site reactions	not in the common list	6%	8%	8%
Hair loss	3%	5%	4%	5%

The numbers come from different studies with different placebo groups, so they do not prove Zepbound is easier on the stomach. In SURMOUNT-5, gastrointestinal problems were the most common adverse events with both drugs and were mostly mild to moderate.

With Wegovy HD 7.2 mg, the label reports nausea in 39%, vomiting in 22%, and dysesthesia, an unpleasant tingling, burning or sensitive-skin sensation, in 22%, compared with 6% on 2.4 mg.

Wegovy's label includes a warning about increased resting heart rate. Zepbound's label carries the oral-contraceptive advice described below.

Serious warnings for both

Each label has a boxed warning about thyroid C-cell tumors seen in rodent studies. Do not use either drug if you or a family member has had medullary thyroid carcinoma or if you have MEN 2. Both also warn about pancreatitis, gallbladder problems including gallstones, kidney injury from dehydration, severe gastrointestinal reactions, serious allergic reactions, low blood sugar in people taking insulin or a sulfonylurea, vision changes in people with type 2 diabetes, and aspiration during anesthesia.

Call your prescriber for vomiting or diarrhea that will not stop or signs of dehydration. Go to an emergency room or call 911 for severe, persistent abdominal pain, trouble breathing, or swelling of the face, lips, tongue or throat.

Pregnancy and birth control

Neither drug should be used during pregnancy; weight loss offers no benefit to a pregnant patient and may harm the fetus. Wegovy's label says to stop at least two months before a planned pregnancy because semaglutide stays in the body for weeks. Zepbound's label says to stop when pregnancy is recognized and, separately, advises people on birth control pills to switch to a non-oral method or add a barrier method for four weeks after starting and after each dose increase.

Dosing schedules

Weeks	Wegovy injection	Zepbound
1 to 4	0.25 mg	2.5 mg
5 to 8	0.5 mg	5 mg
9 to 12	1 mg	Stay at 5 mg or go to 7.5 mg
13 to 16	1.7 mg	Stay, or go to 10 mg
17 onward	2.4 mg (1.7 mg is an alternative)	Stay, or go to 12.5 mg and then 15 mg
Optional higher dose	7.2 mg after at least 4 weeks on 2.4 mg	None above 15 mg

Wegovy follows a fixed ladder toward 2.4 mg. Zepbound gives more room to settle: 5 mg, 10 mg and 15 mg are all recommended maintenance doses, and each 2.5 mg step must be held for at least four weeks. If a Wegovy step is hard to tolerate, the label suggests delaying the next increase by four weeks.

Missed doses. Wegovy: take it as soon as possible if your next dose is more than two days away; if two or more doses in a row are missed, the label says to restart escalation at a lower dose. Zepbound: take it within four days of the missed dose, otherwise skip it.

Devices. Wegovy's standard pen is a single-dose auto-injector with a hidden needle; a four-dose FlexTouch pen exists for 2.4 mg. Zepbound comes as single-dose auto-injector pens, as vials you draw up with a syringe, and as the four-dose KwikPen introduced in 2026.

Storage. Both belong in the refrigerator. Wegovy's instructions allow up to 28 days between 46°F and 86°F if needed; Zepbound single-dose pens and vials allow up to 21 days at up to 86°F. Neither may be frozen.

The pill option

Wegovy tablets, approved in December 2025, are taken once a day on an empty stomach with up to 4 ounces of water, followed by a 30-minute wait before eating, drinking or taking other medicines. The dose steps from 1.5 mg to 4, 9 and then 25 mg at 30-day intervals. In the OASIS 4 trial, average weight loss at 64 weeks was 13.6% versus 2.2% on placebo. Zepbound has no tablet; Lilly's weight-loss pill is a different drug, compared in Foundayo vs the Wegovy pill.

Zepbound vs Wegovy cost

All prices below were checked on the manufacturers' sites on October 14, 2026. Introductory offers and savings cards carry end dates; confirm before you fill.

	Wegovy	Zepbound
List price per month	$1,349	$1,086.37 for pens; $499 and up for self-pay presentations
Self-pay, starter doses	$199 a month for the first two fills of 0.25 mg or 0.5 mg (new patients, through December 31, 2026)	$299 (2.5 mg)
Self-pay, next step	$349 for 0.25 mg through 2.4 mg after the intro fills	$399 (5 mg)
Self-pay, higher doses	$349 for 2.4 mg; $399 for Wegovy HD 7.2 mg	$449 for 7.5 to 15 mg if you refill within 45 days; otherwise $499 (7.5 mg) and $699 (10, 12.5, 15 mg)
Tablets	$149 (1.5 mg), $199 (4 mg), $299 (9 and 25 mg)	No tablet form
Commercial insurance that covers it, with savings card	As little as $25 a month, maximum savings $100 a month	As little as $25 for a 1- to 3-month fill of single-dose pens; savings capped monthly and at $1,300 a year; card expires December 31, 2026
Commercial insurance that does not cover it	Self-pay prices	Self-pay prices; $499 a month for single-dose pens with the savings card

A worked example for a cash-paying adult at a typical maintenance dose, counting 12 monthly fills: Wegovy 2.4 mg at $349 is $4,188. Zepbound 10 mg at $449 with on-time refills is $5,388, and $8,388 at the regular $699 price if refills lapse. Wegovy tablets at 25 mg are $3,588. Injection fills cover four weeks, so a full calendar year takes 13 of them. The 45-day refill rule is the detail most people miss with Zepbound: a late refill moves you to the higher price.

The government's TrumpRx.gov site lists the same manufacturer cash offers, starting at $199 a month for the Wegovy pen and $299 for Zepbound. It is a price-comparison portal, not a pharmacy.

Insurance and Medicare

• Employer and marketplace plans vary. Many exclude weight-loss drugs or require prior authorization with a documented BMI and a period of lifestyle treatment. Some formularies cover only one of the two, which often settles the question.
• Medicare. From July 1, 2026 through December 31, 2027, the Medicare GLP-1 Bridge lets eligible people with Part D get Wegovy (injection or tablets), the Zepbound KwikPen or Foundayo for a $50 monthly copay. You must be 18 or older and have a BMI of 35 or higher; or a BMI of 30 or higher with diastolic heart failure, uncontrolled high blood pressure or stage 3a or higher chronic kidney disease; or a BMI of 27 or higher with prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease. Your provider must submit prior authorization. People with type 2 diabetes, moderate to severe sleep apnea or fatty liver disease are directed to their regular Part D plan instead. The copay does not count toward your Part D deductible or out-of-pocket limit.
• Medicaid coverage for weight management differs by state.

More scenarios, including Ozempic, Mounjaro and compounded products, are in GLP-1 cost without insurance.

Switching between Wegovy and Zepbound

People switch for three main reasons: a plateau, side effects, or an insurance change. There is no FDA-approved dose conversion between the two. In practice, prescribers start the new drug one week after the last dose of the old one and choose a starting dose based on what you were taking and how you tolerated it, often a low dose with a quicker review. Starting too high after a gap risks a rough return of nausea and vomiting.

Will you gain weight switching from Zepbound to Wegovy? Not necessarily, but it is possible. On average Wegovy 2.4 mg produces less weight loss than Zepbound 10 or 15 mg, so some people see a partial regain or a stall after moving in that direction. No randomized trial has measured this switch directly. If the change is forced by insurance, ask your prescriber about a timeline for reassessing and whether the 7.2 mg dose is appropriate for you. The step-by-step version is in switching between semaglutide and tirzepatide.

Mounjaro vs Wegovy: a common mix-up

Mounjaro is Zepbound's diabetes-labeled twin: the same tirzepatide, the same doses, approved for type 2 diabetes instead of weight management. So "Mounjaro vs Wegovy for weight loss" is, pharmacologically, the same comparison as Zepbound vs Wegovy. The practical difference is coverage. Insurers generally approve Mounjaro only with a type 2 diabetes diagnosis and Wegovy for weight management or cardiovascular risk. If you have type 2 diabetes and obesity, either molecule may be reasonable, and your plan's formulary will often point the way. See Mounjaro vs Zepbound and Ozempic vs Wegovy for how the twins differ.

Is Wegovy or Zepbound better for you?

Online forums are full of people who did well on one after failing the other, in both directions. That fits the data: averages favor Zepbound for weight loss, and individual responses scatter around those averages. A fair way to frame the decision:

• Maximum average weight loss is the priority: Zepbound has the strongest head-to-head evidence.
• You have had a heart attack or stroke, or have known cardiovascular disease: Wegovy has outcome data and an FDA indication in people without diabetes.
• You have moderate to severe sleep apnea with obesity: Zepbound is approved for it.
• You have MASH with fibrosis: Wegovy is approved for it.
• The patient is 12 to 17: Wegovy.
• You do not want injections: Wegovy tablets, or Foundayo.
• You pay cash: Wegovy is cheaper at maintenance doses as of October 2026.
• You are on Medicare: both can be $50 a month through the Bridge if you qualify, with Zepbound limited to the KwikPen.
• You take birth control pills: Zepbound requires backup contraception around dose changes.

Whichever you start, plan for the long run. In the STEP 1 extension, participants regained about two-thirds of their lost weight within a year of stopping semaglutide. In SURMOUNT-4, people who stayed on tirzepatide kept losing while those switched to placebo regained 14% of their body weight over the following year. For a wider look that includes the pills, see the best GLP-1 for weight loss, and for the diabetes-labeled pair, Ozempic vs Mounjaro.