Zepbound vs Wegovy: Head-to-Head Results, Side Effects
Zepbound (tirzepatide) and Wegovy (semaglutide) are both GLP-1 medicines, weekly injection versus weekly injection or daily tablet. They were tested against each other in SURMOUNT-5. Self-pay starts at $299 per month for Zepbound and $149 per month for Wegovy.
- Tested head to head
- SURMOUNT-5
A quick look at Zepbound and Wegovy
How Zepbound and Wegovy compare
| Zepbound | Wegovy | |
|---|---|---|
| Medicine | Zepbound |  Wegovy |
| Active ingredient | tirzepatide | semaglutide |
| Manufacturer | Eli Lilly | Novo Nordisk |
| How it is taken | Weekly injection | Weekly injection or daily tablet |
| Approved for | Weight loss and sleep apnea | Weight loss, heart risk and MASH liver disease |
| First FDA approval | 2023 | 2021 |
| Average weight loss in trials | 20.9% (SURMOUNT-1, 72 weeks) | 14.9% (STEP 1, 68 weeks) |
| Most common side effect | Nausea 29% vs 8% on placebo | Nausea 44% vs 16% on placebo |
| List price | $499 to $1,086 per fill | $1,349.02 per month |
| Self-pay from | $299 per month | $149 per month |
| Medicare GLP-1 Bridge | $50 per month, eligible Part D | $50 per month, eligible Part D |
| FDA shortage | Resolved December 19, 2024 | Resolved February 21, 2025 |
Sources: FDA label, FDA label (DailyMed), pricinginfo.lilly.com, TrumpRx.
A head-to-head test of weight loss
SURMOUNT-5 put one group on Zepbound and another on Wegovy, so the numbers compare directly.
| Trial | Who took part | Length | Group | Average weight loss |
|---|---|---|---|---|
| SURMOUNT-5 | Adults with obesity, without type 2 diabetes | 72 weeks | Tirzepatide 10 or 15 mg weekly (Zepbound) | 20.2% |
| SURMOUNT-5 | Adults with obesity, without type 2 diabetes | 72 weeks | Semaglutide 1.7 or 2.4 mg weekly (Wegovy) | 13.7% |
Trial sources: SURMOUNT-5 (PubMed).
Side effects compared
Each drug's own placebo was the control for a separate group in its label, so compare each one with its placebo first
| Side effect | Zepbound | Placebo (Zepbound trials) | Wegovy | Placebo (Wegovy trials) |
|---|---|---|---|---|
| Nausea | 29% | 8% | 44% | 16% |
| Diarrhea | 23% | 8% | 30% | 16% |
| Constipation | 17% | 5% | 24% | 11% |
| Vomiting | 13% | 2% | 24% | 6% |
| Abdominal Pain | 10% | 5% | 20% | 10% |
| Dyspepsia | 10% | 4% | 9% | 3% |
| Injection Site Reactions | 8% | 2% | Not listed | Not listed |
| Fatigue | 7% | 3% | 11% | 5% |
| Headache | Not listed | Not listed | 14% | 10% |
Price and coverage compared
| Medicine | How you pay | Price |
|---|---|---|
| Zepbound | List price before insurance | $499 to $1,086 per fill |
| Zepbound | Zepbound Savings Program (insured) | from $25 for up to a 3-month fill |
| Zepbound | Commercial plan that does not cover it | $299 per month |
| Zepbound | Self-pay: LillyDirect vial or KwikPen 2.5 mg | $299 per month |
| Zepbound | Self-pay: LillyDirect vial or KwikPen 5 mg | $399 per month |
| Zepbound | Self-pay: LillyDirect doses of 7.5 mg to 15 mg, when you refill within 45 days | $449 per month |
| Zepbound | Self-pay: the regular price if you do not refill within 45 days | each month costs $499 ($7.5 mg) or $699 ($10 to $15 mg) |
| Zepbound | Self-pay via TrumpRx | $299 per month |
| Zepbound | Medicare GLP-1 Bridge (Zepbound KwikPen, eligible Part D) | $50 per month |
| Wegovy | List price before insurance | $1,349.02 per month |
| Wegovy | Wegovy Savings Offer (insured) | from $25 per month |
| Wegovy | Self-pay: Wegovy pill 1.5 mg | $149 per month |
| Wegovy | Self-pay: Wegovy pill 4 mg | $199 per month |
| Wegovy | Self-pay: Wegovy pill 9 mg and 25 mg | $299 per month |
| Wegovy | Self-pay: The Wegovy pen intro covers the first 2 fills with 0.25 mg and 0.5 mg doses | $199 per month |
| Wegovy | Self-pay: Wegovy pen 0.25 mg to 2.4 mg | $349 per month |
| Wegovy | Self-pay: Wegovy HD 7.2 mg pen | $399 per month |
| Wegovy | Self-pay via TrumpRx | $149 per month |
| Wegovy | Medicare GLP-1 Bridge (Wegovy, eligible Part D) | $50 per month |
Prices checked November 2026 (8)
pricinginfo.lilly.com, zepbound.lilly.com, Eli Lilly, TrumpRx 1 2, CMS, NovoCare 1 2.
Who should pick which?
- Zepbound has approval to treat sleep apnea.
- For MASH liver disease, Wegovy is approved as a treatment.
- Wegovy is approved to reduce the risk of heart attack and stroke.
- Approval for Wegovy covers some children under 18
- If you pay cash, Wegovy begins at a lower price of $149 per month.
Your prescriber looks at your health history, the other medicines you take, and your coverage.