Ozempic vs Wegovy vs Mounjaro vs Zepbound: how to compare GLP‑1 medications

Introduction

Ozempic and Wegovy contain semaglutide; Mounjaro and Zepbound contain tirzepatide. Ozempic and Mounjaro are approved for type 2 diabetes. Wegovy and Zepbound are approved for weight management in eligible patients, with additional uses that differ by product and formulation. Their brands, doses, and indications are not interchangeable. [1] [2] [3] [4]

This comparison uses U.S. prescribing information checked on October 5, 2026. Your prescriber should consider your medical history, treatment goals, side effects, and access when helping you choose.

Approved uses and formulations

Semaglutide activates the GLP‑1 receptor. Tirzepatide activates both GIP and GLP‑1 receptors. Both affect appetite and blood glucose, but the number of receptors does not predict an individual’s response. [1] [3]

Wegovy’s weight-management indication covers adults with obesity, or overweight with a weight-related condition. Injection also covers children age 12 and older with obesity. Its cardiovascular indication covers adults with established cardiovascular disease and overweight or obesity. Injection has accelerated approval for adults with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and moderate to advanced liver fibrosis, stages F2 to F3. Oral Wegovy is approved for adults, not for MASH. [2]

Starting and maintenance doses differ

The following are adult doses, not instructions for changing treatment:

• Ozempic: Starts at 0.25 mg weekly. Blood glucose maintenance doses are 0.5, 1, or 2 mg weekly; the starting dose is not a maintenance dose. [1]
• Wegovy injection: Starts at 0.25 mg weekly. For adult weight management, maintenance is 1.7 or 2.4 mg weekly, with 2.4 mg recommended. The prescriber may increase to 7.2 mg after at least four weeks tolerating 2.4 mg if further weight reduction is clinically indicated. [2]
• Wegovy tablets: Start at 1.5 mg daily and escalate to 25 mg daily. Oral and injection doses are not equivalent milligram for milligram. [2]
• Mounjaro: Starts at 2.5 mg weekly, with further increases based on need and the labeled schedule; the adult maximum is 15 mg weekly. [3]
• Zepbound: Starts at 2.5 mg weekly. Weight-management maintenance doses are 5, 10, or 15 mg weekly; sleep-apnea maintenance doses are 10 or 15 mg weekly. [4]

There is no FDA-approved oral tirzepatide product in the current labels. Mounjaro and Zepbound are injections. Lilly’s oral GLP‑1 medicine Foundayo contains orforglipron, a different ingredient. [3] [4] [5] See our oral Wegovy guide and Foundayo guide for those options.

Weight-loss results from clinical trials

These trials studied injections in adults without diabetes. All included dietary and physical-activity support. Results are group averages, not promised outcomes.

STEP 1 and SURMOUNT‑1 were separate placebo-controlled trials. SURMOUNT‑5 directly compared the two medicines, but it did not test semaglutide 7.2 mg or oral formulations. Its results cannot establish which of those newer options works better. [8]

Side effects and practical considerations

Both ingredients can cause nausea, vomiting, diarrhea, and constipation. In SURMOUNT‑1, nausea occurred in 31.0% of participants receiving tirzepatide 15 mg versus 9.5% receiving placebo over 72 weeks. In STEP 1, it occurred in 44.2% receiving semaglutide 2.4 mg versus 17.4% receiving placebo over 68 weeks. These figures come from the adult populations above; comparing separate trials does not establish which drug you will tolerate better. [6] [7]

Discuss these points with your prescriber:

• Medical history: Approved heart, kidney, liver, and sleep-apnea uses may affect the choice. All four products have a boxed warning about thyroid C-cell tumors in rodents and contraindications involving personal or family history of medullary thyroid carcinoma or MEN2. [1] [2] [3] [4]
• Daily routine: Tablets and injections have different administration requirements. Follow the instructions for your specific product.
• Coverage and cost: Check your plan’s formulary, prior-authorization rules, and current pharmacy price. Savings-program eligibility varies; an advertised price may not be your cost. See our GLP‑1 cost guide.

Switching requires an individual plan

A switch may be considered because of response, side effects, access, or delivery preferences. There is no universal FDA dose-conversion schedule between semaglutide and tirzepatide. Your prescriber needs to choose the starting dose, timing after your last dose, and escalation plan using your treatment history and the new product’s instructions. Do not overlap medicines or assume equal milligram doses have equal effects. [1] [2] [3] [4]

Use our switching guide to prepare questions. Severe or persistent abdominal pain, repeated vomiting, or inability to keep fluids down needs prompt medical assessment. Seek emergency help for trouble breathing or swelling of the face or throat. [1] [4]

Keep your treatment history in Shotsy

Shotsy lets you record doses, weight, side effects, and notes across medication changes. Bring those records to appointments so your prescriber can review what happened on each treatment.

Conclusion

Start with the approved use that fits your health needs, then consider tolerability, practical requirements, and access. Trial averages help explain the evidence, but your response and the specific prescription matter. Plan any change with your prescriber.

For related reading, see the first-month guide and GLP‑1 side-effects overview.