GLP-1 comparison
Zepbound vs Wegovy
The two FDA-approved once-weekly injections for chronic weight management. One produced more average weight loss in trials. The other has proven cardiovascular protection. Which one wins depends on you.
Zepbound
Tirzepatide — biggest average loss
~20% average weight loss at the highest dose. Also approved for obstructive sleep apnea. Cardiovascular outcomes trial still ongoing.
Wegovy
Semaglutide — proven CV benefit
~15% average weight loss. FDA-labelled to reduce major cardiovascular events (SELECT trial). Longer safety record for the class.
Side by side
Zepbound
Tirzepatide, Eli Lilly
Wegovy
Semaglutide, Novo Nordisk
Highlighted cells indicate the clearer choice on that row. Sourced from FDA prescribing information and the SURMOUNT, STEP, and SELECT pivotal trials — see references below.
How much would you lose on each?
Project your expected weight loss on tirzepatide or semaglutide from your own starting weight.
Which one is right for you?
Weight loss is the primary goal
SURMOUNT-5 favored Zepbound (tirzepatide) by ~6.5 percentage points on average weight loss versus Wegovy. If maximum average weight loss matters most, this is where the evidence points.
You have established cardiovascular disease
Wegovy has SELECT trial evidence for a 20% reduction in major cardiovascular events and an FDA label to match. That is a real, patient-oriented outcome that tirzepatide has not yet demonstrated.
You have moderate-to-severe sleep apnea
Zepbound is now FDA-approved for OSA in adults with obesity — the only GLP-1 with that indication. It may enable insurance coverage where weight-loss alone would not.
Cost is decisive
Zepbound's list price is currently lower ($1,060 vs $1,350). Manufacturer savings cards and direct-from-Lilly / Wegovy pen options can shift the calculus. Confirm your out-of-pocket before you commit.
Related in your GLP-1 journey
Full GLP-1 hub →Frequently Asked Questions
Common questions and answers about this calculator.
What's the biggest difference between Zepbound and Wegovy?
Zepbound is tirzepatide (a dual GIP + GLP-1 receptor agonist made by Eli Lilly) and Wegovy is semaglutide (a GLP-1 receptor agonist made by Novo Nordisk). Both are FDA-approved for chronic weight management in adults with obesity or overweight plus a weight-related condition. In trials Zepbound produced greater average weight loss, while Wegovy has the stronger cardiovascular outcomes evidence from the SELECT trial.
Which produces more weight loss on average?
In the SURMOUNT-5 head-to-head trial in adults with obesity, tirzepatide (Zepbound) produced about 20.2% weight loss versus 13.7% for semaglutide 2.4 mg (Wegovy) over 72 weeks. This is consistent with each drug's flagship monotherapy trial: SURMOUNT-1 showed ~20.9% for Zepbound at 15 mg, and STEP 1 showed ~14.9% for Wegovy at 2.4 mg.
Do they cost the same?
US list prices differ: Zepbound lists around $1,060 for a 28-day supply and Wegovy around $1,350. Actual out-of-pocket cost is driven by insurance coverage and manufacturer savings cards. Both have direct-from-manufacturer options (Lilly LingoDirect and Wegovy pens through Novo Nordisk) that can lower costs for uninsured patients.
Which has better cardiovascular evidence?
Semaglutide (Wegovy) has the SELECT trial, published in 2023, which showed a 20% relative reduction in major cardiovascular events in adults with established cardiovascular disease and obesity but no diabetes. That is what expanded Wegovy's FDA label to include reducing MACE. Tirzepatide's dedicated cardiovascular outcomes trial (SURMOUNT-MMO) is still ongoing, so at present Wegovy has the more mature CV evidence base.
What about side effects — are they different?
Both are dominated by gastrointestinal side effects during titration: nausea, diarrhea, constipation, vomiting. Rates are broadly similar between the two in trials. Both carry an FDA boxed warning for the risk of thyroid C-cell tumors and are contraindicated in people with a personal or family history of medullary thyroid carcinoma or MEN 2. Side-effect intensity typically peaks during dose escalation and eases at maintenance.
Can either treat sleep apnea?
Yes — Zepbound. In December 2024 the FDA approved Zepbound for moderate-to-severe obstructive sleep apnea in adults with obesity, based on the SURMOUNT-OSA trial. Wegovy is not approved for OSA at this time.
Sources
- Zepbound (tirzepatide) Prescribing InformationU.S. Food & Drug Administration (FDA). 2024.
- Wegovy (semaglutide) Prescribing InformationU.S. Food & Drug Administration (FDA). 2023.
- Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1)Jastreboff AM, Aronne LJ, Ahmad NN, et al. N Engl J Med. 2022;387(3):205–216. doi:10.1056/NEJMoa2206038
- Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1)Wilding JPH, Batterham RL, Calanna S, et al. N Engl J Med. 2021;384(11):989–1002. doi:10.1056/NEJMoa2032183
- Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT)Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. N Engl J Med. 2023;389(24):2221–2232. doi:10.1056/NEJMoa2307563
Tool Information
August 5, 2026
Dr. Jaydeep Sanghani
Meet Akabari
Dr. Jaydeep Sanghani
MBBS, MD, DNB(Anaesth.), PDCC(CCM), DrNB(CCM)
AIIMS Bhubaneswar · AIIMS Rishikesh
Critical care specialist and anesthesiologist with advanced training from AIIMS. Reviews health calculators at Calqulate to ensure medical accuracy and evidence-based standards.