Compounded tirzepatide alternatives: 9 options and which are FDA-approved

The medication in brief

Why people look for alternatives

• Higher doses can cost more than Zepbound

  At Temi's lowest listed rate of $12.00 per mg (Belmar 10 mg vial, $119.99), four weekly 10 mg doses come to about $480 of drug, against $449 for Zepbound 10 mg with on-time refills (both checked 5 Oct 2026). Low doses still cost less compounded.

• Providers changed what they offer

  FDA declared the tirzepatide shortage resolved on 19 December 2024 and ended its grace period for 503A pharmacies in March 2025 (FDA compounding policy page). Our post on compounded tirzepatide access rules explains what that means.

• Wanting trial evidence behind the product

  SURMOUNT and SURPASS results describe Zepbound and Mounjaro. No compounded tirzepatide vial has its own trial, and the FDA had over 730 adverse event reports for compounded versions by 31 May 2026.

• Wanting a pill

  Tirzepatide has no approved oral form. The Wegovy pill and Foundayo are FDA-approved daily tablets for weight management, both starting at $149 a month self-pay.

• Side effects or a contraindication

  Tirzepatide carries a thyroid C-cell tumor boxed warning; a personal or family history of MTC, or MEN 2, rules it out (Zepbound label). Non-GLP-1 drugs such as Contrave or Qsymia avoid that warning.

How we compared

Prices checked on October 5, 2026

Alternatives

• Zepbound (tirzepatide vial or KwikPen)

  Kind

  FDA-approved GLP-1

  How it differs

  Lilly's FDA-approved tirzepatide for weight management and obstructive sleep apnea with obesity. Fixed-dose vials or a four-dose KwikPen, made to an approved specification.

  Evidence

  In SURMOUNT-1, adults with obesity or overweight and without diabetes lost an average of 20.9% of body weight on 15 mg over 72 weeks, compared with 3.1% on placebo; 5 mg averaged 15.0% (Zepbound label). In adults with obstructive sleep apnea, the label also reports fewer breathing interruptions per hour. These are averages, not a forecast for one person.

  Starting price

  2.5 mg costs $299 a month and 5 mg $399; 7.5 mg through 15 mg cost $449 if each refill is within 45 days (Zepbound savings page, checked 5 Oct 2026)

  Best for

  Anyone who wants to stay on tirzepatide with an FDA-approved product, especially at 7.5 mg and above

  Tradeoffs

  Costs more than compounded at 2.5 and 5 mg. Late refills raise 7.5 mg to $499 and 10 to 15 mg to $699. Same side effects as any tirzepatide.

• Mounjaro (tirzepatide pen)

  Kind

  FDA-approved GLP-1

  How it differs

  The same molecule as Zepbound, labeled for blood sugar control in adults with type 2 diabetes rather than for weight.

  Evidence

  In SURPASS-2, adults with type 2 diabetes on metformin saw HbA1c fall by 2.0 to 2.3 points on Mounjaro 5 to 15 mg, against 1.9 on semaglutide 1 mg, with weight down 7.6 to 11.2 kg versus 5.7 kg over 40 weeks (Mounjaro label). Trial averages.

  Starting price

  Savings card price as low as $499 for a 28-day fill, only for people with commercial coverage that excludes Mounjaro (Mounjaro savings page, checked 5 Oct 2026)

  Best for

  Adults with type 2 diabetes who were using compounded tirzepatide and have commercial insurance

  Tradeoffs

  The card price needs commercial insurance. For weight without diabetes, Zepbound is the labeled product and usually cheaper for cash.

• Wegovy pen and Wegovy HD (semaglutide)

  Kind

  FDA-approved GLP-1

  How it differs

  A GLP-1-only agonist, injected weekly at 2.4 mg or 7.2 mg (Wegovy HD). FDA-approved for weight management and cardiovascular risk reduction.

  Evidence

  STEP 1 on the Wegovy label: people on 2.4 mg averaged a 14.9% loss after 68 weeks, compared with 2.4% for placebo. The label also covers lowering major cardiovascular events in adults with established heart disease and overweight. Averages from trials; individual results vary.

  Starting price

  New patients pay $199 for two fills of 0.25 or 0.5 mg, then $349 a month up to 2.4 mg, or $399 for HD (NovoCare Wegovy price page, checked 5 Oct 2026)

  Best for

  People with heart disease, or those who want an approved weekly injection at a price close to Zepbound's

  Tradeoffs

  Lower average loss on its label than tirzepatide 10 to 15 mg. Switching molecules means a new escalation.

• Wegovy pill (semaglutide 25 mg)

  Kind

  FDA-approved GLP-1

  How it differs

  Oral semaglutide approved for weight management, taken once daily on an empty stomach. FDA-approved.

  Evidence

  Over 64 weeks in OASIS 4, the 25 mg tablet produced an average 13.6% fall in body weight versus 2.4% with placebo, and 47% of people taking it lost 15% or more (Wegovy label). These figures are averages from one trial in adults without diabetes.

  Starting price

  Starts at $149 (1.5 mg); 4 mg is $199, and both 9 mg and 25 mg are $299 a month (NovoCare Wegovy price page, checked 5 Oct 2026)

  Best for

  People ready to stop injecting who want an approved oral GLP-1 with label trial data

  Tradeoffs

  Smaller average loss than tirzepatide at top doses. Morning fasting rule: up to 4 oz of water, then 30 minutes before anything else.

• Foundayo (orforglipron)

  Kind

  FDA-approved GLP-1

  How it differs

  A daily small-molecule GLP-1 tablet from Lilly, approved for weight management in April 2026. No fasting rule.

  Evidence

  In the 72-week trial without diabetes on the Foundayo label, the 17.2 mg dose produced 11.1% average weight loss against 2.1% for placebo, and in adults with type 2 diabetes 9.6% against 2.5%. There is no head-to-head trial with tirzepatide on the label.

  Starting price

  Both 0.8 mg and, through 31 Dec 2026, 2.5 mg are $149 per 30 days self-pay (Foundayo savings page, checked 5 Oct 2026)

  Best for

  People who want an approved pill they can take with breakfast and a lower entry price

  Tradeoffs

  Average loss is roughly half of tirzepatide 15 mg's in SURMOUNT-1. Higher doses cost $299 to $349. Temi can prescribe it; LillyDirect dispenses.

• Compounded semaglutide injection

  Kind

  compounded (not FDA-approved)

  How it differs

  Semaglutide prepared by a 503A pharmacy in a multi-dose vial. A different molecule from tirzepatide, and also not FDA-approved.

  Evidence

  No compounded semaglutide product has trial data of its own; the FDA lists 990 adverse event reports for compounded semaglutide through 31 May 2026 and warns that multi-dose vials should be discarded 28 days after first use (FDA, updated 1 Oct 2026). Semaglutide's shortage was declared over in February 2025.

  Starting price

  $59.99 buys a 7.5 mg vial ($8.00 per mg) in California; Temi adds $39 per order (Temi compounded semaglutide page, checked 5 Oct 2026)

  Best for

  Cash payers who want the lowest-cost GLP-1 route and accept a non-FDA-approved product

  Tradeoffs

  Not FDA-approved. Semaglutide's label averages are lower than tirzepatide's. Dose conversion between the two molecules is not one-to-one.

• Qsymia (phentermine and topiramate ER)

  Kind

  FDA-approved other weight-loss drug

  How it differs

  Not a GLP-1. A daily capsule that combines phentermine with topiramate, FDA-approved for chronic weight management. Schedule IV.

  Evidence

  Study 1 on the label enrolled adults with a BMI of 35 or more. At week 56, weight fell 10.9% on the 15 mg/92 mg dose and 5.1% on 3.75 mg/23 mg, versus 1.6% on placebo, and 67% on the top dose lost at least 5% (Qsymia label). Topiramate's risk to a fetus means pregnancy is a contraindication.

  Starting price

  $75 for a 30-day fill with the manufacturer discount at retail or home delivery (Qsymia.com, checked 5 Oct 2026)

  Best for

  Adults who want an approved oral option at a fraction of GLP-1 prices and can use a controlled medicine

  Tradeoffs

  Controlled substance, which Temi does not prescribe. Can cause tingling, altered taste, insomnia and mood changes.

• Contrave (naltrexone and bupropion ER)

  Kind

  FDA-approved other weight-loss drug

  How it differs

  Not a GLP-1. A tablet taken twice daily that targets appetite and craving pathways in the brain. FDA-approved and not controlled.

  Evidence

  COR-I ran 56 weeks: average weight change was -5.4% on Contrave against -1.3% on placebo (Contrave label). About 24% of people on Contrave stopped because of side effects in the trials, against 12% on placebo. It carries a boxed warning about suicidal thoughts.

  Starting price

  $99 a month, shipped free, through the CurAccess program (Contrave.com, checked 5 Oct 2026)

  Best for

  People who need a non-controlled oral option without the GLP-1 thyroid warning

  Tradeoffs

  Much smaller average loss than tirzepatide. Nausea is common. Not for people on opioids or with a seizure history.

• Phentermine (Lomaira or generic)

  Kind

  FDA-approved other weight-loss drug

  How it differs

  Not a GLP-1. An older stimulant-type appetite suppressant approved only for short-term use, a few weeks, alongside diet and exercise. Schedule IV.

  Evidence

  The Lomaira label states that in short-term trials, the extra weight lost on drugs of this type compared with placebo was "only a fraction of a pound a week", with the rate of loss slowing after the first weeks. The label lists pulmonary hypertension and heart valve disease among its warnings.

  Starting price

  Capped at 50 cents a tablet for Lomaira 8 mg through the maker's savings program (lomaira.com, checked 5 Oct 2026)

  Best for

  A short, supervised course where cost is the deciding factor

  Tradeoffs

  Short-term use only on its label. Raises heart rate and blood pressure. Controlled, so Temi does not prescribe it.

Which to choose

Switching