Zepbound vs. Wegovy in 2026: shots, doses, the pill and Wegovy HD
Medically reviewed by Kevin Brandstetter, M.D.Last reviewed September 28, 2026
Zepbound vs Wegovy is tirzepatide against semaglutide, both FDA-approved for chronic weight management. In SURMOUNT-5, Zepbound's molecule averaged 20.2% weight loss at 72 weeks versus 13.7% for Wegovy 2.4 mg. Since then Wegovy has added a 7.2 mg dose (Wegovy HD) and a daily pill, and it holds a heart-risk indication Zepbound lacks.
The basic difference
Zepbound (tirzepatide, Eli Lilly) is a weekly injection that acts on GIP and GLP-1 receptors. It starts at 2.5 mg and rises in 2.5 mg steps every 4 weeks to a maintenance dose of 5, 10 or 15 mg. It comes as single-dose pens, single-dose and multi-dose vials, and a four-dose KwikPen. It is approved for weight management and for moderate to severe obstructive sleep apnea in adults with obesity.
Wegovy (semaglutide, Novo Nordisk) acts on GLP-1 only and now comes in three forms. The weekly shot climbs from 0.25 mg to 2.4 mg over 16 weeks. Wegovy HD is a 7.2 mg weekly dose, approved in March 2026 for adults with obesity who have tolerated 2.4 mg. The Wegovy pill is 25 mg daily, approved in December 2025. Wegovy's label also covers cardiovascular risk reduction, teens from age 12 and, under accelerated approval, the liver disease MASH.
What the head-to-head trial found
SURMOUNT-5 compared Zepbound's molecule with Wegovy 2.4 mg directly. Adults with obesity and no diabetes took the highest dose they could tolerate for 72 weeks. Average weight change was −20.2% on tirzepatide versus −13.7% on semaglutide, a gap of 6.5 points (NEJM 2025). The trial was open-label and funded by Lilly.
Wegovy HD has not been tested against Zepbound. In STEP UP, semaglutide 7.2 mg produced an average loss of 18.8% over 72 weeks when everyone randomized was counted. Among those who stayed on treatment, it was 20.7%. About 31% of participants lost 25% or more, per Novo Nordisk. SURMOUNT-1 reported 20.9% for Zepbound 15 mg over the same 72 weeks. Those trials enrolled different people, so the similar numbers do not prove the two are equal.
The Wegovy pill reached about 14% loss at 64 weeks in OASIS 4 when all participants were counted. The figure was about 17% for those who kept taking it, compared with 2% to 3% on placebo.
Heart data: SELECT found Wegovy 2.4 mg cut major cardiovascular events by 20% in people with heart disease. Zepbound's label carries no cardiovascular indication.
Side effects
The labels list the same core problems: nausea, diarrhea, vomiting, constipation, belly pain, tiredness and hair loss. Rates come from separate placebo-controlled trials. Nausea hit 25% to 29% on Zepbound and 44% on Wegovy 2.4 mg. Stopping treatment because of side effects was 4.8% to 6.7% on Zepbound and 6.8% on Wegovy.
Wegovy HD raised some rates further. Its label reports nausea in 39% and vomiting in 22% on 7.2 mg, versus 35% and 16% on 2.4 mg. Dysesthesia, meaning burning, tingling or sensitive skin, hit 22% on 7.2 mg against 6% on 2.4 mg.
Zepbound has one extra caution: birth-control pills may work less well for 4 weeks after starting and after each dose increase. Both labels warn about pancreatitis, gallbladder problems, kidney injury from dehydration and aspiration during anesthesia. Both carry the rodent thyroid C-cell tumor boxed warning.
Pricing at Temi
| Option | Starting price at Temi |
|---|---|
| Compounded semaglutide injectable | From $59.99 per 7.5 mg vial + $39 prescription service [usetemi.com/medications/compounded-semaglutide-injectable, verified Sep 28, 2026] |
| Compounded tirzepatide injectable | From $104.99 per 8.5 mg vial + $39 prescription service [usetemi.com/medications/compounded-tirzepatide-injectable, verified Sep 28, 2026] |
Which one is right for you?
Zepbound may be the better fit if you want the option with the strongest head-to-head weight result against Wegovy 2.4 mg. It also fits if you have moderate to severe obstructive sleep apnea with obesity, which only Zepbound is approved to treat.
Wegovy may be the better fit if you have established heart disease, where SELECT gives it an approved cardiovascular indication. It is also the only one of the two approved for teens aged 12 and up and for MASH. If you would rather take a pill, the 25 mg Wegovy pill has no Zepbound equivalent.
Wegovy HD is a step for people already doing well on 2.4 mg who need more effect. It is not a starting dose.
Neither fits with a personal or family history of medullary thyroid carcinoma or MEN2, or during pregnancy. Brand prices and coverage change often, so check your plan. At Temi, compounded semaglutide starts at $59.99 per 7.5 mg vial and compounded tirzepatide at $104.99 per 8.5 mg vial, each plus a $39 service fee [usetemi.com/medications/compounded-semaglutide-injectable and /compounded-tirzepatide-injectable, verified Sep 28, 2026]. Compounded drugs are not FDA-approved.
Frequently asked questions
Is Wegovy HD as strong as Zepbound?
It narrows the gap, but no trial has compared them. STEP UP reported 20.7% average loss on Wegovy HD among people who stayed on treatment. SURMOUNT-1 reported 20.9% on Zepbound 15 mg. Those trials had different participants and ways of counting dropouts, so the numbers cannot be read as a tie. Wegovy HD also brought more tingling and burning skin sensations (22%) than the 2.4 mg dose.
Can I switch from Zepbound to Wegovy?
Yes, with a prescription for Wegovy. There is no official dose conversion between tirzepatide and semaglutide. Wegovy's label starts everyone at 0.25 mg weekly and raises the dose every 4 weeks. A prescriber may choose a different starting point based on how you tolerated Zepbound. People usually switch because of cost, coverage, side effects or a new reason such as heart disease.
Is the Wegovy pill as effective as Zepbound?
On current data, no. In OASIS 4, the 25 mg Wegovy pill produced about 14% average loss at 64 weeks, or about 17% among people who kept taking it. Zepbound averaged 15% to 20.9% across its doses in SURMOUNT-1 at 72 weeks. The pill must be taken fasting each morning with up to 4 ounces of water and a 30-minute wait.
Does Zepbound come in vials?
Yes. The Zepbound label lists single-dose vials and multi-dose vials alongside single-dose pens and a KwikPen that holds four weekly doses. Vials require drawing up the dose with a syringe. Wegovy injection comes as single-dose pens, a four-dose FlexTouch pen and single-dose syringes, plus the tablet. Your prescriber and pharmacy can tell you which forms your plan covers.
Which is approved for sleep apnea?
Only Zepbound. Its label covers moderate to severe obstructive sleep apnea in adults with obesity, at 10 mg or 15 mg weekly. Two trials supported it: one in people not using a CPAP-type machine and one in people who were. Wegovy does not carry a sleep apnea indication. Weight loss from any cause can ease sleep apnea, but only Zepbound has the approved use.
Can teenagers take Zepbound or Wegovy?
Wegovy injection is approved for weight management in children aged 12 and older with obesity, at maintenance doses of 1.7 mg or 2.4 mg weekly. The 7.2 mg HD dose and the Wegovy pill are adult-only. Zepbound is approved only for adults. Mounjaro, which contains the same tirzepatide, is approved from age 10, but for type 2 diabetes rather than weight.
Which is easier on the stomach?
No trial settles it cleanly. In the separate placebo-controlled trials, nausea was reported less often on Zepbound (25% to 29%) than on Wegovy 2.4 mg (44%). In SURMOUNT-5, fewer people stopped tirzepatide for stomach effects (2.7% vs 5.6%). Individual tolerance varies more than those averages. Both labels build in 4-week dose steps so the gut can adjust, and a prescriber can hold a dose longer if needed.
Will I keep the weight off after stopping?
Stopping usually means regain. In SURMOUNT-4, people switched from tirzepatide to placebo regained 14% of body weight over a year. In the STEP 1 extension, people regained about two-thirds of their semaglutide weight loss within a year. Staying on a maintenance dose, or switching to another medicine, are options to discuss with your prescriber before stopping.
Sources
- SURMOUNT-5: tirzepatide vs semaglutide for obesity (Aronne et al., NEJM, 2025)
- SURMOUNT-5 journal scan, American College of Cardiology (July 2025)
- SURMOUNT-1: tirzepatide once weekly for obesity (Jastreboff et al., NEJM, 2022)
- FDA approves Wegovy HD (semaglutide 7.2 mg), Novo Nordisk, March 2026
- FDA approves Wegovy pill (oral semaglutide 25 mg), Novo Nordisk, December 22, 2025
- SELECT: semaglutide and cardiovascular outcomes in obesity without diabetes (Lincoff et al., NEJM, 2023)
- Zepbound (tirzepatide) prescribing information, revised 8/2026, DailyMed
- Wegovy (semaglutide) injection and tablets prescribing information, revised 6/2026, DailyMed
- SURMOUNT-4: continued tirzepatide for weight maintenance (Aronne et al., JAMA, 2024)
- STEP 1 extension: weight regain after semaglutide withdrawal (Wilding et al., Diabetes Obes Metab, 2022)
- FDA's concerns with unapproved GLP-1 drugs used for weight loss, FDA (updated September 1, 2026)
- Temi compounded semaglutide injectable pricing, usetemi.com (checked September 28, 2026)
- Temi compounded tirzepatide injectable pricing, usetemi.com (checked September 28, 2026)
Compounded semaglutide and compounded tirzepatide are not FDA-approved generics of the brand-name products. A licensed 503A compounding pharmacy prepares each one for a single prescription.
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