Ozempic vs Mounjaro vs Zepbound vs Wegovy: differences and which fits you

The difference between Ozempic and Mounjaro is how they work. Ozempic’s semaglutide mimics one gut hormone (GLP-1). Mounjaro’s tirzepatide acts on two (GIP and GLP-1). Both lower blood sugar, curb appetite and slow how fast the stomach empties.

Both are approved for type 2 diabetes, not for weight loss. Using them only to lose weight is off-label; for that purpose there are Wegovy and Zepbound, the same molecules at doses studied for weight.

In people with type 2 diabetes, the SURPASS-2 trial compared tirzepatide with semaglutide 1 mg for 40 weeks: tirzepatide lowered A1c and weight more on average. That trial used a lower semaglutide dose than Ozempic’s current maximum, so it does not tell you which is better for you.

Which is better, Ozempic or Mounjaro? It depends on your diabetes, kidney function, heart history, the side effects you tolerate and what your plan covers. See the semaglutide guide (Ozempic and Wegovy) and the tirzepatide guide (Mounjaro and Zepbound) for the details of each.

Victoza (liraglutide) is injected once a day and Trulicity (dulaglutide) once a week. Their FDA labels approve both to control blood sugar in adults and children 10 and older with type 2 diabetes, and to lower the risk of major cardiovascular events (heart attack, stroke or cardiovascular death) in adults with type 2 diabetes and heart disease; for Trulicity, also with multiple cardiovascular risk factors.

Neither is approved for weight loss: using them for that is off-label. The liraglutide approved for weight management is sold under a different brand, Saxenda; see the guide to weight loss pills and medicines. The Victoza label does not recommend combining it with other liraglutide products.

Like Ozempic and Mounjaro, they carry a boxed warning about thyroid tumors seen in rats: they are not used if you or a family member has had medullary thyroid carcinoma, or if you have multiple endocrine neoplasia syndrome type 2 (MEN 2). Rybelsus, the semaglutide pill for diabetes, is covered in the semaglutide guide. Doses, side effects and how the weekly pen is used are in the Trulicity (dulaglutide) guide. If you already use Victoza or Trulicity, the doctor reviews your treatment in a follow-up visit and decides whether continuing it is appropriate.

Wegovy and Zepbound are both FDA-approved for weight loss. The SURMOUNT-5 trial, published in the New England Journal of Medicine in 2025, compared them directly in 751 adults with obesity and no diabetes, at sites in the United States and Puerto Rico. At 72 weeks, weight fell an average of 20.2% with tirzepatide and 13.7% with semaglutide, alongside diet and physical activity. SURMOUNT-5 used semaglutide up to 2.4 mg; the Wegovy label now allows up to 7.2 mg (Wegovy HD), a dose that trial did not compare.

Before that, each drug was tested against placebo: in STEP 1, semaglutide 2.4 mg lowered weight by 14.9% on average over 68 weeks (2.4% on placebo); in SURMOUNT-1, tirzepatide lowered weight by 15.0% to 20.9% depending on the dose over 72 weeks (3.1% on placebo).

These are averages, not a promise: some people lose much more and some much less. Results depend on the dose you tolerate, how long you stay on treatment and changes in eating and activity.

All four have a similar profile. The most common side effects are digestive: nausea, diarrhea, vomiting, constipation and belly pain, especially when starting or raising the dose. That is why the dose goes up slowly. In SURMOUNT-5, 6.1% of people on tirzepatide and 8.0% on semaglutide stopped treatment because of side effects; the trial was not designed to compare safety, so the two are considered similar.

The FDA labels warn about pancreatitis, gallbladder problems, low blood sugar when combined with insulin or sulfonylureas, dehydration that can affect the kidneys, and aspiration risk if you are sedated for surgery or a procedure (tell the care team).

What Ozempic, Mounjaro, Wegovy or Zepbound costs depends on the pharmacy, the manufacturer’s savings programs and your health plan. Many plans cover Ozempic or Mounjaro for type 2 diabetes, but coverage for weight loss varies widely; ask your plan whether it requires prior authorization.

The medicine is paid separately from the visit, directly at the pharmacy. The clinic charges only for the visit, by card, and does not bill health plans. See visit prices and the guide to seeing a doctor without insurance.

Compounded semaglutide and tirzepatide are not FDA-approved, and the clinic does not prescribe them: only FDA-approved brand medicines are prescribed. The FDA has received reports of dosing errors with these versions and also warns about counterfeit Ozempic; use only medicines from a licensed pharmacy.

There is no single best GLP-1 for everyone. The choice depends on whether you have diabetes, your other conditions (high blood pressure, heart disease, sleep apnea, fatty liver, kidneys), your labs, the medicines you already take, how you tolerate side effects and what your plan covers.

Doctor online 24/7 in Puerto Rico: video visits any time with the doctor, a general physician licensed in Puerto Rico. She reviews your history, weight, blood pressure and medicines; if needed, she gives you a lab order for a lab near you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. Dose adjustments happen in a follow-up visit.

Prefer pills? See the guide to weight loss pills.

If you use any of these medicines and have severe belly pain that will not go away, vomiting that keeps you from holding down fluids, signs of a serious allergic reaction or very low blood sugar, call 911 or go to the emergency room. A lump or swelling in the neck, hoarseness that does not go away or trouble swallowing needs a prompt medical evaluation.