---
title: "Wegovy vs Zepbound: SURMOUNT-5, Doses & Side Effects (2026) | GLPMate"
url: https://glpmate.me/blog/wegovy-vs-zepbound-2026
language: en
description: "Wegovy vs Zepbound compared from US labels and the SURMOUNT-5 head-to-head trial: weight loss, approved uses, doses, side effects, pens, vials and tablets."
updated: 2026-10-14
---
[Blog](/blog)

# Wegovy vs Zepbound: how the two weight-management injections compare on results, approvals, doses and side effects

By [the GLPMate team](/editorial-policy) · Based on FDA prescribing information & peer-reviewed sources · Updated 2026-10-14 · 7 min read

Quick answer

Wegovy (semaglutide) and Zepbound (tirzepatide) are weekly weight-management injections. In the 72-week SURMOUNT-5 trial, adults with obesity but no diabetes lost 20.2% of body weight on average with tirzepatide vs 13.7% with semaglutide 1.7–2.4 mg. Digestive side effects were most common with both. Wegovy also has heart and MASH approvals, Zepbound sleep apnea. Your prescriber decides which fits.

## What is the difference between Wegovy and Zepbound?

Wegovy and Zepbound are once-weekly injections approved in the US for long-term weight management, used alongside a reduced-calorie diet and more physical activity. The difference starts with the molecule:

- **Wegovy** contains **semaglutide** (Novo Nordisk), which activates the GLP-1 receptor.
- **Zepbound** contains **tirzepatide** (Eli Lilly), which activates both the GIP and GLP-1 receptors.

They are the weight-management siblings of Ozempic and Mounjaro, with their own doses and approvals. If you want the molecule-level science, see [semaglutide vs tirzepatide](/blog/semaglutide-vs-tirzepatide-2026). This article sticks to the two branded products: what they’re approved for, how they’re dosed and supplied, and what the trials found.

**−20.2% vs −13.7%** Average body-weight change after 72 weeks in SURMOUNT-5: tirzepatide (Zepbound's ingredient, 10 or 15 mg) vs semaglutide (Wegovy's ingredient, 1.7 or 2.4 mg) in adults with obesity but no diabetes. Open-label and funded by Eli Lilly; Wegovy's 7.2 mg dose wasn't tested, and individual results vary.

## Wegovy vs Zepbound at a glance

From the current US labels on DailyMed, checked 14 October 2026. Labels change, so your pharmacist has the final word.

**Wegovy** | **Zepbound**

Active ingredient | Semaglutide (GLP-1 receptor agonist) | Tirzepatide (GIP + GLP-1 receptor agonist)

Weight management | Adults; injection also for ages 12+ | Adults

Other approved uses (US) | Lowering major heart-event risk in adults with heart disease and overweight or obesity; MASH with moderate to advanced fibrosis (accelerated approval) | Moderate to severe obstructive sleep apnea in adults with obesity

Starting dose | 0.25 mg weekly (tablet: 1.5 mg daily) | 2.5 mg weekly (starting dose only)

Maintenance | 1.7 or 2.4 mg weekly; adults using it for weight may go up to 7.2 mg | 5, 10 or 15 mg weekly (sleep apnea: 10 or 15 mg)

Presentations | Single-dose pens and syringes, 4-dose FlexTouch pen, daily tablets | Single-dose pens and vials, 4-dose vials and KwikPen

Missed dose | Take it if the next dose is more than 2 days away | Take within 4 days, otherwise skip

Half-life | About 1 week | About 5–6 days

## What did the SURMOUNT-5 trial find?

SURMOUNT-5 is the first head-to-head trial of the two molecules for obesity (Aronne et al., NEJM 2025). It enrolled 751 adults with obesity but without type 2 diabetes, randomly assigned to the maximum tolerated dose of tirzepatide (10 or 15 mg) or semaglutide (1.7 or 2.4 mg) once weekly for 72 weeks.

### The results

- **Body weight:** −20.2% on average with tirzepatide vs −13.7% with semaglutide, about −22.8 kg vs −15.0 kg according to an ACC summary.
- **Waist circumference:** −18.4 cm vs −13.0 cm.
- **Bigger milestones:** people on tirzepatide were more likely to reach weight losses of at least 10%, 15%, 20% and 25%.
- **Side effects:** digestive events were the most common in both groups, mostly mild to moderate and mainly during dose escalation.

### The caveats

- It was **open-label** and **funded by Eli Lilly**, Zepbound’s maker.
- Semaglutide topped out at **2.4 mg**. Wegovy’s label now allows up to 7.2 mg for adult weight reduction, which SURMOUNT-5 didn’t test.
- People with type 2 diabetes were excluded, so results may differ for them.
- These are group averages. Some people lose more on either medicine, some less.

## How much weight was lost in each drug’s own trials?

Each label also reports placebo-controlled trials. They’re separate studies with different people and durations, so read them side by side, not as a head-to-head result.

- **Wegovy 2.4 mg** (STEP 1, 68 weeks): −14.9% vs −2.4% on placebo.
- **Wegovy 7.2 mg** (72 weeks): −18.8%, vs −15.5% on 2.4 mg and −3.9% on placebo.
- **Zepbound** (SURMOUNT-1, 72 weeks): −15.0%, −19.5% and −20.9% on 5, 10 and 15 mg, vs −3.1% on placebo.

In both labels, people with type 2 diabetes lost less on average than people without it.

## What else are Wegovy and Zepbound approved for?

This is where the two differ most, and it can matter more than a few percentage points of weight.

### Wegovy

- **Heart risk:** in adults with established heart disease and overweight or obesity, Wegovy lowered the risk of heart attack, stroke or cardiovascular death by about 20% vs placebo in the SELECT trial (hazard ratio 0.80). The daily tablet shares this approval.
- **MASH:** treatment of noncirrhotic MASH (fatty-liver inflammation) with moderate to advanced fibrosis, under accelerated approval that depends on confirmatory results.
- **Teenagers:** the injection is approved for weight management from age 12.

### Zepbound

- **Obstructive sleep apnea:** for moderate to severe OSA in adults with obesity. In the label’s two 52-week studies, breathing interruptions fell by about 25–29 events per hour vs about 5 on placebo, from a starting average near 50.

Zepbound’s label doesn’t include a heart-outcome indication. Tirzepatide’s cardiovascular-outcome trial was in type 2 diabetes and sits on the Mounjaro label.

## How do Wegovy and Zepbound doses compare?

Both labels start low and step up no faster than every 4 weeks to limit digestive side effects.

- **Wegovy:** 0.25 mg (weeks 1–4), 0.5 mg, 1 mg, 1.7 mg, then 2.4 mg (or 1.7 mg) from week 17. Adults using it for weight reduction may step up to 7.2 mg after at least 4 weeks on 2.4 mg if more weight loss is clinically indicated. If a step isn’t tolerated, the label lets prescribers delay escalation by 4 weeks.
- **Zepbound:** 2.5 mg for 4 weeks, then 5 mg, then 2.5 mg steps after at least 4 weeks each. If a maintenance dose isn’t tolerated, the label suggests considering a lower one.

Missed doses differ too: if two or more Wegovy doses in a row are missed, the label says to restart escalation at a lower dose. Our [GLP-1 dose escalation schedule](/blog/glp-1-dose-escalation-schedule-2026) covers each step in detail.

## Pens, vials or tablets: how are they supplied?

- **Wegovy** comes as single-dose pens (0.25 mg up to 2.4 mg, plus a 7.2 mg “Wegovy HD” pen), single-dose syringes, a 4-dose FlexTouch pen at 2.4 mg, and a once-daily 25 mg tablet. No vial is listed.
- **Zepbound** comes as single-dose pens, single-dose vials, 4-dose vials and a 4-dose KwikPen, each in all six strengths from 2.5 to 15 mg.

Vials are drawn up with a syringe, using a new syringe and needle every time. Multi-dose pens must never be shared, even with a new needle. If your presentation changes, the labels call for fresh training. For keeping pens and vials at the right temperature, see [GLP-1 pen storage and travel](/blog/glp-1-pen-storage-travel-2026).

## Wegovy or Zepbound side effects: what do the labels show?

Both have similar side-effect profiles, mostly digestive and mostly during dose increases. The rates below come from each drug’s own placebo-controlled trials and can’t be compared directly.

- **Wegovy 2.4 mg:** nausea 44% (placebo 16%), diarrhea 30% (16%), vomiting 24% (6%), constipation 24% (11%), abdominal pain 20% (10%). 6.8% stopped because of side effects vs 3.2% on placebo.
- **Wegovy 7.2 mg:** altered skin sensation (dysesthesia) was reported by 22%, vs 6% on 2.4 mg.
- **Zepbound 5–15 mg:** nausea 25–29% (placebo 8%), diarrhea 19–23% (8%), vomiting 8–13% (2%), constipation 11–17% (5%), injection-site reactions 6–8% (2%). 4.8–6.7% stopped because of side effects vs 3.4% on placebo.

Hair loss appears on both labels (3% on Wegovy 2.4 mg, 4–5% on Zepbound, vs 1% on placebo). Both carry the same core warnings: a boxed warning about thyroid C-cell tumors in rodents, pancreatitis, gallbladder disease, kidney injury from dehydration, low blood sugar with insulin or sulfonylureas, and aspiration risk under anesthesia.

## What happens with maintenance, or if you stop?

Both labels cover weight reduction and long-term maintenance, and both include trials where people who’d lost weight were randomly switched to placebo:

- **Wegovy:** after a 20-week run-in, those who stayed on 2.4 mg lost a further 7.9% by week 68, while those switched to placebo regained 6.9%.
- **Zepbound:** after 36 weeks of treatment (average loss 20.9%), those who continued lost a further 5.5% by week 88, while those switched to placebo regained 14.0%.

The designs differ, so the numbers aren’t directly comparable. The shared lesson is that weight tends to return after stopping; our article on [stopping a GLP-1 and weight regain](/blog/stopping-glp-1-weight-regain-2026) covers what to plan with your doctor.

## When should you call your doctor?

Contact your care team promptly, or get urgent help, if you notice:

- Severe stomach pain that won’t go away, sometimes spreading to your back (possible pancreatitis)
- Vomiting or diarrhea that stops you keeping fluids down, dizziness or very little urine (dehydration)
- Upper stomach pain, fever, or yellow skin or eyes (possible gallbladder problems)
- Swelling of the face, lips, tongue or throat, or trouble breathing (possible allergic reaction; get help right away)
- A lump in the neck, trouble swallowing or persistent hoarseness

## Tracking whichever one you use

Whichever medicine you and your prescriber choose, your own data tells you more than any average. GLPMate logs every dose with reminders, maps your injection sites, keeps a side-effect log with severity next to your weight trend and body measurements, and creates a doctor report (PDF) for appointments. See the [Wegovy tracker](/wegovy-tracker-app) or the [Zepbound tracker](/zepbound-tracker-app).

This article is educational only and not medical advice. Talk to your prescriber before starting, stopping, switching or changing the dose of any medicine.

FAQ

## FAQ

### Which works better for weight loss, Wegovy or Zepbound?

In the head-to-head SURMOUNT-5 trial, adults with obesity but no diabetes lost 20.2% of body weight on average with tirzepatide (Zepbound's ingredient) vs 13.7% with semaglutide 1.7–2.4 mg (Wegovy's ingredient) over 72 weeks. The trial was open-label, funded by Eli Lilly, and didn't test Wegovy's newer 7.2 mg dose. Averages don't predict any one person's result.

### Does Wegovy or Zepbound have more side effects?

Both mainly cause nausea, diarrhea, vomiting and constipation, mostly while the dose is going up. SURMOUNT-5 reported digestive events as the most common for both medicines, mostly mild to moderate. Each label's rates come from different trials, so they can't be compared directly; tell your care team about side effects that are severe or don't settle.

### What is the highest dose of Wegovy and Zepbound?

Zepbound's maximum is 15 mg once weekly. Wegovy's usual maintenance dose is 2.4 mg weekly, and since the label update, adults using it for weight reduction may go up to 7.2 mg once they've tolerated 2.4 mg for at least 4 weeks and more weight loss is clinically indicated. Your prescriber decides whether any step is right for you.

### Does Zepbound come in vials?

Yes. The current Zepbound label lists single-dose vials and 4-dose multi-dose vials alongside single-dose pens and a 4-dose KwikPen. Vials are drawn up with a syringe, using a new syringe and needle each time. Wegovy comes as single-dose pens, single-dose syringes, a 4-dose FlexTouch pen and daily tablets, with no vial listed.

## Sources

1. Aronne et al., NEJM 2025 (SURMOUNT-5) — tirzepatide 10/15 mg vs semaglutide 1.7/2.4 mg, 72 weeks, 751 adults with obesity without diabetes — −20.2% vs −13.7% body weight, −18.4 vs −13.0 cm waist, more people reaching 10–25% weight loss, GI events mostly mild to moderate and during escalation; open-label, funded by Eli Lilly
2. American College of Cardiology, Journal Scan (July 2025) — SURMOUNT-5 summary — average weight change about −22.8 kg vs −15.0 kg; higher share of men than earlier trials
3. FDA Prescribing Information — Wegovy (semaglutide) injection and tablets, DailyMed (June 2026 version, checked 14 Oct 2026) — indications (weight in adults and ages 12+, CV risk reduction, MASH), dose schedule incl. 7.2 mg, presentations, missed-dose rule, adverse-reaction tables, STEP and SELECT results, randomized-withdrawal trial
4. FDA Prescribing Information — Zepbound (tirzepatide), DailyMed (revised 08/2026, checked 14 Oct 2026) — indications (weight, obstructive sleep apnea), dose schedule, vials, pens and KwikPen, missed-dose rule, adverse-reaction table, SURMOUNT-1, SURMOUNT-4 and sleep apnea results
5. FDA Prescribing Information — Mounjaro (tirzepatide), DailyMed (revised 08/2026, checked 14 Oct 2026) — tirzepatide's cardiovascular-outcome indication (SURPASS-CVOT) sits on the Mounjaro label for type 2 diabetes, not on Zepbound

Sources checked: October 14, 2026

This article is educational and is not medical advice, diagnosis or treatment. Medication decisions — including dose changes and what to do after a missed dose — belong with your prescriber. If you experience severe symptoms, seek medical care.

## Keep reading

[Semaglutide vs tirzepatide ](/blog/semaglutide-vs-tirzepatide-2026)[Stopping a GLP-1: will weight return? ](/blog/stopping-glp-1-weight-regain-2026)[Wegovy tracker app ](/wegovy-tracker-app)

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