Your Weight, Your Choice

Ozempic is the brand name for semaglutide, FDA approved for people with diabetes. Doses available: 0.25 mg to 2 mg

Wegovy is the brand name for semaglutide, FDA approved for weight loss. Doses available: 0.25 mg to 2.4 mg

Semaglutide is the generic, or non-branded version for both Ozempic and Wegovy. Doses available: 0.25 mg to 2.4 mg

All three medications have the same active ingredient, semaglutide!

All three medications are once-a-week injections.

Mounjaro is the brand name for tirzepatide, FDA approved for people with diabetes. 

Zepbound is the brand name for tirzepatide, FDA approved for weight loss. 

Tirzepatide is the generic, or non-branded version for both Mounjaro and Zepbound. 

Doses available for all three medications are the same: 2.5 mg to 15 mg.

All three medications have the same active ingredient, tirzepatide! 

All three medications are once-a-week injections.

Semaglutide was first approved as Ozempic in December 2017 for people with diabetes. Semaglutide works by mimicking a hormone that is naturally released by the gut after eating (glucagon-like peptide-1, or GLP-1) and therefore reduces appetite.

Tirzepatide was first approved as Mounjaro in May 2022 for people with diabetes. Tirzepatide works like semaglutide (mimics GLP-1) and additionally mimics gastric inhibitory polypeptide (GIP), a hormone that naturally stimulates insulin. Trials have shown greater weight loss with tirzepatide when compared to semaglutide. 3,4,5

Semaglutide has been shown to reduce the risk of heart attack, stroke, and heart-related death in patients with heart disease. 1 By reducing in blood pressure and cholesterol, tirzepatide is also protective against heart disease, heart attack, and stroke. 2

Both semaglutide and tirzepatide are:

• FDA approved for treatment of diabetes (Ozempic, Mounjaro)
• FDA approved for weight loss in people without diabetes (Wegovy, Zepbound).
• Once-a-week injections
• Must be refrigerated (not frozen)
• Both can lower cholesterol, blood pressure, and blood sugar; by decreasing weight, the
• risk of obstructive sleep apnea (OSA) is also reduced. 1,2
• Both have similar side effects, most commonly nausea, vomiting, diarrhea, constipation, and acid reflux.

The SURMOUNT-1 (2022) and STEP-1 (2021) trials showed that after 16 months:

• People on once-a-week semaglutide lost an average of 12.4% of body weight 5
• People on once-a-week tirzepatide lost an average of 17.8% of body weight 5

Outcomes vary from person to person, and both our clinical experience and the available evidence has shown significant weight loss on both semaglutide and tirzepatide. If semaglutide is not helping with significant weight loss, switching to tirzepatide is an option to try as well.

The most common side effects with both semaglutide and tirzepatide are:

• Nausea (18% with semaglutide vs. 17% with tirzepatide) 6
• Diarrhea (12% with semaglutide vs. 13% with tirzepatide) 6
• Vomiting (8% with semaglutide vs. 6% with tirzepatide) 6
• Constipation (5.8% with semaglutide vs.6.8% with tirzepatide) 7

Side effects are dose-dependent, meaning side effects become more common at higher doses. While taking these medications, reducing the portion size of meals by 50%, avoiding alcohol, avoiding the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, and drinking plenty of water can help mitigate side effects.

Over-the-counter fiber supplements such as psyllium fiber (Metamucil) or wheat dextrin (Benefiber) or methyl cellulose (Citrucel) can be helpful for both constipation and diarrhea. 

Over-the-counter famotidine (Pepcid) or omeprazole (Prilosec) for any acid reflux symptoms including nausea and vomiting can also be helpful.

You should not use semaglutide or tirzepatide if you:

• Are pregnant or breastfeeding, or plan to become pregnant in the next 90 days
• Have a personal or family history of medullary thyroid carcinoma (MTC)
• Have a personal or family history of multiple endocrine neoplasia (MEN2)
• Have a personal or family history of acute or chronic pancreatitis

Use caution and discuss these medications with your provider if you have:

• Personal history of cholelithiasis and cholecystitis
• Diabetic retinopathy
• Chronic kidney disease

A review of 503 studies showed that there is no increased risk of pancreatitis, pancreatic cancer, or thyroid cancer with the use of semaglutide and tirzepatide. 6  These medications have only demonstrated a theoretical risk for medullary thyroid cancer (MTC) in animal studies, but not in human studies. 6  Therefore, people with a personal or family history of MTC, or a rare condition known as multiple endocrine neoplasia 2 (MEN2) - which can cause MTC - should not take semaglutide or tirzepatide. 6  The risk for kidney injury (0.2% of patients on semaglutide in the 2021 STEP 1 Trial) is associated with not drinking enough water while taking semaglutide or tirzepatide, and due to dehydration from vomiting and/or diarrhea; this risk is easily decreased as long as individuals taking these medications remember to drink enough water daily. 6 There is currently not enough data on the use of semaglutide or tirzepatide during pregnancy or breastfeeding. 8,9  For this reason, we do not recommend semaglutide or tirzepatide if you are pregnant or breastfeeding, or plan on becoming pregnant or breastfeeding while taking this medication in the next 90 days. 8,9  Semaglutide and tirzepatide should be discontinued at least 2 months before a planned pregnancy due to the washout period. 8,9

References

1. Di Folco U, Vallecorsa N, Nardone MR, Pantano AL, Tubili C. Effects of semaglutide on cardiovascular risk factors and eating behaviors in type 2 diabetes. Acta Diabetol. 2022;59(10):1287-1294. doi:10.1007/s00592-022-01936-6
2. Kanbay M, Copur S, Siriopol D, et al. Effect of tirzepatide on blood pressure and lipids: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2023;25(12):3766-3778. doi:10.1111/dom.15272
3. Vadher K, Patel H, Mody R, et al. Efficacy of tirzepatide 5, 10 and 15 mg versus semaglutide 2 mg in patients with type 2 diabetes: An adjusted indirect treatment comparison. Diabetes Obes Metab. 2022;24(9):1861-1868. doi:10.1111/dom.14775
4. le Roux CW, Hankosky ER, Wang D, et al. Tirzepatide 10 and 15 mg compared with semaglutide 2.4 mg for the treatment of obesity: An indirect treatment comparison. Diabetes Obes Metab. 2023;25(9):2626-2633. doi:10.1111/dom.15148
5. Azuri J, Hammerman A, Aboalhasan E, Sluckis B, Arbel R. Tirzepatide versus semaglutide for weight loss in patients with type 2 diabetes mellitus: A value for money analysis. Diabetes Obes Metab. 2023;25(4):961-964. doi:10.1111/dom.14940
6. Filippatos TD, Panagiotopoulou TV, Elisaf MS. Adverse effects of GLP-1 receptor agonists. Rev Diabet Stud. 2014;11(3-4):202-230. doi:10.1900/RDS.2014.11.202
7. Nauck MA, D'Alessio DA. Tirzepatide, a dual GIP/GLP-1 receptor co-agonist for the treatment of type 2 diabetes with unmatched effectiveness regarding glycaemic control and body weight reduction. Cardiovasc Diabetol. 2022;21(1):169. Published 2022 Sep 1. doi:10.1186/s12933-022-01604-7
8. Skov K, Mandic IN, Nyborg KM. Semaglutide and pregnancy. Int J Gynaecol Obstet. 2023;163(2):699-700. doi:10.1002/ijgo.15092
9. Farzam K, Patel P. Tirzepatide. [Updated 2023 Jul 2]. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585056/