ZepBOUND (Tirzepatide) vs Wegovy (Semaglutide)

Q: Which works better: Zepbound (tirzepatide) or Wegovy (semaglutide)?

In a 72-week NEJM trial, Zepbound (tirzepatide) produced greater weight loss than Wegovy (semaglutide). At maximum doses, average weight loss was ~21% vs ~15%.

Q: What are the side effects of Zepbound (tirzepatide) vs Wegovy (semaglutide)?

Both cause similar GI side effects including nausea, GERD, constipation, or diarrhea. Each carries a boxed warning for thyroid C-cell tumors, and risks include pancreatitis, gallbladder disease, and aspiration during anesthesia.

Q: Is Zepbound (tirzepatide) safer than Wegovy (semaglutide)?

Neither drug is categorically safer. Both have similar class warnings and side effects. Safety depends on medical history and supervision by a physician.

Q: Can I switch from Wegovy (semaglutide) to Zepbound (tirzepatide)?

Yes, this is common in clinical practice. Patients often stop semaglutide and start tirzepatide at 7.5 mg to 10 mg, with gradual titration under medical supervision.

Q: Which is covered by insurance in Utah?

Coverage varies. Medicare may cover Wegovy (semaglutide) for patients with obesity and cardiovascular disease. Zepbound (tirzepatide) coverage depends on commercial plans and employer policies.

Joshua Silva, MD
Oct 7
3 min read

Which works better: Zepbound (tirzepatide) or Wegovy (semaglutide)?

In a 72-week head-to-head NEJM randomized controlled trial of adults with obesity, Zepbound (tirzepatide) produced greater weight loss and waist reduction than Wegovy (semaglutide 2.4 mg). In the flagship single-drug trials, average weight

loss at 72/68 weeks was about 21% with Zepbound (tirzepatide 15 mg) vs 15% with Wegovy (semaglutide 2.4 mg).

Comparison chart of Wegovy (semaglutide) vs Zepbound (tirzepatide) effectiveness for weight loss based on NEJM STEP and SURMOUNT trials.

What are the side effects of Zepbound (tirzepatide) vs Wegovy (semaglutide)?

Both medications have the potential to cause the same side effect profile, though the vast majority of people report fewer side effects with tirzepatide, giving it a distinct advantage.

The most common side effects are gastrointestinal and include nausea, GERD, constipation, or diarrhea. Both medications carry a boxed warning for a rare type of thyroid cancer (thyroid C-cell tumors). Therefore, they should not be used in individuals with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2.

Other warnings include pancreatitis, gallbladder disease, and potential aspiration risk during anesthesia or deep sedation. Review each full label for details.

Is Zepbound (tirzepatide) safer than Wegovy (semaglutide)?

Neither drug is categorically “safer.” Both have similar class warnings (thyroid C-cell tumors, pancreatitis, gallbladder disease) and gastrointestinal side effects. Safety depends on each person’s medical history and pre-existing health conditions.

The key point is that these medications should be prescribed and used under the supervision of a competent physician. Unsupervised use, as sometimes occurs with internet clinics, can lead to uncomfortable and potentially dangerous side effects.

Utah patients: If you’re considering GLP-1 therapy, schedule a free consultation with Dr. Joshua Silva, MD in St. George or Cedar City—or connect by telehealth if you live too far to travel to our clinics.

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Can I switch from Wegovy (semaglutide) to Zepbound (tirzepatide)?

Yes—this transition happens frequently in clinical practice and is generally straightforward, though no standard protocol exists. A typical approach is to stop Wegovy (semaglutide) and start Zepbound (tirzepatide) at a comparable starting dose, then titrate based on tolerance and effectiveness.

For example, if a patient has reached maximum weight loss on Wegovy (semaglutide 2.4 mg), they generally tolerate a transition to Zepbound (tirzepatide) at 7.5 mg to 10 mg, with gradual titration upward as needed to support continued weight loss.

Disclaimer: This article is for educational purposes only and is not a substitute for medical advice.

Which is covered by insurance in Utah?

Coverage varies by plan:

Wegovy (semaglutide): After FDA added a cardiovascular risk-reduction indication (adults with obesity/overweight and established CVD), Medicare Part D plans may cover Wegovy (semaglutide) for that use (not for weight loss alone); commercial plans differ.
Zepbound (tirzepatide): Approved for chronic weight management, coverage depends on commercial plan policies and employer exclusions. Check your plan’s formulary for BMI and comorbidity requirements.

Considering Zepbound (tirzepatide) or Wegovy (semaglutide)? Book your free consultation with Potere Health MD in St. George or Cedar City, Utah — offering both in-person and virtual appointments available.

About the Author

Dr. Joshua Silva, MD, is a licensed physician and Medical Director of Potere Health MD. He completed residency training in Occupational and Environmental Medicine from the University of Utah and now specializes in evidence-based weight management, including GLP-1/GIP therapies (semaglutide, tirzepatide). Dr. Silva provides in-person and virtual care for patients throughout Utah.