Zepbound and Wegovy are the two weekly injections FDA has approved for chronic weight management. Zepbound is tirzepatide from Eli Lilly; Wegovy is semaglutide from Novo Nordisk. They're different molecules, and a 2025 trial put them head to head. This page sticks to the two brands and their labels. For how the molecules differ underneath, see semaglutide vs tirzepatide.
Zepbound produced more weight loss in the head-to-head trial
SURMOUNT-5 enrolled 751 adults with obesity and no type 2 diabetes. Each person took the highest dose they could tolerate of either drug for 72 weeks. On Zepbound, average weight loss was 20.2%; on Wegovy, 13.7%. People on Zepbound were also more likely to reach 10%, 15%, 20% and 25% weight loss [1].
Eli Lilly, Zepbound's maker, funded the trial, and it was open-label. Each drug's own placebo trial shows a similar gap: 20.9% at Zepbound's top dose in SURMOUNT-1 [2] and 14.9% on Wegovy 2.4 mg in STEP 1 [3]. Wegovy's label added a higher 7.2 mg dose, sold as Wegovy HD, in March 2026. That dose wasn't part of SURMOUNT-5.
Wegovy has more approvals beyond weight; Zepbound has sleep apnea
| Zepbound | Wegovy | |
|---|---|---|
| Active ingredient | Tirzepatide (Eli Lilly) | Semaglutide (Novo Nordisk) |
| Head-to-head weight loss (SURMOUNT-5) | −20.2% at 72 weeks | −13.7% at 72 weeks |
| Own placebo trial | SURMOUNT-1: −20.9% (top dose) | STEP 1: −14.9% |
| Weight management | Adults, approved November 2023 | Adults and teens 12 and older, approved June 2021 (teens December 2022) |
| Heart-attack and stroke risk | Not an approved use | Adults with heart disease and obesity or overweight, March 2024 |
| MASH liver disease | Not an approved use | Adults with moderate to advanced fibrosis, accelerated approval, August 2025 |
| Sleep apnea | Moderate to severe, adults with obesity, December 2024 | Not an approved use |
| Forms | Weekly single-dose pen or vial, multi-dose vial, KwikPen | Weekly single-dose pen, syringe or FlexTouch pen; daily pill |
| Self-pay from the maker | $299 to $449 a month | Pen $349 after intro; HD $399; pill $149 to $299 |
Zepbound label [8]; Wegovy label [9]; SURMOUNT-5 [1]; SURMOUNT-1 [2]; STEP 1 [3]; prices [10] [11].
Each extra label rests on its own trial. Wegovy's heart indication comes from SELECT, which enrolled 17,604 adults with heart disease and overweight but no diabetes; semaglutide cut heart attacks, strokes and heart deaths by 20% [4]. The label itself covers adults with established heart disease and either obesity or overweight. The MASH approval comes from ESSENCE, where liver inflammation resolved in 62.9% on semaglutide against 34.3% on placebo [5]. Zepbound's sleep apnea approval comes from SURMOUNT-OSA, where breathing interruptions during sleep fell by about 20 to 24 more events an hour than on placebo [6].
In practice, if one of those conditions applies to you, it often settles the choice before weight loss does. It also tends to shape coverage, since a plan may treat a heart or sleep apnea indication differently from weight management alone.
Only Wegovy is approved for teens, and only Wegovy comes as a pill
Wegovy's injection is approved for weight management in teens 12 and older with obesity [9]. Zepbound's label says its safety and effectiveness "have not been established in pediatric patients" [8], so it's an adult drug.
Wegovy also comes as a daily tablet for adults, approved in December 2025. In its main trial, OASIS 4, the 25 mg pill averaged 13.6% weight loss at 64 weeks against 2.2% on placebo; Novo Nordisk funded it [7]. There's no Zepbound pill. Foundayo is a daily Lilly pill, but it's a different drug, orforglipron; the Foundayo guide covers it, and Wegovy pill vs injection compares Wegovy's two forms.
Side effects are similar: mostly digestive, mostly early
- Zepbound label: digestive side effects in 56% of people at each dose, against 30% on placebo. Between 4.8% and 6.7% stopped because of side effects, against 3.4% on placebo [8].
- Wegovy label: digestive side effects in 73% on the 2.4 mg injection, against 47% on placebo. 6.8% stopped because of side effects, against 3.2% [9].
- Both: the same boxed warning about thyroid C-cell tumors in rodents, and the same class warnings about pancreatitis, gallbladder disease and kidney injury from dehydration.
Those numbers come from each drug's own trials with different people, so they don't rank the two. In SURMOUNT-5, digestive side effects were the most common in both groups, mostly mild to moderate, and mainly during dose increases [1]. The Zepbound side effects guide and Wegovy side effects guide go symptom by symptom.
Without insurance, the two now cost about the same
| Product and dose | Self-pay per month | Conditions |
|---|---|---|
| Zepbound 2.5 mg | $299 | Vial or KwikPen; needles bought separately |
| Zepbound 5 mg | $399 | Vial or KwikPen |
| Zepbound 7.5 to 15 mg | $449 | Refill within 45 days; otherwise $499 (7.5 mg) or $699 (10 to 15 mg) |
| Wegovy pen 0.25 and 0.5 mg | $199 | New patients, first 2 fills, through December 31, 2026 |
| Wegovy pen 0.25 to 2.4 mg | $349 | Standard self-pay price |
| Wegovy HD pen 7.2 mg | $399 | Standard self-pay price |
| Wegovy pill 1.5 mg / 4 mg | $149 / $199 | One bottle of 30 tablets |
| Wegovy pill 9 mg and 25 mg | $299 | One bottle of 30 tablets |
LillyDirect [10] and NovoCare [11]. NovoCare says its pricing will be updated after December 31, 2026.
At the doses most people stay on, that's $349 a month for Wegovy against $449 for Zepbound, if you refill Zepbound on time. Wegovy's pill is cheaper still at its lower strengths. If your commercial plan does cover the drug, both makers offer savings cards that can bring the copay down to as little as $25 a month, with monthly caps on the savings; government plans are excluded [10] [11]. The Zepbound cost guide and Wegovy cost guide cover insurance, savings cards and Medicare, and the monthly cost calculator totals any plan by the month.
What about Ozempic? It isn't a weight-loss label
Ozempic is the same molecule as Wegovy, semaglutide, but it's approved for type 2 diabetes, not weight management. If you're comparing all three for weight loss, Ozempic's weight-labeled twin is Wegovy. The Ozempic vs Wegovy comparison explains what separates them, and Ozempic vs Zepbound shows the full brand map.
Can you switch from one to the other? Ask your prescriber
Switching is common, usually for side effects, results or coverage. Because these are different molecules, doses don't convert one to one, and your prescriber sets the new starting point. Don't take both: each label says combining it with another GLP-1 drug is not recommended [9] [8]. The Zepbound guide and Wegovy guide cover each drug on its own.
Compare before you sign up: 21 brand Wegovy and Zepbound self-pay programs, scored on price, care and pharmacy checks.