Zepbound vs Ozempic: how they compare

Zepbound and Ozempic are different drugs from different makers. Zepbound is tirzepatide from Eli Lilly, which acts on two gut-hormone receptors (GIP and GLP-1) and is approved for weight reduction and sleep apnea. Ozempic is semaglutide from Novo Nordisk, which acts on one (GLP-1) and is approved for type 2 diabetes. In the trials that tested the two molecules against each other, tirzepatide produced more weight loss, but neither trial tested Zepbound against Ozempic as it’s actually prescribed.

Here is what the trials show, what carries over to Ozempic, and what each costs as of October 2026.

Zepbound and Ozempic at a glance

Sources: the Zepbound and Ozempic labels, LillyDirect, NovoCare Pharmacy and the CMS Bridge form.

What SURMOUNT-5 tested, and what carries over to Ozempic

SURMOUNT-5 is the trial most people mean when they say Zepbound beats Ozempic. It randomly assigned 751 adults with obesity but without type 2 diabetes to the highest dose they could tolerate of tirzepatide (10 mg or 15 mg) or semaglutide (1.7 mg or 2.4 mg), once a week for 72 weeks. Tirzepatide averaged 20.2% weight loss and semaglutide 13.7%. The trial was open-label, so people knew which drug they took, and Lilly funded it.

What carries over: Ozempic contains the same molecule as the semaglutide arm, so SURMOUNT-5 is the best evidence on how tirzepatide and semaglutide compare for weight loss.

What doesn’t:

• The doses. SURMOUNT-5 used 1.7 mg and 2.4 mg, the Wegovy maintenance doses. Ozempic’s maximum is 2 mg, and its label goes above 0.5 mg only if blood sugar needs more control.
• The people. Nobody in SURMOUNT-5 had type 2 diabetes, and Ozempic is approved only for people who do. On the same drug, people with type 2 diabetes lost less in the label trials: 14.9% on Wegovy 2.4 mg without diabetes against 9.6% with it, and 20.9% on Zepbound 15 mg without diabetes against 14.7% with it, on each label.
• The goal. Ozempic’s trials measured blood sugar. Its label reports weight change as a secondary result, in kilograms.

Our Wegovy vs Zepbound guide covers SURMOUNT-5 against the drug it actually tested.

The trial with an Ozempic dose: SURPASS-2

The closest trial to Zepbound against Ozempic is SURPASS-2. It randomly assigned 1,879 adults with type 2 diabetes on metformin to tirzepatide 5, 10 or 15 mg or semaglutide 1 mg once a week for 40 weeks. Lilly funded it, and it was open-label.

Scroll sideways to see the full table

Source: Mounjaro label, Table 5.

Two caveats. The tirzepatide in SURPASS-2 was given for diabetes, under what became the Mounjaro label, so for someone with type 2 diabetes the real choice is often Mounjaro or Ozempic; see Mounjaro vs Zepbound. And semaglutide 1 mg isn’t Ozempic’s top dose. In a separate 40-week trial, Ozempic 2 mg produced 6.4 kg of weight loss against 5.6 kg on 1 mg, a difference the Ozempic label calls not statistically significant. No trial has tested Zepbound against Ozempic 2 mg.

Side effects

Stomach side effects lead on both. In SURPASS-2, where both drugs were in one trial, rates were close:

In SURMOUNT-5, stomach side effects were the most common in both groups, mostly mild to moderate and mostly during dose escalation. On their own labels, nausea affected 25% to 29% of people on Zepbound in its weight trials (8% on placebo) and 15.8% to 20.3% on Ozempic 0.5 mg and 1 mg in its diabetes trials (6.1% on placebo).

Both carry a boxed warning for thyroid C-cell tumors, and neither is for anyone with a personal or family history of medullary thyroid carcinoma or MEN 2. Both labels warn about pancreatitis, gallbladder disease, low blood sugar with insulin or sulfonylureas, kidney injury from dehydration and severe stomach problems. Zepbound’s label says not to combine it with other tirzepatide products or any GLP-1 medicine. See our Zepbound side effects guide and GLP-1 side effects guide.

Doses and devices

Zepbound starts at 2.5 mg a week for 4 weeks and rises in 2.5 mg steps at least 4 weeks apart to a maintenance dose of 5, 10 or 15 mg. It comes as single-dose vials you draw into a syringe, single-dose pens and a KwikPen that holds four doses.

Ozempic starts at 0.25 mg a week for 4 weeks, then 0.5 mg, with 1 mg and 2 mg allowed after at least 4 weeks on the dose below if blood sugar needs more control. Each pen holds a month of weekly doses. Ozempic also comes as daily tablets (1.5, 4 and 9 mg) for type 2 diabetes.

What each costs in October 2026

Prices read on October 26, 2026 from LillyDirect and NovoCare Pharmacy. At maintenance, Zepbound costs $100 a month more than Ozempic up to 1 mg, and $50 less than Ozempic 2 mg. Because Ozempic isn’t approved for weight loss, the fair cash comparison for weight loss is Zepbound against Wegovy, which also costs $349 a month at NovoCare; see our Zepbound cost and Wegovy cost guides.

Insurance and Medicare

Coverage follows the approved use. Medicare’s GLP-1 Bridge form sends type 2 diabetes and sleep apnea prescriptions to your regular Part D plan, and weight-loss prescriptions to the Bridge, at $50 a month until December 31, 2027, for the Zepbound KwikPen, Wegovy and Foundayo. Commercial plans decide for themselves whether to cover weight-loss drugs. Our insurance guide and Medicare guide go further.

Which one fits you

• If weight loss is the goal, Zepbound is approved for it and Ozempic isn’t. The semaglutide alternative approved for weight loss is Wegovy; see Wegovy vs Ozempic.
• If you have type 2 diabetes, both tirzepatide and semaglutide lower blood sugar; your clinician may compare Ozempic with Mounjaro, the tirzepatide product approved for diabetes.
• If you have sleep apnea and obesity, Zepbound is the one approved for it.
• If you have type 2 diabetes with heart or kidney disease, Ozempic’s label includes heart and kidney risk reduction.

A licensed clinician can weigh these against your history and coverage. Compare programs on our Zepbound rankings and brand-name GLP-1 rankings, or use our match tool.

The bottom line

Zepbound and Ozempic are different molecules with different approvals: tirzepatide for weight reduction and sleep apnea, semaglutide for type 2 diabetes. Tirzepatide produced more weight loss in both head-to-head trials, 20.2% against 13.7% in SURMOUNT-5 at Wegovy doses and up to 11.2 kg against 5.7 kg in SURPASS-2 at Ozempic’s 1 mg dose, but no trial has tested Zepbound against Ozempic 2 mg. Self-pay, Zepbound costs $299 to $449 a month at LillyDirect with on-time refills, as of October 2026. Choose with a licensed clinician, and see our weight-loss hub for more.