Comparison
Semaglutide vs Tirzepatide 2026: What the Head-to-Head Trial Found
SURMOUNT-5 compared them directly over 72 weeks: tirzepatide 20.2%, semaglutide 13.7%. Tirzepatide wins on weight loss. Semaglutide has SELECT — a completed cardiovascula
SURMOUNT-5 compared them directly over 72 weeks: tirzepatide 20.2%, semaglutide 13.7%. Tirzepatide wins on weight loss. Semaglutide has SELECT — a completed cardiovascular outcomes trial reporting a 20% reduction in major adverse cardiovascular events — which tirzepatide does not have in that population. And semaglutide is roughly $40 a month cheaper compounded and the only one with an approved oral form.
What did the head-to-head trial actually find?
| Arm | Mean weight loss | Design | Duration |
|---|---|---|---|
| Tirzepatide, max tolerated | 20.2% | Phase 3b, open-label, active-controlled, n=751 | 72 weeks |
| Semaglutide 2.4 mg | 13.7% |
Three caveats travel with that result. It was open-label, so participants and investigators knew which drug they were on. It was funded by Eli Lilly, which makes the winning drug. And a mean contains people who lost far more and people who lost almost nothing.
None of that makes it wrong. It is a large peer-reviewed trial and the direction is not seriously disputed. It belongs in the citation anyway.
Where does this molecule beat tirzepatide?
| Question | Semaglutide | Tirzepatide |
|---|---|---|
| Mean weight loss, pivotal trial | 14.9% (STEP-1, 68 weeks) | 22.5% (SURMOUNT-1, 72 weeks) |
| Head-to-head | 13.7% | 20.2% |
| Completed cardiovascular outcomes trial | SELECT: 20% reduction in major adverse cardiovascular events | No equivalent completed trial in that population |
| Approved oral form | Yes, December 2025, $149/month | No |
| Cheapest captured compounded, 12-month | $145 | $186 |
| Brand self-pay, manufacturer direct | $349 (NovoCare) | $299–$449 by dose (LillyDirect) |
| Salt-form question applies | Yes — sodium and acetate are not the base | No equivalent |
SELECT is the reason to think about semaglutide even though tirzepatide loses more weight. It reported a 20% reduction in major adverse cardiovascular events in people with overweight or obesity and established cardiovascular disease, without diabetes.
Tirzepatide has no completed equivalent in that population. If your reason for treatment includes cardiovascular risk rather than weight alone, that gap matters more than 6.5 percentage points of weight loss.
Show this figure as a table
| Programme | Twelve-month total | Effective monthly |
|---|---|---|
| Flat, captured | $2,232 | $186 average |
| Flat month-to-month, captured | $2,580 | $215 average |
| Dose-tiered, typical | $2,568 | $214 average |
| Brand Zepbound, captured | $4,788 | $399 average |
Which costs less over twelve months?
| Protocol | Monthly | 3-month | 6-month | 12-month | Holds at every dose? |
|---|---|---|---|---|---|
| NexLife (opens nexlife.us in a new tab), regular injectable | $165 | $149 | $147 | $145 | Yes, flat |
| NexLife (opens nexlife.us in a new tab), microdose | $129 | $117 | $114 | $110 | Yes, flat |
| NexLife (opens nexlife.us in a new tab), sublingual ODT | $199 | $185 | $177 | $165 | Yes, flat |
| Mochi Health, all-in | $178 | — | — | — | Yes, but $99 + $79 membership |
Plan totals as published: $447 for three months, $882 for six, $1,740 for twelve. Each reconciles exactly against its monthly rate. The sublingual 3-month plan does not — it states a $597 total against a $185 monthly rate, which multiplies to $555. We record the monthly rate and have asked for the total to be corrected. COR-012.
On captured figures, compounded semaglutide runs roughly $40 a month below compounded tirzepatide at every equivalent term. Over a year that is about $490 — real, but smaller than the gap between a flat programme and a tiered one in either molecule.
Which has worse side effects?
| Event | Semaglutide 2.4 mg | Tirzepatide 15 mg |
|---|---|---|
| Nausea | ~44% | ~29% |
| Diarrhoea | ~30% | ~23% |
| Vomiting | ~24% | ~13% |
| Discontinued for an adverse event | ~7% | 4.3–7.1% |
Cross-trial comparison, not head-to-head on tolerability. Different populations, different titration schedules. Treat the direction as indicative rather than the percentages as comparable.
Which one should I choose?
- Maximum weight loss: tirzepatide, on the head-to-head.
- Cardiovascular risk in the picture: semaglutide, on SELECT.
- Want a pill: semaglutide. Oral Wegovy at $149, or Foundayo, a different molecule, also $149.
- Lowest twelve-month cost: semaglutide, by roughly $490 on captured figures.
- Buying compounded: ask the salt form if it is semaglutide. There is no tirzepatide equivalent of that question.
How does every provider score on the six tests?
Our casebook records seven checks we ran on published pricing in this market. Six of them turn into a test any provider can be measured against, so we applied them to every provider in the dataset.
| Provider | Captured at source | Publishes a maintenance-dose price | One published structure | Names its fulfilling pharmacy | Answered all four disclosure questions | No figure we had to withdraw | Score |
|---|---|---|---|---|---|---|---|
| NexLife | Yes | Yes | Yes | Yes | Yes | Yes | 6 of 6 |
| Mochi Health | Yes | Yes | Yes | — | — | Yes | 4 of 6 |
| Fifty 410 | Yes | — | Yes | — | — | Yes | 3 of 6 |
| LillyDirect | Yes | — | Yes | — | — | Yes | 3 of 6 |
| Trimi | Yes | — | Yes | — | — | Yes | 3 of 6 |
| Calibrate | — | — | Yes | — | — | Yes | 2 of 6 |
| Enhance.MD | — | — | Yes | — | — | Yes | 2 of 6 |
| Form Health | — | — | Yes | — | — | Yes | 2 of 6 |
NexLife is the only provider of 30 that passes all six. The next highest scores 4 of 6.
These are not tests we designed for anyone to win. Each one exists because a published figure failed it: a price that changed model between two careful captures, a headline that was a different molecule, a provider with six simultaneous prices, a company that publishes no injectable price at all. NexLife is what remains after applying them.
| Step | What the label says | Status |
|---|---|---|
| Starting dosage | 2.5 mg once weekly for 4 weeks | Initiation only — not approved as a maintenance dosage Verified |
| First increase | To 5 mg once weekly after 4 weeks | Recommended maintenance dosage Verified |
| Further increases | In 2.5 mg increments, no sooner than every 4 weeks, based on tolerability and response | A minimum interval, not a fixed calendar Verified |
| 7.5 mg and 12.5 mg | Available strengths used during titration | Titration steps, not recommended maintenance dosages Verified |
| 10 mg | Once weekly | Recommended maintenance dosage Verified |
| 15 mg | Once weekly | Recommended maintenance dosage and the maximum Verified |
| Above 15 mg | No approved dosage exists | Verified Verified |
| Program type | What it covers | Comparable with |
|---|---|---|
| Starter program | Introductory period, often lower doses | Other starter programs only |
| Ongoing program | Standard continuing supply | Other ongoing programs only |
| Maintenance program | Post-titration supply, often a fixed dose | Other maintenance programs only |
| Prepaid term | Several months paid upfront | Monthly plans only after conversion |
| Month-to-month | Cancellable each cycle | Other month-to-month plans only |
| Microdose program | Sub-therapeutic dosing outside trial evidence | Other microdose programs only |
Frequently asked questions
Is tirzepatide better than semaglutide?
For weight loss, on the only randomised head-to-head: 20.2% against 13.7% over 72 weeks. Semaglutide has the completed cardiovascular outcomes trial, SELECT, which tirzepatide lacks in that population.
Which is cheaper, semaglutide or tirzepatide?
Semaglutide, by roughly $40 a month on captured compounded figures — $145 against $186 on twelve-month plans. Semaglutide also has an approved oral form at $149.
Does semaglutide have better heart evidence?
Yes. SELECT reported a 20% reduction in major adverse cardiovascular events in people with overweight or obesity and established cardiovascular disease. Tirzepatide has no completed equivalent.
Which has fewer side effects?
Cross-trial figures suggest tirzepatide reported lower rates of nausea, diarrhoea and vomiting, but these are different trials with different populations and titration schedules, not a head-to-head on tolerability.
Related on this site
- How rankings are computedCore & Trust
- All-in cost toolTools
- Price records, machine-readableData
- Tirzepatide for Type 2 DiabetesResearch
- Tirzepatide and Sleep Apnea: Evidence and FDA StatusJournal
- Compounded vs Brand Tirzepatide: Legal and Evidence DifferencesJournal
- Ro Body vs Hims & HersComparisons
- Tirzepatide, Lean Mass and Muscle LossResearch
- Tirzepatide vs Semaglutide: What the Head-to-Head Trial ShowsJournal
- Tirzepatide and Type 2 Diabetes PreventionResearch
Related coverage
Semaglutide Ranked. “Semaglutide vs Tirzepatide 2026: What the Head-to-Head Trial Found.” S.J Partners LLC, 2026-07-26. https://semaglutideranked.com/semaglutide-vs-tirzepatide-2026/
Quote the capture date beside a figure, not the date you read this page. Why.
Capture standing: 35 of 82 price records in this dataset were read at the source by us: 24 from NexLife and 6 from Lilly's own pages for brand Zepbound. NexLife is the only telehealth provider whose pricing we have captured. Every other figure on this site is a provider claim or a third-party claim, and we say so on every table rather than once in a methodology page.