Semaglutide vs Tirzepatide: How the Two GLP-1s Compare
Semaglutide and tirzepatide are the two medications behind almost every GLP-1 conversation, and they are not the same drug. Semaglutide works on one gut hormone pathway, tirzepatide works on two, and in the only trial that compared them directly, tirzepatide produced more weight loss. That does not automatically make it the right one for you. Here is what actually separates them, including what each costs at Elara.
Medically reviewed by Elara Care Team (Elara editorial, clinical claims reviewed with Wasef Health). Last reviewed September 3, 2026.
| Feature | Semaglutide | Tirzepatide |
|---|---|---|
| How it works | Single agonist. Mimics GLP-1, the gut hormone that signals fullness and slows how quickly the stomach empties. | Dual agonist. Acts on GLP-1 and on GIP, a second gut hormone, which is why it is described as working on two pathways at once. |
| Brand versions | Ozempic, approved for type 2 diabetes, and Wegovy, approved for chronic weight management. Both from Novo Nordisk. | Mounjaro, approved for type 2 diabetes, and Zepbound, approved for chronic weight management and for obstructive sleep apnea with obesity. Both from Eli Lilly. |
| Weight change in its own trial | About 15 percent of body weight at 68 weeks on 2.4 mg, in the STEP 1 trial. | About 21 percent of body weight at 72 weeks on 15 mg, in the SURMOUNT-1 trial. |
| Head to head result | About 13.7 percent at 72 weeks. | About 20.2 percent at 72 weeks. SURMOUNT-5 is the only trial that put the two against each other in the same population. |
| Dosing | Once weekly injection, started low and stepped up over months, to a maximum of 2.4 mg for weight management. | Once weekly injection, the same slow titration, to a maximum of 15 mg. |
| Common side effects | Nausea, reduced appetite, constipation or diarrhea, mostly in the first weeks and while the dose is climbing. | The same gastrointestinal pattern, and in the head to head trial the two were broadly comparable, with most effects mild to moderate. |
| Compounded price at Elara | $247 for one month, $590 for three months, $1,190 for six months. | $355 for one month, $890 for three months, $1,790 for six months. |
| Low dose option | Available as a GLP-1 microdosing plan. | Also available as a GLP-1 microdosing plan. |
| Track record | In use since 2017 for diabetes and 2021 for weight management, so the longer real world history. | In use since 2022 for diabetes and 2023 for weight management, so newer, with the stronger trial numbers. |
What the head to head trial showed
Until 2025, comparing these two meant lining up separate trials run on different people, which is a weak way to compare anything. SURMOUNT-5 changed that: adults with obesity were randomized to one medication or the other and followed for 72 weeks. Tirzepatide produced about 20.2 percent average weight reduction against about 13.7 percent for semaglutide.
That gap is real and worth knowing. It is also an average across a trial population, not a forecast for one person. Plenty of women reach their goal on semaglutide, and the trial average tells you nothing about which one your body tolerates.
Why the bigger average is not automatically the better choice
- Cost. Compounded semaglutide runs $247 for a month against $355 for tirzepatide, and over a year that difference is real money.
- Tolerability. The medication you can stay on beats the one you stop after six weeks because the nausea was unmanageable.
- Where you are starting. A smaller goal does not need the stronger option, and a slower approach is a legitimate plan rather than a compromise.
- Response varies. Some women respond well to one and barely to the other, and there is no test that predicts which in advance.
What they share
Both carry the same boxed warning about thyroid C-cell tumors seen in rodent studies, and neither is prescribed to anyone with a personal or family history of medullary thyroid carcinoma or MEN 2. Neither is used in pregnancy or while breastfeeding. Your provider reviews your history before anything is prescribed.
Both are prescription only, both are once weekly injections, both work best alongside eating and movement changes rather than instead of them, and both tend to see weight return if the medication stops without a plan.
Starting either one
Elara prescribes both after a free online consultation reviewed by a licensed provider, and you are only charged if you are prescribed. Compare the compounded semaglutide plans and the compounded tirzepatide plans, see every price on the pricing page, or start from the weight care overview.
If the dose rather than the molecule is your question, GLP-1 microdosing uses either medication at a lower dose. If you are weighing the brand versions instead, see Ozempic vs Wegovy and Mounjaro vs Zepbound.
Frequently asked questions
Is tirzepatide better than semaglutide?
In the one head to head trial, SURMOUNT-5, tirzepatide produced more average weight loss over 72 weeks, about 20.2 percent against 13.7 percent. Better on average is not the same as better for you: cost, how well you tolerate it, and your own goal all matter, and your provider weighs them with you.
Can I switch from one to the other?
Yes, and it is common. Your provider sets the starting dose on the new medication rather than matching the one you left, because the two are dosed on completely different scales.
Are the compounded versions the same as Ozempic or Zepbound?
They contain the same active ingredient, but they are not the same product. Compounded medications are prepared per prescription for you by licensed US 503A pharmacies, and they are not reviewed by the FDA for safety or effectiveness the way a brand product is.
Which one is cheaper at Elara?
Compounded semaglutide, at $247 for one month against $355 for compounded tirzepatide. Both drop on longer plans, to $1,190 and $1,790 for six months.
Do I have to pay to find out which one is right for me?
No. The consultation is free, a licensed provider reviews your intake, and you are only charged if you are prescribed.