Semaglutide vs. tirzepatide, side by side.

The two most-talked-about weight management medications, compared in plain language: how they work, what the research showed, side effects, cost, and how you and a clinician might choose between them.

Updated October 16, 2026

This page is for general education and is not medical advice. Only a licensed clinician who reviews your health history can decide whether a treatment is right for you.

At a glance

	Semaglutide	Tirzepatide
How it works	Acts on one hormone receptor: GLP-1	Acts on two hormone receptors: GIP and GLP-1
How it's taken	Injection under the skin, once a week	Injection under the skin, once a week
Dosing	Starts low and increases gradually over several weeks	Starts low and increases gradually over several weeks
Average weight loss in the head-to-head trial*	About 13.7% of body weight at 72 weeks	About 20.2% of body weight at 72 weeks
Most common side effects	Nausea, diarrhea, constipation, vomiting	Nausea, diarrhea, constipation, vomiting
At Sequence	Compounded · from $160/month with a 3-month plan	Compounded · from $220/month with a 3-month plan

*From the SURMOUNT-5 trial of the FDA-approved medications, at the highest doses people could tolerate, alongside diet and exercise counseling. Compounded medications were not studied, and individual results vary.

How each one works

After you eat, your gut releases hormones that tell your brain you're full, slow how quickly your stomach empties, and help manage blood sugar. Both medications are designed to act like these natural signals.

Semaglutide

Acts on the GLP-1 receptor. Many people notice they feel full sooner, have fewer food cravings, and think about food less often.

Tirzepatide

Acts on both the GLP-1 receptor and the GIP (glucose-dependent insulinotropic polypeptide) receptor. Acting on two pathways is thought to be one reason it led to more weight loss on average in trials, though researchers are still studying exactly why.

What the research showed

These results come from large clinical trials of the FDA-approved medications, taken alongside diet and exercise counseling. They describe averages. Some people lose more, some less, and some stop because of side effects.

Head-to-head (SURMOUNT-5): 751 adults with obesity and without diabetes. After 72 weeks, those on tirzepatide lost an average of 20.2% of their body weight, compared with 13.7% on semaglutide. Waist size also decreased more with tirzepatide.
Semaglutide on its own (STEP 1): adults taking 2.4 mg weekly lost an average of about 15% of their body weight over 68 weeks, compared with about 2% on placebo.
Tirzepatide on its own (SURMOUNT-1): adults taking the highest dose lost an average of about 21% of their body weight over 72 weeks, compared with about 3% on placebo.

Beyond the number on the scale, trials of both medications also showed improvements in measures like blood sugar, blood pressure and waist size.

An important difference Sequence offers compounded semaglutide and compounded tirzepatide. Compounded medications are not FDA-approved, are not the products studied in these trials, and the FDA does not evaluate them for safety, effectiveness, or quality. Your results may differ from the trial results above.

Side effects and safety

The two medications have very similar side effects and the same important warnings. Digestive side effects are the most common and are usually most noticeable when starting or increasing a dose. In the head-to-head trial, slightly fewer people stopped tirzepatide than semaglutide because of digestive side effects.

Both carry warnings about possible thyroid C-cell tumors (seen in rodent studies), pancreatitis, gallbladder problems, low blood sugar when combined with certain diabetes medicines, kidney problems from dehydration, and serious allergic reactions. Our weight management guide covers these in detail, including who should not take them.

Cost at Sequence

Pricing depends on your dose and plan. Compounded semaglutide starts at $160/month and compounded tirzepatide at $220/month with a 3-month plan. Pricing applies only if a licensed provider prescribes treatment. See full pricing on the semaglutide and tirzepatide pages.

How a clinician helps you choose

There isn't one right answer for everyone. A licensed clinician looks at your full picture, including:

Your health history, current medications and any conditions that affect which option is safe for you
How you've responded to any medication you've tried before, including side effects
Your goals and how quickly you want to increase doses
Cost and what fits your budget over time

Some people start with one and later switch, which should only be done with your clinician's guidance.

Frequently asked questions

Is tirzepatide stronger than semaglutide?

In a head-to-head trial of the FDA-approved versions, adults taking tirzepatide lost more weight on average than those taking semaglutide over 72 weeks. Averages do not predict any one person's result, and the better choice depends on your health history, how you tolerate each medication, and cost.

Can I switch from semaglutide to tirzepatide?

Sometimes. Switching should only be done with your clinician, who will decide whether it makes sense and what starting dose to use. Never combine the two or change doses on your own.

Do they have the same side effects?

Mostly. Both commonly cause digestive side effects such as nausea, diarrhea, constipation and vomiting, especially when starting or increasing a dose, and both carry the same important safety warnings.

Are compounded versions the same as the medications studied in trials?

No. Compounded semaglutide and tirzepatide are not FDA-approved and were not the products studied in these clinical trials. Results with compounded medications may differ.

Not sure which is right for you?

Complete a short health intake and a licensed clinician will review it and talk through your options with you.

Start your intake Completing an intake does not guarantee treatment. Prescriptions are issued only when a licensed provider determines they are clinically appropriate. Compounded medications are not FDA-approved.