Zepbound vs. Ozempic for Weight Loss

When it comes to weight loss medications, two of the newest and most talked-about are Zepbound and Ozempic. Both have shown promising results in helping people lose weight. However, some key differences between these drugs are important when considering weight loss treatment options.

This article compares and contrasts Zepbound and Ozempic in terms of their mechanisms of action, FDA-approved uses, dosages, efficacy in clinical trials, potential side effects, costs, and insurance coverage implications.

1. Mechanism of Action

Zepbound and Ozempic belong to the GLP-1 receptor agonists, but they work slightly differently. Here is an overview of how they work to promote weight loss:

Zepbound

Zepbound (tirzepatide) is a GIP and GLP-1 receptor agonist. It activates GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) hormone receptors.

By doing so, Zepbound helps in weight loss by reducing appetite and slowing food movement from the stomach into the small intestine. This leads to a feeling of fullness, making individuals eat less and aiding in weight management.

Ozempic

On the other hand, Ozempic (semaglutide) is also a GLP-1 receptor agonist that works by binding to GLP-1 receptors. It helps lower blood sugar levels, increase insulin production, decrease liver sugar production, and slow down food passage through the digestive tract.

While Ozempic is primarily approved for treating type 2 diabetes, it has also shown effectiveness in weight loss. The weekly injection of Ozempic, similar to Zepbound, contributes to appetite suppression and sustained weight reduction.

2. Approved Uses

While Zepbound is approved for weight management, Ozempic is currently just indicated for type 2 diabetes. Below outlines the FDA-approved indications for both medications:

Zepbound

Zepbound is approved by the U.S. FDA for chronic weight management in adults with obesity (BMI of 30 kg/m² or greater) or adults who are overweight (BMI of 27 kg/m² or greater) and have weight-related medical problems, such as:

• Hypertension
• Dyslipidemia
• Type 2 diabetes mellitus
• Obstructive sleep apnea
• Cardiovascular disease

The medication is designed to be used with diet and increased physical activity.

Ozempic

Ozempic is indicated for the treatment of type 2 diabetes in adults. It is utilized to improve blood sugar levels and has also demonstrated efficacy in lowering the risk of major cardiovascular events, such as stroke, heart attack, or death, in adults with type 2 diabetes and heart disease.

Additionally, Ozempic has shown the ability to contribute to weight loss in clinical trials. However, it's important to note that Ozempic is not specifically FDA-approved for weight loss; its primary approval is for managing type 2 diabetes.

3. Dosage and Administration

Zepbound and Ozempic have different starting doses that are increased weekly based on individual responses. Here’s a breakdown:

Zepbound

Zepbound is available in a pre-filled single-dose pen with strengths ranging from 2.5 mg to 15 mg per 0.5 mL. The recommended initiation for Zepbound is a 2.5 mg subcutaneous injection once a week, with subsequent increases to 5 mg, 10 mg, or 15 mg based on the individual's response.

Zepbound injections can be administered into the thigh, abdomen, or upper arm, and it is advised to rotate the injection site with each dose. The flexibility of changing the weekly administration day allows for individual preferences as long as a three-day interval is maintained between doses.

Ozempic

Ozempic is offered in subcutaneous injection pens with strengths of 0.25 mg, 0.5 mg, 1 mg, and 2 mg. The initiation of Ozempic involves a 0.25 mg subcutaneous injection once a week for the first 4 weeks, followed by an increase to 0.5 mg and further titration to 1 mg or 2 mg as needed.

Similar to Zepbound, Ozempic injections can be administered into the abdomen, thigh, or upper arm, with a recommendation to avoid injecting into the same site consecutively. The day of weekly administration for Ozempic can be altered, ensuring a two-day interval between doses.

4. Efficacy for Weight Loss

Studies show Zepbound drives substantial weight loss, while Ozempic also demonstrates meaningful but off-label effects. See below for the summary of clinical trial data on weight loss efficacy with both medications:

Zepbound

The study on tirzepatide, branded as Zepbound, presents promising results for weight loss in individuals with obesity. In a 72-week trial involving 2539 adults, Zepbound demonstrated substantial and sustained reductions in body weight across its three dosage levels—5 mg, 10 mg, and 15 mg. The percentage change in weight ranged from -15.0% to -20.9%, significantly outperforming the placebo. Moreover, a high percentage of participants achieved a weight reduction of 5% or more, with even more impressive results for those reaching a 20% reduction.

The improvements extended beyond weight loss, as prespecified cardiometabolic measures also showed positive outcomes with Zepbound. Although gastrointestinal events were the most common adverse effects, they were mostly mild to moderate and occurred primarily during dose escalation. Importantly, the trial emphasized the safety and efficacy of Zepbound for individuals with obesity, offering a valuable option for weight management.

Ozempic

While Ozempic, with its active compound semaglutide, is not explicitly marketed as a weight loss drug, studies sponsored by Novo Nordisk, the manufacturer of Ozempic, suggest weight loss benefits. In a clinical trial with 1961 adults without diabetes, those taking 2.4 milligrams of semaglutide (the dose in the FDA-approved weight loss drug Wegovy) experienced a substantial 14.9% body weight loss over 68 weeks, outperforming the placebo. This underscores the potential weight loss effects of semaglutide, the key ingredient in Ozempic.

However, it's crucial to note that Ozempic is FDA-approved solely for treating diabetes, not weight loss. Its higher-dose counterpart, Wegovy, is specifically indicated for weight management. Individuals using Ozempic off-label for weight loss should be aware of potential insurance coverage issues, as Ozempic is typically covered, while Wegovy may not be.

Despite the efficacy of semaglutide in promoting weight loss, discontinuing Ozempic may lead to weight regain. Studies suggest that stopping Ozempic completely could result in regaining most of the lost weight within several months. It emphasizes the importance of considering GLP-1 medications like Ozempic as chronic treatments for chronic conditions, highlighting the need for long-term use for sustained benefits.

5. Side Effects

Both medications may cause mostly gastrointestinal reactions, as well as serious effects needing prompt medical attention. Below outlines some of the side effects reported with Zepbound and Ozempic:

Zepbound

Zepbound may cause both common and serious side effects. Common side effects, affecting 5% or more patients, include:

• Abdominal pain
• Burping
• Constipation
• Diarrhea
• Dyspepsia
• Fatigue
• Gastroesophageal reflux disease
• Hair loss
• Hypersensitivity reactions
• Injection site reactions
• Nausea
• Vomiting

On the more serious side, individuals using Zepbound should seek emergency medical help if they experience signs of an allergic reaction, such as:

• Hives
• Difficulty breathing
• Swelling of the face, lips, tongue, or throat

Other serious side effects include pancreatitis with symptoms of severe pain in the upper stomach spreading to the back, nausea, and vomiting. Patients should also contact their doctor promptly for:

• Severe stomach problems
• Eye side effects or vision changes
• Signs of a thyroid tumor
• Gallbladder problems
• Kidney problems

It's crucial to note that this is not an exhaustive list, and individuals may experience other side effects. If any unusual symptoms occur, consulting a healthcare professional is recommended.

Ozempic

Similarly, Ozempic has common and serious side effects. Common side effects include:

• Low blood sugar (in people with type 2 diabetes)
• Upset stomach
• Heartburn
• Burping
• Gas
• Bloating
• Nausea
• Vomiting
• Stomach pain
• Loss of appetite
• Diarrhea
• Constipation
• Runny nose
• Sore throat
• Headache
• Dizziness
• Tiredness

Serious side effects necessitating immediate medical attention involve:

• Signs of an allergic reaction
• Vision changes
• Unusual mood changes
• Pounding heartbeats
• A light-headed feeling
• Signs of a thyroid tumor
• Symptoms of pancreatitis
• Gallbladder problems
• Low blood sugar
• Kidney problems
• Stomach flu symptoms
• Symptoms of ileus (stomach paralysis)

As with Zepbound, this list is not exhaustive, and individuals should promptly report any unexpected or severe side effects to their healthcare provider.

6. Cost

Weighing affordability plays a key role in access. See below for the list prices and potential out-of-pocket costs for Zepbound and Ozempic:

Zepbound

Zepbound, used for weight loss, comes with a list price of $1,059.87 for six doses ranging from 2.5 to 15 mg. This list price is approximately 20% lower than semaglutide 2.4 mg injection for weight loss. However, it's important to note that the list price does not necessarily reflect the typical out-of-pocket cost for patients, considering insurance coverage and discounts.

For individuals with commercial insurance coverage for Zepbound, there is an option to pay as low as $25 for a 1-month or 3-month prescription. Those commercially insured without coverage may still benefit, with the potential to pay as low as $550 for a 1-month prescription—approximately 50% lower than the list price. This cost reduction is facilitated through a commercial savings card program.

Ozempic

The cost of Ozempic subcutaneous solution varies depending on the dosage and quantity. For the 2 mg/1.5 mL (0.25 mg or 0.5 mg dose), the price is around $994.86 for a supply of 1.5 milliliters. The same price applies to the 2 mg/3 mL, 4 mg/3 mL, and 8 mg/3 mL (2 mg dose) options. These prices are for cash-paying customers and may not be valid with insurance plans. It's worth noting that Ozempic is available only as a brand-name drug and no generic version is currently on the market.

Various savings options are available to help offset the cost of Ozempic. The Drugs.com Discount Card can save customers up to 80% or more of the prescription cost and is accepted at major pharmacies nationwide.

Wrap Up

Zepbound and Ozempic are promising new weight-loss medications but differ significantly in their approval status, efficacy, side effects, costs, and insurance coverage. While both show the ability for weight reduction in studies, Zepbound is specifically FDA-approved for chronic weight management. In contrast, Ozempic is only approved for type 2 diabetes currently.

Careful consideration of the benefits and downsides of a medical provider can clarify if one may suit an individual's situation.

Can I take Zepbound and Ozempic together?

No, Zepbound and Ozempic should not be used together since they contain similar medications. Combining them provides no added benefit and increases the risk of side effects.

How long do Zepbound and Ozempic take to work?

Zepbound and Ozempic can start lowering blood sugar and A1C levels within 1-2 weeks, but maximum effects may take up to 12-16 weeks.

How long will I need to take Zepbound or Ozempic?

Zepbound and Ozempic are both meant for long-term use to manage type 2 diabetes. You would typically continue the medication unless your doctor advises stopping or if intolerable side effects occur.

What should I avoid while using Zepbound or Ozempic?

Avoid dense carbohydrates and sugars, which can spike blood sugar. Limit alcohol, which can also impact blood glucose levels, especially if taking sulfonylureas or insulin.