Comparison

Semaglutide vs Tirzepatide 2026: What the Head-to-Head 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 cardiovascular

Dr. Parmis, Editorial Lead · Jonathan Michael Snipes, MD, Medical Reviewer

Published 2026-05-02Updated 2026-05-02Sources captured 2026-07-26Medically reviewed not yet — why

Direct answer

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 lacks in that population — and it is about $40 a month cheaper compounded.

Answer last reviewed: 2026-07-26

What did the head-to-head actually find?

SURMOUNT-5: the only randomised head-to-head
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%	Phase 3b, open-label, active-controlled, n=751	72 weeks

Three caveats travel with that result. It was open-label. 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 disputed. It belongs in the citation anyway.

Where does semaglutide win, and it is not weight?

The evidence each molecule actually holds
Question	Semaglutide	Tirzepatide
Mean weight loss, pivotal trial	14.9% (STEP-1)	22.5% (SURMOUNT-1)
Head-to-head	13.7%	20.2%
Completed cardiovascular outcomes trial	SELECT: 20% MACE reduction	No completed equivalent in that population
Approved oral form	Yes, $149/month	No
Cheapest captured, 12-month	$145	$186
Brand self-pay, manufacturer direct	$349	$299–$449 by dose
Salt-form question applies	Yes	No equivalent

The asymmetry that decides it for some people

SELECT is the reason to consider 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. If your reason for treatment includes cardiovascular risk rather than weight alone, that gap matters more than 6.5 percentage points.

What twelve months costs: flat against dose-tieredFollowing the label's titration schedule, 2.5 mg to a maintenance dose

Show this figure as a table

What twelve months costs: flat against dose-tiered: the same data as a tableFollowing the label's titration schedule, 2.5 mg to a maintenance dose

What twelve months costs: flat against dose-tiered: the same data 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

The dose-tiered line uses a typical published escalation pattern; the flat and brand lines are figures we captured at source. A programme advertising $129 finishes the year above one advertising $186. That crossover is the argument this whole site is built on. How we record price structure.

Which costs less over twelve months?

Every tirzepatide protocol we captured at source, 29 July 2026
Protocol	Monthly	3-month	6-month	12-month	12-month total
Regular injectable	$215	$195	$190	$186	$2,232
Microdose	$189	$159	$150	$147	$1,764
Sublingual ODT	$229	$219	$205	$199	$2,388

Plan totals as published, each reconciled against its own monthly rate. Two microdose totals differ by $1–$2 from the rate multiplied by the term; we record the monthly rate, which is what a patient is billed — COR-012.

Every semaglutide protocol we captured at source, 29 July 2026
Protocol	Monthly	3-month	6-month	12-month	12-month total
Regular injectable	$165	$149	$147	$145	$1,740
Microdose	$129	$117	$114	$110	$1,320
Sublingual ODT	$199	$185	$177	$165	$1,980

One published plan total does not reconcile against its own monthly rate: the sublingual 3-month plan states $597 against $185 × 3 = $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 tirzepatide at every equivalent term — about $490 a year. Real, but smaller than the gap between a flat programme and a tiered one in either molecule.

Which has worse side effects?

Gastrointestinal adverse events, pivotal trials
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 and 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 has an approved oral form at $149.
Lowest twelve-month cost: semaglutide, by about $490.
Buying compounded semaglutide: ask the salt form. Sodium and acetate are not the same active ingredient as the base, and the FDA has said they are not appropriate for compounding. 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.

Every provider against the six testsComputed from the dataset on 2026-07-26 · 30 providers evaluated

Every provider against the six tests
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

Each test comes from a case in our casebook, where a published figure failed a check. The table is generated from the records, not written.

The result

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.

Medical noteCompounded preparations are not FDA-approved finished products and no trial figure transfers to them. Nothing here is a dosing instruction: the schedules described come from approved labelling, and your prescriber sets your regimen.

Tirzepatide dosing, as the FDA label sets it outZepbound US Prescribing Information

Tirzepatide dosing, as the FDA label sets it out
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

Escalation is driven by tolerability and response, not by a calendar. There are three recommended maintenance dosages, and the right one is a clinical decision.

Why 'cheapest' needs a definition attached

Why 'cheapest' needs a definition attached
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

Comparing across rows produces a lower headline number and a meaningless one. We never do it, and neither should a provider quoting you a price.

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, 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, not a head-to-head on tolerability.

How rankings are computedCore & Trust
All-in cost toolTools
Price records, machine-readableData
Ro Body vs Hims & HersComparisons
Hims & Hers vs Henry MedsComparisons
Brand-Name vs Compounded TirzepatidePillar / Money
Tirzepatide for Type 2 DiabetesResearch
Tirzepatide and Sleep Apnea: Evidence and FDA StatusJournal
Compounded vs Brand Tirzepatide: Legal and Evidence DifferencesJournal
NexLife vs Hims & HersComparisons

Cite this pageCC BY 4.0

GLP-1 Tirzepatide Ranked. “Semaglutide vs Tirzepatide 2026: What the Head-to-Head Found.” S.J Partners LLC, 2026-07-26. https://glp1tirzepatideranked.com/semaglutide-vs-tirzepatide-2026/

Quote the capture date beside a figure, not the date you read this page. Why.

Report an error

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.