Switching from semaglutide to tirzepatide: what you need to know

Interested in switching from semaglutide to tirzepatide? Understanding the differences between these medications can help you and your healthcare provider decide which one may be right for you, or if it's time to make a move from one to the other.

In this article, we’ll cover how to switch from semaglutide to tirzepatide and answer other frequently asked questions about this process. 

Both semaglutide and tirzepatide are once-weekly injections that can treat type 2 diabetes and obesity, when paired with diet and exercise. While they both work on the GLP-1 hormone, semaglutide and tirzepatide differ in three key ways:

1. Their mechanism of action (aka how they work)

2. The specific conditions they’re approved to treat

3. Their effectiveness at treating those conditions

Let’s start by reviewing their mechanism of action (how they work). 

Semaglutide’s mechanism

Semaglutide works by mimicking a naturally occurring hormone in your body called glucagon-like peptide-1 (GLP-1) and targeting its receptors throughout your body. That’s why it’s called a GLP-1 receptor agonist. 

As a GLP-1, semaglutide drugs like Ozempic and Wegovy work by:

• Slowing down how quickly food leaves your stomach

• Regulating your appetite by sending signals of satiety (fullness) to your brain

• Encouraging your pancreas to release more insulin after you eat

• Reducing the amount of glucose produced by your liver

Together, these effects help you feel full longer, reduce cravings, and keep your blood sugar levels in check. All of this explains why these drugs can be so effective at treating obesity and type 2 diabetes.

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Tirzepatide’s dual-action mechanism 

Tirzepatide mimics GLP-1, just like semaglutide, but it also mimics another hormone called glucose-dependent insulinotropic polypeptide (GIP). This dual-action mechanism is what makes tirzepatide more effective at all the things semaglutide does, including:

• Slowing down digestion

• Regulating your appetite

• Controlling blood sugar by increasing insulin production and inhibiting glucagon

Its dual-action approach is also most likely the reason tirzepatide can provide even greater weight loss and blood sugar control than medications that target only GLP-1, such as semaglutide. 

In a word: yes. Multiple studies have shown that tirzepatide can be more effective than semaglutide at both blood sugar control and weight loss. 

But that doesn’t mean it’s the best fit for everybody. Along with its greater weight loss and blood sugar control comes the potential for more intense side effects. 

Still, if you haven’t been experiencing benefits on Ozempic or Wegovy, it may be worth switching from semaglutide to tirzepatide to at least give it a try. 

Let’s take a closer look at how the two drugs compare. 

Weight loss results 

Several studies show that tirzepatide consistently beats semaglutide when it comes to weight loss. 

For example, according to a study of over 41,000 adults with obesity, people taking tirzepatide:

• Were nearly twice as likely to lose at least 5% of their body weight than those taking semaglutide

• Were more than twice as likely to lose at least 10% of their body weight, and more than three times as likely to lose at least 15% of their body weight.

• Lost more weight at each check-in point during the study (3 months, 6 months, and 1 year)

A separate study of adults with type 2 diabetes had similar findings. 

• People taking the highest dose of tirzepatide lost nearly 18% of their body weight. 

• People taking the highest dose of semaglutide, on the other hand, lost about 12.5%.

Blood sugar control 

Tirzepatide also appears to do a better job controlling blood sugar than semaglutide, according to research. 

In studies comparing Mounjaro vs. Ozempic (the forms of tirzepatide and semaglutide approved for type 2 diabetes):

• The two highest doses of tirzepatide drove greater reductions in HbA1c levels than any doses of semaglutide. 

• Participants also lost about twice as much weight on tirzepatide vs. semaglutide.

How much more does tirzepatide lower blood sugar when compared to semaglutide? Some studies have found that tirzepatide lowers HbA1c levels by an additional 0.15%–0.45%. Other studies have found an even larger difference — almost an entire percentage point! 

The difference depends on what dosages of tirzepatide and semaglutide are being used for the comparison. The highest doses of tirzepatide typically results in the greatest differences in HbA1c.

Who might benefit the most from switching from semaglutide to tirzepatide?

People who might benefit the most from switching from semaglutide to tirzepatide include those who:

• Haven’t lost as much weight as they hoped to on semaglutide, or have run into a weight loss plateau

• Haven’t reached their target HbA1c levels on semaglutide, or are hoping for further reductions

• Have another health condition that only tirzepatide is FDA-approved to treat, such as obstructive sleep apnea

If semaglutide hasn’t been working well for you, it might be worth switching to tirzepatide. Even if it has been working well — but not great — it might still be worth a discussion with your healthcare provider. 

Research shows that when people make the switch to tirzepatide, they lose even more body weight and achieve better blood sugar control in as little as three months. 

Yes, you can switch from semaglutide to tirzepatide if you and your healthcare provider decide that tirzepatide would be a better option for you. 

The first thing to consider is whether you’re a candidate for tirzepatide based on who it's meant for and what it’s been proven effective to treat. 

Taking tirzepatide for an FDA-approved condition can make it easier to get insurance coverage as well. Here’s a quick look at the conditions each version of tirzepatide has been approved for:

Whatever it’s prescribed for, tirzepatide is meant to be taken in combination with lifestyle changes such as diet and exercise.

There are many potential reasons why switching from semaglutide to tirzepatide might be beneficial.

Your weight loss goals 

Research suggests that tirzepatide leads to more weight loss than semaglutide. 

In a study comparing the two drugs for weight loss, people lost an average of 5.9% of their body weight in three months with tirzepatide, compared to 3.6% with semaglutide. After a year, tirzepatide led to a 15.3% decrease in body weight vs. 8.3% for semaglutide. 

While percentages may vary between studies, this could be due to different dosages or different characteristics of the study population. (For example, some studies look at those with diabetes while others look at those without diabetes.) The important thing is that tirzepatide consistently garners better results than semaglutide.

So if you’re not losing weight on semaglutide or think you’ve hit a plateau, tirzepatide could be worth a try.

Your tolerance for side effects

Both tirzepatide and semaglutide have similar side effects, like nausea, vomiting, and diarrhea. These side effects usually subside over time as your body gets used to the medication. But studies show that these side effects are usually — but not always — more common with tirzepatide.

However, everyone's body reacts differently, and studies don’t always predict individual experiences.  If you’ve been taking semaglutide and the side effects are too much, you could try switching to tirzepatide to see if it is more tolerable for you. If you continue to experience side effects or find that they worsen, tell your healthcare provider so they can adjust your treatment accordingly. 

Your insurance coverage or budget 

Both medications are expensive, but tirzepatide costs around $300 less per month based on the retail prices without insurance or discounts. 

• Zepbound’s list price is $1,086.37 for a month's supply

• Wegovy’s list price is $1,349.02 for a month's supply 

If cost is a concern, switching could save you money — especially if your insurance covers one medication but not the other. Speak with your healthcare provider and insurance company to get a better understanding of the financial details. (FYI, Ro’s Insurance Checker can also help you figure out coverage — for free!) 

Your blood sugar levels 

Studies show that tirzepatide outperforms semaglutide in controlling blood sugar levels. If you need additional blood sugar control after trying semaglutide for a while, you might want to consider switching from semaglutide to tirzepatide.

Bottom line: If any of these reasons resonate with you, it might be time to talk with your healthcare provider about making the switch. They can help determine if tirzepatide may be a better fit.

The first step to switching from semaglutide to tirzepatide is to schedule an appointment with a healthcare provider. 

Tell the provider that you’re interested in switching to tirzepatide and why. They’ll likely want to discuss how well you’ve tolerated semaglutide, your weight loss progress, and whether you’re meeting your health goals. 

If they recommend switching from semaglutide to tirzepatide, your healthcare provider will guide you through the process. Here’s what you can expect.

1. Stop semaglutide 3–10 days before the switch

Both tirzepatide and semaglutide are injected under the skin (subcutaneously) once a week. If you switch from one to the other, it’s likely you’ll start tirzepatide one week after your last dose of semaglutide.

In research involving people with type 2 diabetes who switched from semaglutide to tirzepatide, participants stopped semaglutide 3–10 days before starting tirzepatide. 

Your healthcare provider will provide you with specific instructions on how to time your switch from semaglutide to tirzepatide. 

If you still have semaglutide left, you shouldn’t continue to use it with tirzepatide. The drug label advises against using tirzepatide with other weight loss treatments, including GLP-1 agonists. 

That’s because there’s not enough research on the efficacy or safety of combining them. You could increase the risks of dangerous side effects by combining treatments against the advice of your healthcare provider, so be sure to follow their recommendations closely.

2. Begin tirzepatide at the recommended dose

Just like semaglutide, tirzepatide follows a gradual dosing schedule. Meaning, you will start at a low dose and work your way up over several weeks or months. This gives your body time to get used to the medication until you reach an effective maintenance dose.

Even if you were on a higher dosage of semaglutide, your healthcare provider may have you start at the recommended starting dosage of 2.5 mg weekly for tirzepatide. Then, about every four weeks, they may increase your dose by another 2.5 mg until you land on a maintenance dose that works well for you and keeps side effects manageable. The maximum dose of tirzepatide is 15 mg weekly.

It’s also possible your provider will have you start at a higher dose. In clinical studies, people successfully made the switch by starting at a 5 mg dose of tirzepatide. Side effects were manageable, and researchers concluded that this higher starting dose was safe. 

The bottom line? Your healthcare provider will decide your starting dosage for tirzepatide and prescribe it accordingly. As with all medications, be sure to take it as prescribed. 

3. Expect some side effects

As you probably know from taking semaglutide, GLP-1s can cause side effects. The same is true for tirzepatide. 

In an aforementioned study, about 13% of people experienced gastrointestinal (GI) side effects like nausea, constipation, and diarrhea after switching to tirzepatide. 

Tirzepatide’s side effects are similar to semaglutide and may include:

• Nausea

• Diarrhea

• Vomiting

• Constipation

• Stomach pain

• Indigestion

• Injection site reactions

• Fatigue

• Allergic reactions

• Belching

• Hair loss

• Heartburn 

It’s important to be aware of these side effects and report any new or severe symptoms to your provider. 

Your healthcare provider will recommend a starting dosage of tirzepatide for you. 

Some providers may have you start at the lowest dose of 2.5 mg of tirzepatide weekly; others may have you start at the next highest dose of 5 mg weekly. Studies have shown that 5 mg is safe and well-tolerated by people switching from semaglutide to tirzepatide. 

Your healthcare provider will personalize your initial dose based on individual factors such as how you respond to medication and your tolerance to side effects. Over time, your healthcare provider will gradually increase your dosage based on your response to the medication, any side effects you experience, and treatment goals. Stick to their recommendations and work closely with them to determine your dosing plan. 

Both tirzepatide and semaglutide can cause side effects. On the drugs, side effects tend to be worse at the beginning of treatment and when increasing your dose, then gradually improve with time. 

If you’re switching to tirzepatide, you may experience those side effects again and in fuller force. In a study of people who switched from semaglutide to tirzepatide, the most common side effects were nausea, constipation, and diarrhea. They ranged from mild to moderate in intensity. 

It’s also possible that you might experience more — or more intense — side effects on tirzepatide. Studies generally show that GI side effects are more common on tirzepatide, especially on higher doses. Serious side effects are also slightly more common on tirzepatide. 

If you have concerns about side effects during the transition or afterward, consult your healthcare provider. They can help you better understand your risk and offer guidance for managing side effects. 

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If you’re thinking about switching from semaglutide to tirzepatide, talk to your healthcare provider. Research suggests tirzepatide can lead to up to 1.5–2 times more weight loss and improved blood sugar control. 

• Tirzepatide works differently than semaglutide. Since it targets two hormones (GLP-1 and GIP) instead of just one (like semaglutide), it can be more effective for weight loss and blood sugar control.

• You may lose more weight. Studies show that people taking tirzepatide lose significantly more body weight, which may be especially helpful if you’ve hit a plateau on semaglutide.

• Blood sugar control may improve. Even at lower doses, tirzepatide can reduce HbA1c more than the highest doses of semaglutide.

• Side effects can be more common. While both medications cause GI symptoms like nausea and diarrhea, tirzepatide may trigger these more often.

• Cost and insurance coverage matter. Tirzepatide’s retail price is slightly lower than semaglutide’s, but coverage varies. Always check your plan before switching.