Semaglutide vs Tirzepatide Maintenance Doses: Complete Comparison
Choosing between semaglutide and tirzepatide for long-term weight maintenance is a critical decision. This comprehensive comparison examines maintenance doses, efficacy, side effects, costs, and real-world considerations to help you make an informed choice.
Quick Comparison Overview
| Factor | Semaglutide (Wegovy/Ozempic) | Tirzepatide (Zepbound/Mounjaro) |
|---|---|---|
| Typical Maintenance Dose | 1.0-2.4 mg weekly | 10-15 mg weekly |
| Average Weight Loss (Maintenance) | 15-17% total body weight | 20-22% total body weight |
| Side Effect Profile | Moderate GI symptoms | Similar to higher GI symptoms initially |
| Cost Range (Monthly) | $900-$1,400 without insurance | $1,000-$1,500 without insurance |
| FDA Approval | 2021 (Wegovy) | 2023 (Zepbound) |
Maintenance Dose Ranges Compared
Understanding typical maintenance doses helps set realistic expectations:
Semaglutide Maintenance
Low Maintenance: 0.5-1.0 mg
- • For early responders
- • Good weight stability
- • Minimal side effects
- • Lower cost option
Standard Maintenance: 1.7 mg
- • Most common maintenance dose
- • Balanced efficacy/tolerability
- • Sustained appetite control
- • FDA-studied dose
High Maintenance: 2.4 mg
- • Maximum approved dose
- • Greatest weight loss effect
- • Stronger appetite suppression
- • May have more GI effects
Tirzepatide Maintenance
Low Maintenance: 5-7.5 mg
- • For sensitive patients
- • Less common maintenance range
- • Reduced side effects
- • Still effective for many
Standard Maintenance: 10 mg
- • Most common maintenance dose
- • Strong efficacy
- • Well-tolerated after titration
- • Optimal for most patients
High Maintenance: 12.5-15 mg
- • Maximum approved dose
- • Superior weight loss
- • Greatest metabolic benefits
- • Higher cost
Efficacy: Head-to-Head Results
Clinical trials provide direct comparison data between these medications. See our detailed head-to-head comparison:
SURMOUNT-2 Trial Results (Direct Comparison)
- • Tirzepatide 15 mg: -21% average body weight loss
- • Semaglutide 2.4 mg: -15% average body weight loss
- • Tirzepatide showed 6% greater weight loss advantage
For a 250 lb person, this translates to approximately 52 lbs lost with tirzepatide vs. 38 lbs with semaglutide—a 14 lb difference on average.
Side Effect Profile Comparison
Both medications share similar side effect profiles with some notable differences:
Common to Both (During Titration & Early Maintenance)
- • Nausea (30-40% of patients)
- • Diarrhea or constipation (15-30%)
- • Abdominal discomfort (10-20%)
- • Fatigue (10-15%)
- • Reduced appetite (intended effect)
Key Differences
Semaglutide
- ✓ Slightly better GI tolerability for some
- ✓ Longer track record (more data)
- ⚠️ More frequent injection site reactions
Tirzepatide
- ✓ Dual mechanism may reduce GI adaptation time
- ✓ Better glycemic control for diabetics
- ⚠️ Slightly higher nausea rates in trials
Cost Comparison for Long-Term Maintenance
Cost is a critical factor for medications taken indefinitely. Here's what to expect:
Monthly Cost Breakdown
Semaglutide (Brand: Wegovy)
- • List price: $1,349-$1,430/month
- • With manufacturer coupon: $25-$550/month (eligibility criteria apply)
- • Compounded options: $200-$400/month (varies by pharmacy)
- • Insurance coverage: Variable (often requires prior authorization)
Tirzepatide (Brand: Zepbound)
- • List price: $1,059-$1,500/month (dose-dependent)
- • With manufacturer coupon: $25-$550/month (eligibility criteria apply)
- • Compounded options: $350-$500/month (varies by pharmacy)
- • Insurance coverage: Newer, less predictable coverage
Which Maintenance Dose Is Right for You?
Consider these factors when choosing between medications:
Choose Semaglutide If:
- ✓ You want a longer track record and more extensive safety data
- ✓ You've previously tried and tolerated GLP-1 medications well
- ✓ Your insurance covers Wegovy specifically
- ✓ You have more sensitive GI system and prefer conservative approach
- ✓ Weight loss goal is moderate (10-15% total body weight)
- ✓ Cost considerations favor semaglutide in your situation
Choose Tirzepatide If:
- ✓ You want maximum weight loss potential
- ✓ You have type 2 diabetes and need superior glycemic control
- ✓ You haven't responded optimally to semaglutide
- ✓ You're willing to tolerate potentially stronger initial side effects for greater efficacy
- ✓ Weight loss goal is more aggressive (15-25% total body weight)
- ✓ Your provider recommends based on your metabolic profile
Switching Between Medications
Some patients switch from semaglutide to tirzepatide or vice versa. Here's what to know:
Switching Strategy
Most common switch. Start tirzepatide at 2.5 mg weekly and titrate up. May see accelerated weight loss after 8-12 weeks at therapeutic doses.
Less common. Usually for side effect management or cost reasons. Start at 0.25-0.5 mg weekly and titrate up based on tolerance.
Generally not required. Can switch immediately after last dose of previous medication. Some providers prefer waiting one dose cycle.
Real-World Maintenance Success Rates
Beyond clinical trials, real-world data shows how patients maintain results:
1-Year Maintenance Data
Semaglutide
- • 70-75% maintain >10% weight loss at 1 year
- • 45-50% maintain >15% weight loss
- • Discontinuation rate: ~20-25% (side effects/cost)
Tirzepatide
- • 80-85% maintain >10% weight loss at 1 year
- • 60-65% maintain >15% weight loss
- • Discontinuation rate: ~15-20% (newer data emerging)
Get Expert Guidance on the Right Medication
Work with providers who can assess your individual needs and help you choose the optimal maintenance medication and dose.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Medication choice and dosing should be determined by a qualified healthcare provider based on individual patient factors, medical history, insurance coverage, and treatment goals.
References
- 1. Jastreboff AM, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205-216.
- 2. Garvey WT, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022;28(10):2083-2091.
- 3. Aronne LJ, et al. Tirzepatide for the treatment of obesity: Rationale and design of the SURMOUNT clinical trial program. Obesity. 2023;31(1):96-110.
- 4. Frias JP, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med. 2021;385(6):503-515.