Tirzepatide vs Semaglutide: Key Differences & Side Effects

The Basics

If you’re comparing tirzepatide vs semaglutide, you’re not alone. Both are prescription medications typically taken as a weekly injection. Both may help curb appetite, which can make people feel less hungry and more satisfied after eating.

We’ll keep it easy: the differences, what they might feel like, and what to watch for so that you can decide with a licensed clinician what makes sense for you. Just a heads-up; this is general info, not medical advice. Everyone responds differently.

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Who They’re For: Based on FDA Indications

• Weight management (adults): Wegovy® (semaglutide) and Zepbound® (tirzepatide) are indicated for adults with BMI ≥30, or BMI ≥27 with at least one weight-related condition.
• Type 2 diabetes: Ozempic® (semaglutide) and Mounjaro® (tirzepatide) are indicated (with diet and exercise) to improve blood sugar control in people with type 2 diabetes.
• Sleep apnea: Zepbound® is also indicated to treat moderate to severe obstructive sleep apnea in adults with obesity.

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How Are They Different?

Both medications affect appetite and blood sugar signaling, but they’re not the same.

Semaglutide

Semaglutide is a GLP-1 receptor agonist. 

Here’s what you might notice: 

•  Feeling fuller sooner
• Thinking about foods less often
• Having an easier time sticking to smaller portions

Tirzepatide

Tirzepatide acts on both GLP-1 and GIP receptors. Like semaglutide, tirzepatide can support appetite control–helping you feel full sooner and making cravings easier to manage.

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On average, tirzepatide (as studied in the SURMOUNT trials and later marketed as Zepbound® for weight management and Mounjaro® for type 2 diabetes) tends to come out ahead in studies (about 20-21% vs about 15% in the STEP weight-management trials of semaglutide 2.4 mg  [Wegovy®], a separate trial). But everyone’s experience is different, especially when it comes to side effects.

If you’re comparing semaglutide vs tirzepatide for weight management, this “one pathway vs two pathways” difference is usually the simplest place to start.

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What Do These Medications Feel Like?

When someone starts treatment, they often say that it doesn’t feel dramatically different. But there’s less mental noise around food, and they have an easier time stopping when they’re satisfied.

People often describe:

• Less food noise (you still get hungry, but it doesn’t feel as urgent)
• More satisfaction from meals, so stopping earlier feels easier
• Less intense cravings, especially for sweets or snack foods
• Sometimes less interest in alcohol over time

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Side Effects and Important Safety Notes

No matter which direction you’re leaning in the tirzepatide vs semaglutide conversation, the side effect list overlaps quite a bit.

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• Common side effects
• Nausea
• Diarrhea
• Constipation
• Vomiting
• reflux/indigestion
• decreased appetite

These are often more noticeable during dose increases and may improve after your body adjusts.

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Serious Risks And Warnings to Discuss With Your Doctor

These medications have important warnings and are not appropriate for everyone. A clinician may advise against use (or use extra caution) depending on your history, including:

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• thyroid C-cell tumor warning (do not use if you or a family member has medullary thyroid cancer or MEN2)
• history of pancreatitis
• gallbladder disease
• kidney issues, especially if dehydration occurs from vomiting/diarrhea
• low blood sugar risk when combined with certain diabetes medications
• severe allergic reactions

Seek medical care promptly for severe or persistent abdominal pain, ongoing vomiting, dehydration symptoms, or anything that feels urgent.

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How to Choose Between Semaglutide And Tirzepatide

Rather than asking which one is “best,” most clinicians think in terms of fit:

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your medical history and current medications

• How sensitive your stomach tends to be
• Whether type 2 diabetes treatment is part of the picture
• Your goals and how you respond as the dose is adjusted
• What you can access (coverage, supply, out-of-pocket cost)

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Helpful questions to ask:

• “What would you start with for someone like me—and why?”
• “If side effects show up, what’s the plan?”
• “How will we decide whether to adjust the dose or switch options?”

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A Note on Compounded Medications (If They Come Up)

Compounded medications are not FDA-approved and do not undergo FDA review for safety, effectiveness, or manufacturing quality. A compounded medication may be prescribed only when a licensed prescriber determines a clinically significant difference for an identified patient. Formulations and potency may vary by pharmacy.

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Ready For The Next Step?

If you’re deciding between tirzepatide vs semaglutide, the best next step is a clinical evaluation that looks at your health history, goals, and how you tend to tolerate side effects. With Eden, you can start by completing the intake, then a licensed provider reviews your information and helps you figure out what makes the most sense for your body and your goals. Not everyone qualifies, and eligibility depends on your health history.

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