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semaglutide (Wegovy) to tirzepatide (Zepbound). Dose mapping, washout, expected side effects, and the editorial verdict.
Plateau on semaglutide is the most common reason. Zepbound (tirzepatide) shows ~5-6 percentage points more weight loss versus Wegovy in head-to-head SURMOUNT-5 (May 2026 readout). Tirzepatide adds GIP receptor activity to the GLP-1 mechanism.
No formal washout, but restart at Zepbound 2.5 mg, not equivalent dose. The receptor profile differs, so the dose-response curve does not translate one-to-one. Expect 16-20 weeks to reach maintenance.
Wegovy-to-Zepbound is the most-asked switch in our editorial queue, driven by the SURMOUNT-5 readout.
GI side effects (nausea, constipation) reset because you are titrating again. Tirzepatide tends to cause less nausea than semaglutide at matched efficacy in some patients, but more burping or sulfur taste.
Both have weight-loss PA pathways. Plans that authorized Wegovy generally authorize Zepbound. LillyDirect cash-pay vials at $349/mo (2.5-5 mg) or $499/mo (7.5+ mg) are the most aggressive cash price in the category.
LillyDirect undercuts NovoCare on cash-pay. Insurance copays usually similar tier.
If Wegovy is working and you are still losing, do not switch for marginal gain. The transition resets titration and adds 2-3 months of side-effect adjustment.
Editorial summary, not medical advice. Drug switches should be coordinated with your prescriber. Dose conversions reflect typical practice; your prescriber may adjust based on tolerance, comorbidities, or interactions.