What to know about switching from Zepbound to Ozempic

In this article:

• Can you switch from Zepbound to Ozempic?
• What are the benefits of switching from Zepbound to Ozempic?
• How to switch from Zepbound to Ozempic
• Zepbound vs. Ozempic dosage comparison
• Side effects from stopping Zepbound and starting Ozempic
• Who should not take Ozempic?

In this article

• Can you switch from Zepbound to Ozempic?
• What are the benefits of switching from Zepbound to Ozempic?
• How to switch from Zepbound to Ozempic
• Zepbound vs. Ozempic dosage comparison
• Side effects from stopping Zepbound and starting Ozempic
• Who should not take Ozempic?

If you have Type 2 diabetes, obesity, or both, you’ve probably heard of the injectable medications that lower blood sugar and suppress appetite. Zepbound (tirzepatide) and Ozempic (semaglutide) are two examples. That said, while both cause weight loss, only Zepbound is FDA approved for weight management, while using Ozempic for weight loss is considered off-label. 

Some people may wonder whether it’s possible to switch from Zepbound to Ozempic for weight loss, whether due to side effects, insurance coverage, or even a new diagnosis of Type 2 diabetes. The answer depends on whether your healthcare provider agrees that the switch would be beneficial.

Can you switch from Zepbound to Ozempic?

You can switch from Zepbound to Ozempic if your healthcare provider recommends doing so. Still, it’s important to know that these are different drugs with different active ingredients, dosages, and intended uses.

Zepbound is classified as a dual-action GIP/GLP-1 receptor agonist. Ozempic is only a GLP-1 receptor agonist and does not affect GIP receptors. These drugs also have different approved uses. 

Although you can switch from Zepbound to Ozempic if your healthcare provider recommends it, there’s no guarantee that insurance will cover Ozempic. Insurance is more likely to cover a medication if it is prescribed for one of its FDA-approved uses. 

What are the benefits of switching from Zepbound to Ozempic?

Switching from Zepbound to Ozempic isn’t recommended for everyone. “Zepbound is more effective for weight loss, so switching is typically not going to be more beneficial,” says Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California. 

Research shows that tirzepatide, the active ingredient in Zepbound, can reduce body weight by up to 21%, whereas semaglutide, the active ingredient in Ozempic, reduces body weight by up to 11%—although results may vary based on individual experiences and dose. 

A cohort study of 18,386 patients on tirzepatide or semaglutide (the active ingredients in Zepbound and Ozempic, respectively) found similar results. After three months on the medication, tirzepatide users lost an average of 5.9% of their body weight, whereas semaglutide users lost an average of 3.6% of their body weight. After six months, tirzepatide users had lost about 10.1% of their body weight compared to 5.8% lost for semaglutide users. After 12 months of treatment, tirzepatide body weight loss was 15.3% compared to semaglutide’s 8.3%.

Ultimately, switching from Zepbound to Ozempic is unlikely to result in greater weight loss. However, sometimes switching medications has benefits unrelated to weight loss. In these cases, a healthcare professional may decide that discontinuing Zepbound to start Ozempic could be a good move.

Diabetes treatment and cardiovascular risk reduction

Ozempic is FDA approved to help lower blood sugar levels in people with Type 2 diabetes and reduce the risk of heart attacks and strokes in people with cardiovascular disease. It’s also FDA approved for people with both Type 2 diabetes and chronic kidney disease. This means people on Zepbound who have Type 2 diabetes, heart disease, or kidney disease could benefit from switching to Ozempic. Insurance coverage is also more likely when switching to Ozemipic for an FDA-approved reason.

Side effects

Individual responses vary, but fewer or less intense side effects could be a potential benefit of switching from Zepbound to Ozempic. Both Zepbound and Ozempic may cause common side effects such as nausea, diarrhea, constipation, and vomiting. Like all drugs, Zepbound and Ozempic also present a risk of allergic reaction (including injection site reactions since these drugs are administered subcutaneously). 

However, Zepbound may be more likely than Ozempic to cause side effects. In clinical trials of Ozempic, 36.4% of participants on a standard maintenance dose of 1 mg/week experienced gastrointestinal side effects. In clinical trials of Zepbound, 56% of participants at all doses experienced gastrointestinal side effects. 

RELATED: Ozempic side effects in females

Cost  and coverage

The list prices of Zepbound and Ozempic are both high, but Zepbound costs over $100 more per month. Since these drugs are intended to be used long-term, this price difference could equate to thousands of dollars throughout treatment. 

Insurance coverage is often the biggest factor in determining an individual’s out-of-pocket drug cost. In general, Ozempic is covered by insurance more often than Zepbound is, especially since some health plans have dropped Zepbound from their drug formulary (list of preferred drugs).

RELATED: Does Kaiser cover Ozempic?

Some patients might save significant money by switching from Zepbound to Ozempic if their insurance covers Ozempic. That said, coverage varies by insurance company and policy, and Ozempic is typically only covered for Type 2 diabetes and other FDA-approved uses, but may not be covered for weight loss.

Zepbound vs. Ozempic comparison chart
	Zepbound	Ozempic
Percentage weight loss at 3 months	5.9%	3.6%
Percentage weight loss at 6 months	10.1%	5.8%
Percentage weight loss at 12 months	15.3%	8.3%
Approved uses	Weight loss Obstructive sleep apnea	Type 2 diabetes Reduced cardiovascular risk Kidney disease
Covered by insurance?	Varies by plan, may require prior authorization	Varies by plan, may require prior authorization
Average retail price per month*	$1,512	$1,388
SingleCare price*	$950	$825

*Average price at the time of publication. Drug prices fluctuate and vary by pharmacy.

How to switch from Zepbound to Ozempic

The first step when switching from Zepbound to Ozempic is to consult a healthcare provider. Only a healthcare professional familiar with your medical and family history, other health conditions, and other medications you are taking can offer personalized medical advice.

According to Dr. Pepin, switching from Zepbound to Ozempic typically involves “a washout period” of stopping Zepbound and waiting for it to clear from the body before starting at the lowest Ozempic dose.

Here is an example transition period schedule for a patient whose healthcare provider recommends a typical washout period of two weeks: 

1. Administer the last dose of Zepbound on the first Monday of the month.
2. Wait for Zepbound to clear from your system (some healthcare professionals recommend waiting up to two weeks).
3. Administer Ozempic at the lowest dose, 0.25 mg, on the third Monday of the month.
4. Continue at the lowest Ozempic dose for three more weeks.
5. Increase Ozempic dosage to 0.5 mg the fifth time it is administered (after one month), then continue at 0.5 mg/week three more times.
6. Continue increasing the dosage every four weeks as needed, as determined by your healthcare provider.  

RELATED: What is the maximum dose of Ozempic?

Zepbound vs. Ozempic dosage comparison
	Zepbound	Ozempic
Month 1	2.5 mg/week	0.25 mg/week
Month 2	5 mg/week	0.5 mg/week
Month 3	5 mg or 7.5 mg/week	0.5 mg or 1 mg/week
Month 4	5 mg or 10 mg/week	0.5 mg, 1 mg, or 2 mg/week
Month 5	5 mg, 10 mg, or 12.5 mg/week	0.5 mg, 1 mg, or 2 mg/week
Month 6 and thereafter	5 mg, 10 mg, or 15 mg/week	0.5 mg, 1 mg, or 2 mg/week

These are example schedules of dosing for weight loss. Your dosing schedule may vary based on your individual needs, so always follow the schedule prescribed by your healthcare provider.

Side effects from stopping Zepbound and starting Ozempic

There are no side effects explicitly associated with stopping Zepbound to start Ozempic. Zepbound and Ozempic share most of the same potential side effects, including:

• Gastrointestinal issues (nausea, diarrhea, constipation, vomiting, abdominal pain)
• Injection site reactions (redness, itching, bumps, or swelling)

Serious adverse effects include hypoglycemia (especially when used along with insulin or certain diabetes medicines), pancreatitis, gallbladder problems, kidney injury, and worsening diabetic retinopathy. Zepbound and Ozempic also have boxed warnings about thyroid cancer—however, this risk has been found in animal studies but not established in human studies.

Because these are different medications and individual responses vary, Dr. Pepin recommends telling your healthcare provider about any new or worsening side effects, even common ones. 

How to minimize Ozempic side effects 

“I recommend people eat smaller, more frequent meals to manage gastrointestinal symptoms,” Dr. Pepin says. She also emphasizes the importance of staying hydrated to help prevent constipation and reporting persistent or severe side effects to a healthcare professional to avoid worsening adverse reactions. “It’s always a good idea to schedule follow-up appointments with the doctor to monitor progress,” she says.

RELATED: When is the best time to inject Ozempic?

Who should not take Ozempic?

Ozempic may worsen or increase the risks of other health conditions. Specifically, Ozempic should be avoided in people with the following medical conditions:

• A personal or family history of medullary thyroid carcinoma
• Multiple Endocrine Neoplasia syndrome type 2 (MEN2), a rare type of cancer syndrome
• Known sensitivity (previous allergic reaction) to other semaglutide products such as Wegovy, Rybelsus, or compounded semaglutide, or to any ingredient in Ozempic

Individuals with a history of pancreatitis or diabetic retinopathy might also be recommended to avoid Ozempic. It’s also important to tell your healthcare provider if you are pregnant or plan to become pregnant because there is limited data on the safety of Ozempic use during pregnancy or breastfeeding.