Tirzepatide vs Semaglutide: Pros and Cons

[Nelson Vergel]

Tirzepatide and semaglutide are both injectable medications used for weight loss and type 2 diabetes management, but they differ in their mechanisms of action and effectiveness. Here's a comparison of the two drugs:

Mechanism of Action​

Tirzepatide:

• Dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist
• Activates both GIP and GLP-1 receptors

Semaglutide:

• Selective GLP-1 receptor agonist
• Activates only GLP-1 receptors

Effectiveness for Weight Loss​

Tirzepatide:

• Associated with greater weight loss compared to semaglutide
• In a study of adults with overweight or obesity:
  • Patients were 1.76 times more likely to achieve ≥5% weight loss
  • 2.54 times more likely to achieve ≥10% weight loss
  • 3.24 times more likely to achieve ≥15% weight loss compared to semaglutide

Semaglutide:

• Effective for weight loss, but generally less so than tirzepatide
• Approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition

Effectiveness for Type 2 Diabetes​

Both medications are effective in treating type 2 diabetes, but tirzepatide has shown superior results:Tirzepatide:

• In a 40-week trial, tirzepatide at doses of 5 mg, 10 mg, or 15 mg was superior to semaglutide 1 mg in reducing glycated hemoglobin levels
• 82-86% of patients reached the target glycated hemoglobin level of <7.0%

Semaglutide:

• Effective in lowering blood sugar levels in adults with type 2 diabetes
• 79% of patients reached the target glycated hemoglobin level of <7.0% in the same trial

Dosage and Administration​

Tirzepatide (Zepbound):

• Weekly subcutaneous injection
• Dosage increased over 4-20 weeks to target doses of 5 mg, 10 mg, or 15 mg

Semaglutide (Wegovy):

• Weekly subcutaneous injection
• Typical dose for weight loss is 2.4 mg

Side Effects​

Both medications have similar side effect profiles, with gastrointestinal issues being the most common:

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal discomfort

Considerations​

• Tirzepatide is a newer medication, approved by the FDA in November 2023 for chronic weight management
• Semaglutide has been in use longer and has more established safety data
• Both medications should be used in conjunction with diet and exercise for optimal results
• Neither medication is recommended for patients with a history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2

In conclusion, while both tirzepatide and semaglutide are effective medications for weight loss and type 2 diabetes management, current evidence suggests that tirzepatide may be more effective in achieving weight loss and glycemic control. However, the choice between the two should be made in consultation with a healthcare provider, considering individual patient factors, medical history, and treatment goals.

Citations:
[1] Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity
[2] FDA Approves New Medication for Chronic Weight Management
[3] Medications Containing Semaglutide
[4] https://www.nejm.org/doi/full/10.1056/NEJMoa2107519
[5] Tirzepatide (Subcutaneous Route) Description and Brand Names - Mayo Clinic
[6] Semaglutide, also known as Ozempic, for weight loss - what you need to know