Semaglutide vs Retatrutide

The GLP-1 drug in Ozempic and Wegovy vs Lilly's triple agonist still in phase 3

By MoveWell Research Team Updated November 1, 2026

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Which one for what

Semaglutide is approved, with heart and kidney outcome data; retatrutide beat Ozempic 2 mg in one trial reported by press release but isn't approved or legally available.

  • Any use today: semaglutide
  • Weight loss vs Ozempic 2 mg in type 2 diabetes: retatrutide (one trial, press release)
  • Heart or kidney risk: semaglutide
  • A pill: semaglutide
  • Retatrutide today: clinical trials only

See all three side by side: Semaglutide vs Tirzepatide vs Retatrutide

Sequence diagram of semaglutide showing its 31 amino acids and the side chain at Lys26
SemaglutideGLP-1 agonist · 31 amino acidsSemaglutide guide
Schematic, not a structure: retatrutide activating the GIP, GLP-1 and glucagon receptors
RetatrutideSchematic only: sequence not verified in our sourcesRetatrutide guide
In this guide
  1. Verdict
  2. At a glance
  3. Evidence by goal
  4. Head-to-head trials
  5. Side effects
  6. Key differences
  7. Can you use both?
  8. Where to get each
  9. FAQ
  10. References

At a glance

SemaglutideRetatrutide
What it isGLP-1 receptor agonist. A modified GLP-1 peptide with a fatty acid chain that binds albumin1GIP, GLP-1 and glucagon receptor agonist, a "triple agonist"2, 3
StatusFDA-approved as three brands (Ozempic, Wegovy and Rybelsus), as weekly injections and daily tablets1, 4, 5, 6Not approved anywhere. In phase 3. Lilly plans to submit a Biologics License Application to FDA in Q1 2027 and has given no approval date3, 7
Evidence5/5FDA-approved, with large outcome trials4/5Phase 2 trials and two phase 3 trials published (TRIUMPH-1 in NEJM and TRIUMPH-2 in the Lancet, September 29, 2026). Other phase 3 results are Lilly press releases8, 9
Dosing frequencyWeekly injection (Ozempic, Wegovy, Wegovy HD) or daily tablet (Rybelsus, Ozempic tablets, Wegovy pill)1, 4, 5Weekly injection, in clinical trials only. No approved dose10
Oral optionYes. Wegovy pill for weight; Rybelsus and Ozempic tablets for type 2 diabetes1, 5, 6No
Self-pay price (US)Injections: $349 a month for Wegovy (0.25 to 2.4 mg) and Ozempic (0.25 to 1 mg); Ozempic 2 mg $499 (per Nov 2025 announcement)11, 12. Wegovy pill: $149 to $299 a month by dose (at launch, Jan 2026)13No lawful price. Retatrutide sold online is unapproved14
Main side effectsNausea (44% vs 16% on placebo with Wegovy 2.4 mg), diarrhea, vomiting, constipation1Nausea (42.4% vs 14.8% at 12 mg in TRIUMPH-1), diarrhea, constipation, vomiting; abnormal skin sensation (dysesthesia)15
Boxed warningThyroid C-cell tumors in rodents. Don't use with a personal or family history of medullary thyroid cancer or with MEN 21No label. No boxed warning has been set

Evidence scale: 5 FDA-approved, 4 strong human, 3 limited human, 2 animal or lab only, 1 anecdotal. Prices are self-pay with a prescription, as checked November 1, 2026, and change often. Current per-dose Wegovy pill prices are Unverified.

Retatrutide can't be bought legally. Any retatrutide sold today, including vials labeled "research use only," is unapproved and unlawful to sell for human use. FDA has said compounded retatrutide doesn't qualify for the compounding exemptions and recommends that consumers not buy unapproved products containing it14. It sent warning letters to at least three sellers on December 10, 2024, calling their products "unapproved new drugs" despite research-only labels16, 17, 18. In Aug 2026 Lilly sued six companies it says sold counterfeit retatrutide19, and in Jun 2026 health officials in Victoria, Australia, reported six cases of liver injury across Australia linked to products labeled retatrutide, possibly from a contaminant20. The only legal way to take it is in a clinical trial. See the peptide regulatory tracker for FDA actions.

Evidence by goal

Each goal is graded separately. Approved means an FDA-approved use. Trial data means human trial results but no approval for that use. "No study found" means no data in the sources we reviewed.

GoalSemaglutideRetatrutide
Weight lossApproved5/5Wegovy. STEP 1 (n=1,961): −14.9% vs −2.4% on placebo at 68 weeks21. The 25 mg pill: −13.6% vs −2.2% at 64 weeks22Trial data4/5TRIUMPH-1 (n=2,339; NEJM): −25.0% on 12 mg vs −3.9% on placebo at 80 weeks8. Lilly's May 2026 press release also gave −28.3% vs −2.2% counting only people who stayed on treatment (efficacy estimand), which makes the gap look larger15
Type 2 diabetesApproved5/5Ozempic, Ozempic tablets and Rybelsus, for blood sugar4, 5, 6Trial data4/5Phase 2: A1C down up to 2.02 points vs 1.41 on dulaglutide at 24 weeks2. Phase 3: TRIUMPH-2 (n=1,152; Lancet), in obesity with type 2 diabetes: −18.8% body weight on 12 mg vs −5.1% on placebo at 80 weeks, counting everyone who started9; TRANSCEND-T2D-1 and -2 reported by press release23, 7 Press release
Heart attack and stroke riskApproved5/5Wegovy, based on SELECT (n=17,604): 6.5% vs 8.0%, HR 0.80, in people with heart disease and overweight, without diabetes24, 1. Ozempic and Rybelsus have heart-risk indications in type 2 diabetes only4, 5Trial dataTRIUMPH-3 (n=1,949, established heart disease) included pre-planned heart-event analyses; neither was significant: MACE-5 HR 0.82 (0.55–1.22), MACE-3 HR 1.12 (0.64–1.96). No result from a dedicated heart-outcome trial yet3 Press release
Sleep apneaNo study foundNo data in the sources we reviewedTrial data3/5Limited: one pre-specified TRIUMPH-1 substudy (n=243): apnea-hypopnea index (AHI) fell −31.7 events per hour on 12 mg vs −9.9 on placebo at 80 weeks (NEJM; first presented at ADA, Jun 2026). Not an approved use8, 25
Kidney diseaseApproved5/5Ozempic, in type 2 diabetes. FLOW (n=3,533): 24% lower risk of kidney decline, kidney failure or death26, 4No study foundNo data in the sources we reviewed
MASH (fatty liver)Approved5/5Wegovy, accelerated approval for noncirrhotic MASH with F2–F3 fibrosis. ESSENCE: resolved in 62.9% vs 34.3%27, 28No study foundNo data in the sources we reviewed
Heart failure (HFpEF)Trial data4/5STEP-HFpEF (n=529): symptom score +16.6 vs +8.7. Not an approved use29No study foundNo data in the sources we reviewed

Two retatrutide phase 3 trials are peer reviewed: TRIUMPH-1 in NEJM and TRIUMPH-2 in the Lancet, both published September 29, 20268, 9. TRIUMPH-3, TRIUMPH-4 and the TRANSCEND-T2D results are so far Lilly press releases.

Head-to-head trials

  • TRANSCEND-T2D-2Retatrutide vs Ozempic 2 mgPress release
    Type 2 diabetes on metformin, n=1,298, 80 weeks, open label. A1C −2.2 vs −1.8 points; weight −20.9% (12 mg) vs −9.4%, counting people who stayed on treatment (efficacy estimand). Side effects, 12 mg vs Ozempic: nausea 23.8% vs 21.3%; stopped for side effects 7.9% vs 2.7%; dysesthesia 6.5% vs 2.7%. Lilly press release, October 28, 2026; not peer reviewed. Ozempic 2 mg is a diabetes dose, not Wegovy's weight dose7, 30

Without more direct trials, the best overview is a 2025 review of 26 trials in about 15,491 adults without diabetes. Placebo-adjusted weight loss was about 22% for retatrutide 12 mg (one 48-week phase 2 trial), 18% for tirzepatide 15 mg (72 weeks) and 14% for semaglutide 2.4 mg (68 weeks)31. The trials were too different to pool, so the reviewers ran no combined analysis, and the retatrutide figure predates phase 332.

Numbers from separate trials can't be ranked against each other: lengths (68 and 80 weeks), populations and analysis methods differ.

Side effects

All carry mostly stomach side effects that are worst while the dose is going up. Rates are each drug vs placebo in its own trials, not a head-to-head comparison.

EffectSemaglutideRetatrutide
SourceWegovy 2.4 mg vs placebo, label112 mg vs placebo, TRIUMPH-115 Press release
Nausea44% vs 16%42.4% vs 14.8%
Diarrhea30% vs 16%32.0% vs 13.5%
Vomiting24% vs 6%25.3% vs 4.8%
Constipation24% vs 11%26.1% vs 10.9%
Stopped for side effects6.8% vs 3.2% (Wegovy 2.4 mg, label)111.3% vs 4.9% (TRIUMPH-1, 12 mg)15
Stands outNAION, a sudden optic-nerve problem: a very rare side effect per Europe's regulator, up to 1 in 10,000. Not on US labels33, 1Dysesthesia (tingling or touch-sensitive skin): 12.5% vs 0.9% in TRIUMPH-1 and 20.9% at 12 mg in TRIUMPH-415, 34. Heart rate rose early in phase 2, peaking at 24 weeks10

Semaglutide and tirzepatide labels list warnings for serious allergic (hypersensitivity) reactions, pancreatitis, gallbladder disease, low blood sugar (with insulin or insulin secretagogues), kidney injury from dehydration, diabetic eye complications and inhaling stomach contents under anesthesia1.

Key differences

  • Approved vs not. Semaglutide is FDA-approved as three brands: Ozempic, Wegovy and Rybelsus1, 4, 5. Retatrutide is investigational, with a filing planned for Q1 20273.
  • Receptors. Semaglutide hits the GLP-1 receptor only. Retatrutide also hits GIP and glucagon receptors1, 2.
  • Head to head. In TRANSCEND-T2D-2, people with type 2 diabetes lost 20.9% on retatrutide 12 mg vs 9.4% on Ozempic 2 mg over 80 weeks, counting people who stayed on treatment. That's a Lilly press release, not yet peer reviewed7.
  • Track record. Semaglutide has outcome trials for heart and kidney events24, 26. Retatrutide's only heart-event data so far are pre-planned analyses in TRIUMPH-3, neither significant (HR 0.82 and 1.12); there is no result from a dedicated heart-outcome trial yet3.
  • Pill or injection. Semaglutide comes as a tablet or injection. Retatrutide is a weekly injection in trials1, 10.

Can you use both?

NoNot tested, not legal

Retatrutide isn't approved, so it isn't a legal option alongside semaglutide, and we found no study of combining them.

FDA actions on GLP-1 compounding and retatrutide sellers are on the peptide regulatory tracker.

Where to get each

MoveWell sells nothing. Prices as checked November 1, 2026

DrugOptionFormPriceNotes
SemaglutideNovoCareWegovy or Ozempic pen$349 a month (Wegovy to 2.4 mg, Ozempic to 1 mg); Ozempic 2 mg $499 (per Nov 2025 announcement)11, 12Prescription needed. Also at retail pharmacies
SemaglutideNovoCareWegovy pill$149 (1.5 mg) to $299 (9 and 25 mg) a month at launch, Jan 202613Prescription needed. Current pill prices Unverified
SemaglutideNovoCare provider finderTelehealth prescriptionVaries by serviceNovoCare listed seven services in Jan 2026 and said it does not endorse them35
SemaglutideNovoCare coverage checkInsuranceDepends on planCoverage depends on your plan and diagnosis
RetatrutideNot available legally. Clinical trials onlyNone approvedNo lawful priceFind a trial on ClinicalTrials.gov. Anything sold today is unapproved and unlawful to sell for human use14, 16

Left off: compounded copies and "research use only" vials. FDA declared the semaglutide shortage over on February 21, 202536. The Fifth Circuit upheld that decision on August 27, 202637. Routine compounded copies are no longer allowed, and FDA says compounded drugs are not FDA-approved and not the same as generics38. Compounded retatrutide has no lawful path14. More on the regulatory tracker. More options in the Semaglutide guide.

FAQ

Did retatrutide beat Ozempic?

In one trial, yes, per Lilly's press release: 20.9% vs 9.4% weight loss among people who stayed on treatment, and a larger A1C drop, over 80 weeks in type 2 diabetes. It hasn't been peer reviewed, and Ozempic 2 mg isn't the Wegovy weight dose.

Is retatrutide approved?

No. Lilly plans to file in Q1 2027.

Can I buy retatrutide instead of Wegovy?

Not legally. Anything sold today is unapproved, and FDA recommends consumers not buy it.

Is there a retatrutide pill?

No. It's a weekly injection in trials. Semaglutide comes as a tablet or an injection.

References

38 sources, with links
  1. FDA. Wegovy (semaglutide) injection and tablets, prescribing information, revised 05/2026. PDF
  2. Rosenstock J et al. Retatrutide, a GIP, GLP-1 and glucagon receptor agonist, for people with type 2 diabetes: a phase 2 trial. Lancet 2023 (online Jun 26, 2023). doi:10.1016/S0140-6736(23)01053-X. Author PDF
  3. Eli Lilly press release (via BioSpace). TRIUMPH-2 and TRIUMPH-3 topline results; BLA submission planned for Q1 2027 (Jul 23, 2026). Link
  4. FDA. Ozempic (semaglutide) injection, prescribing information, revised 05/2026. PDF
  5. FDA. Rybelsus (semaglutide) tablets, prescribing information, revised 10/2025. PDF
  6. BNN Bloomberg. Novo to launch Ozempic pill for diabetes in second quarter of 2026 (Feb 4, 2026). Link
  7. Eli Lilly press release. TRANSCEND-T2D-2: retatrutide vs Ozempic 2 mg, topline results (Oct 28, 2026). Not peer reviewed. Link
  8. Jastreboff AM, Kaplan LM, Davies MJ et al. Retatrutide, a triple hormone receptor agonist, for treatment of obesity (TRIUMPH-1). NEJM, published online Sep 29, 2026. doi:10.1056/NEJMoa2604169. Summary: GPnotebook
  9. Bellido V, le Roux CW, Ekinci EI et al. Retatrutide in adults with obesity and type 2 diabetes (TRIUMPH-2). Lancet, published online Sep 29, 2026. doi:10.1016/S0140-6736(26)01861-1. Summary: Cardioteca
  10. Jastreboff AM et al. Triple-hormone-receptor agonist retatrutide for obesity: a phase 2 trial. NEJM 2023 (online Jun 26, 2023). doi:10.1056/NEJMoa2301972. Author PDF
  11. ABC7. Cash price of popular weight-loss drug Wegovy dropping, manufacturer says (Nov 17, 2025). Link
  12. Fierce Pharma. Novo unveils newly reduced self-pay prices for Wegovy, Ozempic after White House deal (Nov 2025). Link
  13. KVIA (CNN Health). Starter dose of Wegovy now available as a daily pill instead of weekly injection (Jan 5, 2026). Link
  14. FDA letter to the Federation of State Medical Boards on retatrutide (Apr 2, 2025), posted by the Arizona Board of Osteopathic Examiners. Link
  15. Eli Lilly press release. TRIUMPH-1 topline results (May 21, 2026). Link
  16. FDA warning letter. Swisschems (Dec 10, 2024). fda.gov
  17. FDA warning letter. Prime Vitality Inc. dba Prime Peptides (Dec 10, 2024). fda.gov
  18. FDA warning letter. Summit Research Peptides (Dec 10, 2024). fda.gov
  19. Healio. Eli Lilly files lawsuits against six companies for allegedly selling retatrutide (Aug 14, 2026). Link
  20. Victoria Department of Health. Toxicity linked to unapproved peptide product labelled retatrutide (Jun 19, 2026). Link
  21. Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). NEJM 2021;384:989–1002. Abstract: J Endocr Soc 2021;5(Suppl 1):A10. PMC8089593
  22. AJMC. FDA approves oral semaglutide as first GLP-1 pill for weight loss (OASIS 4). Link
  23. Eli Lilly press release. TRANSCEND-T2D-1 topline results (Mar 19, 2026). Link
  24. American College of Cardiology. SELECT trial summary (Lincoff, NEJM 2023;389:2221–32). Link
  25. HCPLive. Retatrutide improves weight loss, knee osteoarthritis pain, sleep apnea versus placebo (TRIUMPH-1, NEJM; Sep 29, 2026). Link
  26. HCPLive. FDA approves semaglutide (Ozempic) for type 2 diabetes and chronic kidney disease (Jan 28, 2025). Link
  27. HCPLive. FDA approves semaglutide (Wegovy) injection 2.4 mg for noncirrhotic MASH (Aug 15, 2025). Link
  28. Healio. Semaglutide tied to significant improvements in MASH, liver fibrosis at 72 weeks (ESSENCE; May 1, 2025). Link
  29. American College of Cardiology. STEP-HFpEF trial summary (Kosiborod, NEJM 2023;389:1069–84). Link
  30. STAT. Retatrutide vs Ozempic: Lilly diabetes study (Oct 28, 2026). Link
  31. Drugs.com / HealthDay. Some GLP-1s achieve more weight loss than others (on Moiz et al., Ann Intern Med, Jan 2025). Link
  32. TheNNT. Efficacy of tirzepatide, retatrutide and semaglutide for weight loss in obese individuals without diabetes (review of Moiz et al.). Link
  33. European Medicines Agency. PRAC concludes eye condition NAION is a very rare side effect of semaglutide medicines Ozempic, Rybelsus and Wegovy (Jun 6, 2025). Link
  34. Eli Lilly press release. TRIUMPH-4 topline results (Dec 11, 2025). Link
  35. STAT. Telehealth swoops in offering Wegovy pill (Jan 6, 2026). Link
  36. Foley & Lardner. GLP-1 drugs: FDA removes semaglutide from drug shortage list (Feb 2025). Link
  37. US Court of Appeals for the Fifth Circuit. No. 25-10758 (semaglutide shortage decision, affirming FDA), unpublished (Aug 27, 2026; revised Sep 1, 2026). PDF
  38. FDA. FDA warns 30 telehealth companies against illegal marketing of compounded GLP-1s (Mar 3, 2026). fda.gov

This page is for education and is not medical advice. Retatrutide is not approved and is available only in clinical trials. Talk to a clinician before starting, stopping or switching any of these drugs.