Semaglutide vs Tirzepatide vs Retatrutide

Three weekly weight-loss and diabetes drugs: one GLP-1, one dual GIP/GLP-1 and one triple agonist still in trials

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Which one for what

Tirzepatide led to more weight loss than semaglutide head to head; semaglutide has the most approved uses and the only pill; retatrutide's trial weight losses are large, but it hasn't been compared with tirzepatide, isn't approved and can't be bought legally.

  • Most weight loss, approved: tirzepatide
  • Type 2 diabetes: no winner
  • Heart risk without diabetes: semaglutide
  • Sleep apnea: tirzepatide
  • Kidney disease or MASH: semaglutide
  • A pill: semaglutide
  • Retatrutide today: clinical trials only
Sequence diagram of semaglutide showing its 31 amino acids and the side chain at Lys26
SemaglutideGLP-1 agonist · 31 amino acidsSemaglutide guide
Diagram of tirzepatide's label-confirmed changes: Aib at positions 2 and 13, a C20 fatty diacid on Lys20 and a C-terminal amide
TirzepatideGIP + GLP-1 · label changes only; letters not shownTirzepatide 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 combine them?
  8. Where to get each
  9. FAQ
  10. References

At a glance

SemaglutideTirzepatideRetatrutide
What it isGLP-1 receptor agonist. A modified GLP-1 peptide with a fatty acid chain that binds albumin1GIP and GLP-1 receptor agonist. A peptide based on the GIP sequence, with a fatty diacid that binds albumin2GIP, GLP-1 and glucagon receptor agonist, a "triple agonist"3, 4
StatusFDA-approved as three brands (Ozempic, Wegovy and Rybelsus), as weekly injections and daily tablets1, 5, 6, 7FDA-approved: Mounjaro (May 13, 2022) and Zepbound (November 8, 2023)8, 9Not approved anywhere. In phase 3. Lilly plans to submit a Biologics License Application to FDA in Q1 2027 and has given no approval date4, 10
Evidence5/5FDA-approved, with large outcome trials5/5FDA-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 releases11, 12
Dosing frequencyWeekly injection (Ozempic, Wegovy, Wegovy HD) or daily tablet (Rybelsus, Ozempic tablets, Wegovy pill)1, 5, 6Weekly injection only: single-dose pen, single-dose or multi-dose vial, or multi-dose KwikPen2, 13Weekly injection, in clinical trials only. No approved dose14
Oral optionYes. Wegovy pill for weight; Rybelsus and Ozempic tablets for type 2 diabetes1, 6, 7No. Every labeled form is an injection2, 13No
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)15, 16. Wegovy pill: $149 to $299 a month by dose (at launch, Jan 2026)17Zepbound vial or KwikPen $299 to $449 a month by dose, with a refill within 45 days. Mounjaro $499 a month, all doses18, 19No lawful price. Retatrutide sold online is unapproved20
Main side effectsNausea (44% vs 16% on placebo with Wegovy 2.4 mg), diarrhea, vomiting, constipation1Nausea (25% to 29% vs 8% on placebo with Zepbound), diarrhea, vomiting, constipation; hair loss 4% to 5% vs 1%2Nausea (42.4% vs 14.8% at 12 mg in TRIUMPH-1), diarrhea, constipation, vomiting; abnormal skin sensation (dysesthesia)21
Boxed warningThyroid C-cell tumors in rodents. Don't use with a personal or family history of medullary thyroid cancer or with MEN 21Same warning and same contraindication2No 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.

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.

GoalSemaglutideTirzepatideRetatrutide
Weight lossApproved5/5Wegovy. STEP 1 (n=1,961): −14.9% vs −2.4% on placebo at 68 weeks27. The 25 mg pill: −13.6% vs −2.2% at 64 weeks28Approved5/5Zepbound. SURMOUNT-1 (n=2,539): −20.9% on 15 mg vs −3.1% on placebo at 72 weeks29Trial data4/5TRIUMPH-1 (n=2,339; NEJM): −25.0% on 12 mg vs −3.9% on placebo at 80 weeks11. 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 larger21
Type 2 diabetesApproved5/5Ozempic, Ozempic tablets and Rybelsus, for blood sugar5, 6, 7Approved5/5Mounjaro, for adults and children 10 and older13Trial data4/5Phase 2: A1C down up to 2.02 points vs 1.41 on dulaglutide at 24 weeks3. 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 started12; TRANSCEND-T2D-1 and -2 reported by press release30, 10 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 diabetes31, 1. Ozempic and Rybelsus have heart-risk indications in type 2 diabetes only5, 6Approved5/5Mounjaro, in type 2 diabetes at high heart risk (August 28, 2026)32. SURPASS-CVOT vs dulaglutide: HR 0.92, non-inferior; superiority not shown33. Not approved for heart risk without diabetesTrial 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 yet4 Press release
Sleep apneaNo study foundNo data in the sources we reviewedApproved5/5Zepbound, the first drug approved for sleep apnea (with obesity). Breathing pauses −25.3 vs −5.3 per hour without CPAP34, 35Trial 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 use11, 36
Kidney diseaseApproved5/5Ozempic, in type 2 diabetes. FLOW (n=3,533): 24% lower risk of kidney decline, kidney failure or death37, 5No study foundNo data: no kidney indication13No 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%38, 39No study foundNo data in the sources we reviewed. Not an approved use2, 13No 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 use40Trial data4/5SUMMIT (n=731): heart death or worsening heart failure 9.9% vs 15.3%41. Not approved: Lilly withdrew the US application after FDA asked for another trial42No 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, 202611, 12. TRIUMPH-3, TRIUMPH-4 and the TRANSCEND-T2D results are so far Lilly press releases.

Head-to-head trials

  • SURMOUNT-5Tirzepatide vs semaglutidePublished
    Obesity without diabetes, n=751, 72 weeks, open label, highest tolerated dose (tirzepatide 10 or 15 mg; semaglutide 1.7 or 2.4 mg). Weight −20.2% vs −13.7%; waist −18.4 vs −13.0 cm. Stopped for stomach side effects 2.7% vs 5.6%43
  • SURPASS-2Tirzepatide vs semaglutide 1 mgPublished
    Type 2 diabetes, n=1,879, 40 weeks. A1C −2.01 to −2.30 points vs −1.86. Tirzepatide arms lost 1.9 to 5.5 kg more44, 45
  • 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 dose10, 46
  • TRIUMPH-5Retatrutide vs tirzepatideOngoing
    Obesity. No results yet10

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)47. The trials were too different to pool, so the reviewers ran no combined analysis, and the retatrutide figure predates phase 348.

Numbers from separate trials can't be ranked against each other: lengths (68, 72 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.

EffectSemaglutideTirzepatideRetatrutide
SourceWegovy 2.4 mg vs placebo, label1Zepbound 15 mg vs placebo, label212 mg vs placebo, TRIUMPH-121 Press release
Nausea44% vs 16%28% vs 8%42.4% vs 14.8%
Diarrhea30% vs 16%23% vs 8%32.0% vs 13.5%
Vomiting24% vs 6%13% vs 2%25.3% vs 4.8%
Constipation24% vs 11%11% vs 5%26.1% vs 10.9%
Stopped for side effects6.8% vs 3.2% (Wegovy 2.4 mg, label)16.2% vs 2.6% (SURMOUNT-1, 15 mg)2911.3% vs 4.9% (TRIUMPH-1, 12 mg)21
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 labels49, 1Hair loss 4% to 5% vs 1%2Dysesthesia (tingling or touch-sensitive skin): 12.5% vs 0.9% in TRIUMPH-1 and 20.9% at 12 mg in TRIUMPH-421, 50. Heart rate rose early in phase 2, peaking at 24 weeks14

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, 2.

Key differences

  • Receptors. Semaglutide hits one receptor (GLP-1), tirzepatide two (GIP and GLP-1) and retatrutide three (GIP, GLP-1 and glucagon)1, 2, 3.
  • Approved vs not. Semaglutide and tirzepatide are FDA-approved. Retatrutide isn't approved anywhere; Lilly plans to file in Q1 20274.
  • Weight loss. Tirzepatide beat semaglutide head to head (20.2% vs 13.7%)43. Retatrutide beat Ozempic 2 mg in diabetes (20.9% vs 9.4% among people who stayed on treatment, press release)10. It hasn't been compared with tirzepatide yet.
  • Approved uses. Semaglutide covers the most: kidney disease in type 2 diabetes, MASH and heart risk without diabetes (Wegovy). Tirzepatide is the one approved for sleep apnea37, 38, 31, 34.
  • Pill. Only semaglutide comes as a tablet1, 2.
  • Price. Self-pay: semaglutide injections $349 a month for most doses, Zepbound $299 to $449 by dose15, 18. Retatrutide has no lawful price.

Can you combine them?

Don't combineLabel limit

The Zepbound label says using it with other tirzepatide products or any GLP-1 receptor agonist, which includes semaglutide, is not recommended2. Retatrutide isn't approved, so it isn't a legal option to add to either. Switching from one approved drug to another is a prescriber's call.

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)15, 16Prescription needed. Also at retail pharmacies
SemaglutideNovoCareWegovy pill$149 (1.5 mg) to $299 (9 and 25 mg) a month at launch, Jan 202617Prescription needed. Current pill prices Unverified
SemaglutideNovoCare provider finderTelehealth prescriptionVaries by serviceNovoCare listed seven services in Jan 2026 and said it does not endorse them51
SemaglutideNovoCare coverage checkInsuranceDepends on planCoverage depends on your plan and diagnosis
TirzepatideLillyDirect ZepboundSingle-dose vial or multi-dose KwikPen$299 (2.5 mg), $399 (5 mg), $449 (7.5 to 15 mg) a month with a refill within 45 days; otherwise $499 to $69918Prescription needed. Vials need syringes bought separately. The single-dose pen is for insured patients
TirzepatideLillyDirect MounjaroSingle-dose pen$499 a month, all doses19Prescription needed. For type 2 diabetes
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 use20, 22

Left off: compounded copies and "research use only" vials. FDA declared the semaglutide shortage over on February 21, 202552; the tirzepatide shortage over in Oct 2024, confirmed December 19, 202453. The Fifth Circuit upheld both decisions on August 27, 202654, 55. Routine compounded copies are no longer allowed, and FDA says compounded drugs are not FDA-approved and not the same as generics56. Compounded retatrutide has no lawful path20. More on the regulatory tracker. More options in the Semaglutide and Tirzepatide guides.

FAQ

Which one causes the most weight loss?

Among approved drugs, tirzepatide: 20.2% vs 13.7% for semaglutide in SURMOUNT-5. Retatrutide's trial numbers are larger (−25.0% vs −3.9% on placebo at 80 weeks in TRIUMPH-1, published in NEJM), but they come from a separate trial with a different length and population, and the head-to-head with tirzepatide (TRIUMPH-5) hasn't reported.

Is retatrutide approved?

No. It's in phase 3. Lilly plans to file with FDA in Q1 2027 and hasn't given an approval date.

Can I buy retatrutide online?

Not legally. Anything sold today is unapproved, FDA recommends consumers not buy it, and products labeled retatrutide have been linked to liver injury in Australia. Clinical trials are the only legal route.

Is there a tirzepatide pill?

No. Tirzepatide is injection only. Semaglutide is the only one of the three that comes as a tablet.

Which is cheapest?

It depends on dose. Self-pay semaglutide injections are $349 a month for most doses; Zepbound runs $299 to $449 by dose with on-time refills; the Wegovy pill was $149 to $299 a month by dose at launch. Retatrutide has no lawful price.

Do the side effects differ?

All three mainly cause nausea, diarrhea, vomiting and constipation. Retatrutide also causes abnormal skin sensation in some people. The rates come from different trials, so they can't be compared directly.

References

56 sources, with links
  1. FDA. Wegovy (semaglutide) injection and tablets, prescribing information, revised 05/2026. PDF
  2. FDA. Zepbound (tirzepatide) prescribing information, revised 04/2026. PDF
  3. 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
  4. Eli Lilly press release (via BioSpace). TRIUMPH-2 and TRIUMPH-3 topline results; BLA submission planned for Q1 2027 (Jul 23, 2026). Link
  5. FDA. Ozempic (semaglutide) injection, prescribing information, revised 05/2026. PDF
  6. FDA. Rybelsus (semaglutide) tablets, prescribing information, revised 10/2025. PDF
  7. BNN Bloomberg. Novo to launch Ozempic pill for diabetes in second quarter of 2026 (Feb 4, 2026). Link
  8. BioSpace (FDA release). FDA approves novel, dual-targeted treatment for type 2 diabetes (May 13, 2022). Link
  9. BioSpace (FDA release). FDA approves new medication for chronic weight management (Nov 8, 2023). Link
  10. Eli Lilly press release. TRANSCEND-T2D-2: retatrutide vs Ozempic 2 mg, topline results (Oct 28, 2026). Not peer reviewed. Link
  11. 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
  12. 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
  13. FDA. Mounjaro (tirzepatide) prescribing information, revised 08/2026. PDF
  14. 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
  15. ABC7. Cash price of popular weight-loss drug Wegovy dropping, manufacturer says (Nov 17, 2025). Link
  16. Fierce Pharma. Novo unveils newly reduced self-pay prices for Wegovy, Ozempic after White House deal (Nov 2025). Link
  17. KVIA (CNN Health). Starter dose of Wegovy now available as a daily pill instead of weekly injection (Jan 5, 2026). Link
  18. LillyDirect. Zepbound self-pay pricing (page dated Sep 2, 2026; checked Nov 1, 2026). Link
  19. LillyDirect. Mounjaro self-pay pricing (page dated Oct 14, 2026; checked Nov 1, 2026). Link
  20. FDA letter to the Federation of State Medical Boards on retatrutide (Apr 2, 2025), posted by the Arizona Board of Osteopathic Examiners. Link
  21. Eli Lilly press release. TRIUMPH-1 topline results (May 21, 2026). Link
  22. FDA warning letter. Swisschems (Dec 10, 2024). fda.gov
  23. FDA warning letter. Prime Vitality Inc. dba Prime Peptides (Dec 10, 2024). fda.gov
  24. FDA warning letter. Summit Research Peptides (Dec 10, 2024). fda.gov
  25. Healio. Eli Lilly files lawsuits against six companies for allegedly selling retatrutide (Aug 14, 2026). Link
  26. Victoria Department of Health. Toxicity linked to unapproved peptide product labelled retatrutide (Jun 19, 2026). Link
  27. 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
  28. AJMC. FDA approves oral semaglutide as first GLP-1 pill for weight loss (OASIS 4). Link
  29. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). NEJM 2022;387:205–16. Ovid
  30. Eli Lilly press release. TRANSCEND-T2D-1 topline results (Mar 19, 2026). Link
  31. American College of Cardiology. SELECT trial summary (Lincoff, NEJM 2023;389:2221–32). Link
  32. Eli Lilly. FDA approves Lilly's Mounjaro (tirzepatide) to reduce cardiovascular risk (Aug 28, 2026). Link
  33. TCTMD. SURPASS-CVOT published: large trial confirms CVD efficacy of tirzepatide (Nicholls, NEJM 2025;393:2409–20). Link
  34. FDA. FDA approves first medication for obstructive sleep apnea (Dec 20, 2024). fda.gov
  35. American College of Cardiology. SURMOUNT-OSA trial summary (Malhotra, NEJM 2024;391:1193–205). Link
  36. HCPLive. Retatrutide improves weight loss, knee osteoarthritis pain, sleep apnea versus placebo (TRIUMPH-1, NEJM; Sep 29, 2026). Link
  37. HCPLive. FDA approves semaglutide (Ozempic) for type 2 diabetes and chronic kidney disease (Jan 28, 2025). Link
  38. HCPLive. FDA approves semaglutide (Wegovy) injection 2.4 mg for noncirrhotic MASH (Aug 15, 2025). Link
  39. Healio. Semaglutide tied to significant improvements in MASH, liver fibrosis at 72 weeks (ESSENCE; May 1, 2025). Link
  40. American College of Cardiology. STEP-HFpEF trial summary (Kosiborod, NEJM 2023;389:1069–84). Link
  41. American College of Cardiology. SUMMIT trial summary (Packer, NEJM 2024). Link
  42. ConscienHealth. Lilly withdraws tirzepatide application to FDA for heart failure (May 3, 2025). Link
  43. American College of Cardiology journal scan. SURMOUNT-5 (Aronne, NEJM 2025;393:26–36; Jul 10, 2025). Link
  44. AJMC. Complete data show tirzepatide brings greater A1C reduction, weight loss than semaglutide (SURPASS-2; Jun 25, 2021). Link
  45. GPnotebook. SURPASS-2: tirzepatide versus semaglutide once weekly in type 2 diabetes. Link
  46. STAT. Retatrutide vs Ozempic: Lilly diabetes study (Oct 28, 2026). Link
  47. Drugs.com / HealthDay. Some GLP-1s achieve more weight loss than others (on Moiz et al., Ann Intern Med, Jan 2025). Link
  48. TheNNT. Efficacy of tirzepatide, retatrutide and semaglutide for weight loss in obese individuals without diabetes (review of Moiz et al.). Link
  49. 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
  50. Eli Lilly press release. TRIUMPH-4 topline results (Dec 11, 2025). Link
  51. STAT. Telehealth swoops in offering Wegovy pill (Jan 6, 2026). Link
  52. Foley & Lardner. GLP-1 drugs: FDA removes semaglutide from drug shortage list (Feb 2025). Link
  53. Pharmacy Times. FDA affirms tirzepatide shortage resolved, sets transition period for compounding (Dec 2024). Link
  54. US Court of Appeals for the Fifth Circuit. Outsourcing Facilities Ass'n v. FDA, No. 25-10600 (tirzepatide), unpublished (Aug 27, 2026). PDF
  55. 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
  56. 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.