Weight loss at maximum dose
No direct head-to-head trial between injection and pill. Tirzepatide from a 72-week trial; oral semaglutide from a 68-week trial.
For a 240 lb person. Averages from separate studies. Individual results vary substantially.
Monthly cost self-pay
The oral pill is dramatically cheaper. With insurance, both are typically ~$25/month.
List prices and manufacturer self-pay programs. Insurance coverage varies.
A head-to-head trial exists — but not for these two. SURMOUNT-5 compared tirzepatide injection with semaglutide injection (not the pill). Tirzepatide produced 20.2% vs 13.7% for the injection. No trial directly compares tirzepatide injection with oral semaglutide pill.
Side effects comparison
From each drug's main weight loss trial. All stomach side effects are most common in the first 4–8 weeks and usually fade.
Tirzepatide has lower nausea but higher diarrhea. Overall quit rates are similar (~5–6%). Both use slow dose escalation to minimize symptoms.
Beyond weight loss
Form
Heart benefit
Side effects
Usually peaks weeks 2–4, fades by week 8–12
The decision hinges on needle comfort, budget, and weight loss targets. Tirzepatide produces more weight loss through a dual-hormone mechanism, but requires weekly injections and costs 7x more self-pay. Oral semaglutide is affordable ($149/month), has proven heart protection, and avoids injections — but needs a 30-minute daily fast. Many people start with the pill and switch to the injection after 3–6 months if they want more weight loss.
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