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The pharmacological action of tirzepatide includes several key mechanisms

Semaglutide (Wegovy, Ozempic): Overview: Class: GLP-1 receptor agonist Administration: Once-weekly subcutaneous injection Average Weight Loss: 10-15% of body weight FDA Approval: Ozempic (2017), Wegovy (2021) Available Doses: Starting: 0.25 mg weekly Escalation: 0.5 mg, 1.0 mg, 1.7 mg Maximum: 2.4 mg weekly for weight loss Clinical Trial Results (STEP-1): Average weight loss: 14.9% over 68 weeks 5% weight loss: 86.4% of participants 10% weight loss: 69.1% of participants 15% weight loss: 50.5% of participants Brand Options: Wegovy: FDA-approved for weight loss, $1,349/month Ozempic: FDA-approved for diabetes, prescribed off-label for weight loss, $969/month Compounded semaglutide: $199-$599/month, same active ingredient Pros: Highly effective (10-15% weight loss) Proven cardiovascular benefits (20% reduction in heart attacks/strokes) Extensive safety data (on market since 2017) Once-weekly convenience Affordable compounded option available Cons: Nausea in 44% of users (usually improves) Brand-name very expensive without insurance Periodic shortages affecting availability Best For: Patients needing to lose 20-50 pounds Those with cardiovascular disease (proven benefits) Budget-conscious patients (compounded at $199/month) Anyone wanting highly effective, proven medication Tirzepatide (Zepbound, Mounjaro): Overview: Class: Dual GIP/GLP-1 receptor agonist Administration: Once-weekly subcutaneous injection Average Weight Loss: 15-22% of body weight FDA Approval: Mounjaro (2022), Zepbound (2023) Available Doses: Starting: 2.5 mg weekly Escalation: 5 mg, 7.5 mg, 10 mg, 12.5 mg Maximum: 15 mg weekly for weight loss Clinical Trial Results (SURMOUNT-1): Average weight loss: 22.5% over 72 weeks (15 mg dose) 5% weight loss: 96% of participants 10% weight loss: 89% of participants 15% weight loss: 78% of participants 20% weight loss: 63% of participants Brand Options: Zepbound: FDA-approved for weight loss, $1,069/month Mounjaro: FDA-approved for diabetes, prescribed off-label for weight loss, $1,069/month Compounded tirzepatide: $349-$699/month, same active ingredient Pros: Most effective weight loss medication available (15-22% loss) Lower nausea rates than semaglutide despite higher potency Best chance of achieving 20%+ weight loss Affordable compounded option available Cons: More expensive than semaglutide (both brand and compounded) Newer medication (less long-term safety data than semaglutide) Cardiovascular outcomes trial still ongoing Best For: Patients needing maximum weight loss (50+ pounds) Those who plateaued on semaglutide Anyone wanting most effective medication available Patients who can afford $349/month for compounded option Liraglutide (Saxenda, Victoza): Overview: Class: GLP-1 receptor agonist Administration: Daily subcutaneous injection Average Weight Loss: 5-8% of body weight FDA Approval: Victoza (2010), Saxenda (2014) Available Dose: Escalate to 3.0 mg daily Clinical Trial Results (SCALE): Average weight loss: 8.0% over 56 weeks Significantly less effective than newer GLP-1s Cost: $1,400/month No compounded options available Pros: Proven safety record (on market since 2010) Cons: Daily injections (less convenient) Much less effective than semaglutide or tirzepatide More expensive than more effective options Largely obsolete now that better options exist Verdict: Rarely prescribed anymore