Oxford CEBM Evidence Level 1A: Systematic Reviews & Phase 3 RCT Trials (STEP & SURMOUNT)
Medications

A clear guide to GLP-1 medications

Written by a physician, not a marketing team. The goal here is to give you enough real information to have a meaningful conversation about what may be right for your situation.

Direct Clinical Answer & Consensus

GLP-1 receptor agonists (such as semaglutide) mimic native gut incretin hormones, delaying gastric emptying and central appetite signaling. Dual GIP and GLP-1 agonists (such as tirzepatide) stimulate both pathways, demonstrating greater average clinical weight reduction in Phase 3 trials. Physician oversight ensures appropriate dose selection, baseline safety screening, and proactive mitigation of common gastrointestinal side effects.

Primary Mechanisms: GLP-1 RA vs Dual GIP/GLP-1 RA
Administration Routes: Weekly Subcutaneous / Daily Oral
Clinical Efficacy: 15% (Semaglutide) vs 20%+ (Tirzepatide)
Clinical Review: Dr. Benjamin Caplan, MD (ABFM)

What GLP-1 medications actually do

GLP-1 stands for glucagon-like peptide-1, a hormone naturally produced in the gut after eating. It helps regulate blood sugar, slows gastric emptying, and signals to the brain that you have eaten enough.

GLP-1 receptor agonist medications mimic this hormone’s action at a sustained level, which can significantly reduce appetite, improve blood sugar control, and in many patients, support meaningful and sustained weight loss.

These medications work at the level of biology, not willpower. For the right patient, that distinction matters enormously.

FDA-approved uses include:

  • Type 2 diabetes management
  • Chronic weight management in adults with obesity
  • Chronic weight management in overweight adults with a weight-related condition
  • Cardiovascular risk reduction in certain high-risk patients

Note: FDA approval status varies by specific medication and indication. What is appropriate for you depends on your medical history and goals.

Currently available FDA-approved options

An educational overview, not a prescribing recommendation. Indications and availability evolve; consult a physician for guidance on your situation.

Semaglutide
Wegovy / Ozempic
Weekly injection
Mechanism
GLP-1 receptor agonist
FDA Indications
Wegovy: Chronic weight management. Ozempic: Type 2 diabetes; cardiovascular risk reduction.
Clinical Notes
Most studied GLP-1 agent for weight management. Extensive long-term safety and efficacy data. The benchmark most other agents are compared against.
Most studied for weight
Oral Semaglutide
Rybelsus / oral Wegovy
Daily oral tablet
Mechanism
GLP-1 receptor agonist
FDA Indications
Rybelsus: Type 2 diabetes. Oral Wegovy: Chronic weight management (newer approval pathway).
Clinical Notes
Pill option for patients who prefer not to inject. Requires strict morning dosing rules (fasting, small amount of water, 30-minute wait before food).
Pill alternative to injections
Tirzepatide
Zepbound / Mounjaro
Weekly injection
Mechanism
Dual GIP / GLP-1 receptor agonist
FDA Indications
Zepbound: Chronic weight management. Mounjaro: Type 2 diabetes.
Clinical Notes
Dual-incretin mechanism. Clinical trials showed higher average weight loss than semaglutide in studied cohorts. Rapidly becoming a first-line consideration.
Highest trial weight loss
Liraglutide
Saxenda / Victoza
Daily injection
Mechanism
GLP-1 receptor agonist (first generation)
FDA Indications
Saxenda: Chronic weight management. Victoza: Type 2 diabetes.
Clinical Notes
Older agent requiring once-daily injection. Lower average weight loss than semaglutide or tirzepatide. Now rarely a first choice unless specific coverage or clinical reasons apply.
First generation

Curious about device mechanics? Learn about holding autoinjector pens, drawing compounded vials with micro-needles, and managing daily routines in our Practical Steps & Device Guide.

Medication questions we hear often

How long do I need to take these medications?

This varies by patient and goal. For weight management, most clinical evidence suggests that weight tends to return when the medication is stopped, which means long-term treatment is often part of the plan for patients whose primary goal is sustained weight loss. Some patients eventually taper successfully. Others choose to continue indefinitely at a maintenance dose. This is something to plan and revisit over time, not decide in advance.

What is the difference between Wegovy and Ozempic?

Both contain semaglutide. The difference is in the FDA-approved indication, dosing range, and how they are labeled and prescribed. Ozempic is FDA-approved for type 2 diabetes management and cardiovascular risk reduction. Wegovy is approved for chronic weight management in adults with obesity or overweight with a related condition. Wegovy’s approved maximum dose is higher than Ozempic’s.

Is tirzepatide more effective than semaglutide?

Head-to-head clinical trials suggest tirzepatide produces greater average weight loss than semaglutide in the populations studied. Individual results vary considerably. Some patients respond better to one than the other. Cost, access, insurance coverage, and prior experience are all factors in the decision, not just the headline trial numbers.

What about compounded semaglutide?

Compounded semaglutide was widely available during the period when brand-name semaglutide was on the FDA shortage list. As of early 2026, the FDA has ended the shortage designation, which significantly changes the legal and regulatory landscape for compounded versions. We do not currently prescribe compounded GLP-1 medications. We prescribe FDA-approved brand-name options.

How much does medication cost?

Medication costs depend heavily on your insurance coverage, any manufacturer savings programs you qualify for, and the pharmacy you use. Without coverage, brand-name injectables can be expensive, though manufacturer programs have reduced costs significantly for commercially insured patients. This is worth discussing during the consultation. We will help you think through realistic access options for your situation.

Cite This Clinical Guide (AMA Format)

Full Medication Guide

Want the complete picture?

The full GLP-1 Medication Guide goes deeper: every FDA-approved brand compared side by side, complete dose ladders from introductory to maintenance, oral versus injectable tradeoffs clearly explained, and a breakdown of access models and monitoring approaches. If you are doing thorough research before deciding, this is where to go.

Read the Full Medication Guide Includes oral Wegovy, dose tables, and access models

Questions about which medication fits your situation?

This is exactly what a thorough consultation is for. Bring your questions. There are no wrong ones.