Wegovy vs Qsymia: Injection Against the Cheap Oral
Wegovy (semaglutide, Novo Nordisk) vs Qsymia (phentermine-topiramate, VIVUS LLC)
Last verified May 2026
The verdict
STEP-1 reported −14.9% at 68 weeks for Wegovy; EQUIP reported −10.9% at 56 weeks for Qsymia at its top 15/92 mg dose — closer than most people expect. Qsymia runs about $100–$200 a month, and generic phentermine plus topiramate can be around $50, against Wegovy's $499. ⚠ Topiramate carries real teratogenic risk, which is why the pregnancy questions on a Qsymia intake are not a formality.
Side-by-side comparison
| Field | Wegovy | Qsymia |
|---|---|---|
| What the pivotal trial showed | -14.9% of body weight over 68 weeks (STEP-1, Wilding 2021) | -10.9% over 56 weeks at the top 15/92 mg dose (EQUIP, Allison 2012) |
| How it works | A GLP-1 receptor agonist that stays in the body about a week | Two drugs at once: phentermine, a stimulant, plus extended-release topiramate, an anti-seizure drug. Together they blunt appetite through separate brain pathways |
| How you take it | One injection under the skin, weekly | One capsule by mouth each morning |
| Proven effect on heart attacks and strokes | 20% fewer major cardiac events in SELECT (Lincoff 2023), in obesity without diabetes | No outcomes trial has been run. Resting heart rate rose slightly with dose, by 1.6 bpm at 15/92 mg |
| Cash price if you are paying yourself | $499/mo through the NovoCare cash-pay program | Roughly $100-$200/mo through Qsymia Advantage; the two ingredients filled separately as generics run about $50/mo with a discount card |
| Pregnancy rules and required monitoring | No FDA safety program. Guidance is to stop at least 2 months before trying to conceive | An FDA safety program is mandatory: a pregnancy test every month plus effective contraception for anyone who can become pregnant, because topiramate causes cleft palate in the first trimester |
| What most people actually feel | Nausea in roughly 44%, plus diarrhea, vomiting and constipation | Tingling in the hands and feet, altered taste, dry mouth, trouble sleeping, and difficulty finding words or holding attention |
| When it was approved, and for what | June 2021 for long-term weight management; March 2024 for cutting cardiovascular risk | July 2012 for long-term weight management; December 2022 extended down to age 12 |
| Controlled-substance status | Not controlled | Its phentermine half is DEA Schedule IV, so refills are limited and prescriptions are tracked |
| Warnings carried on the label | A boxed warning for thyroid C-cell tumors, carried over from rodent studies | Class warnings for suicidal thoughts and behavior, for birth defects, and for a sudden dangerous rise in eye pressure |
What each one costs in the compounded market
Standing monthly cash prices from the 556 sellers on this register. These are compounded preparations, not the approved products compared above.
Wegovy — semaglutide
from $79 /mo
283 sellers publish a standing price; the median is $174 a month.
Qsymia — phentermine-topiramate
No seller on this register publishes a compounded price for it. For a drug still in trials that is expected — and anyone selling it anyway is doing so outside the system this register covers.
⚠ A compounded preparation is not the approved product. No agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and the legal ground under compounding these molecules narrowed when the shortages closed. The price gap is real, and so is the difference in oversight. Every seller, with its price record.
Frequently asked questions
Are Wegovy and Qsymia the same drug?
No. Wegovy is semaglutide and Qsymia is phentermine-topiramate — different molecules. Results with one do not predict results with the other.
Is Wegovy or Qsymia cheaper?
On the manufacturers' own cash pricing: Wegovy at $499/mo through the NovoCare cash-pay program, Qsymia at Roughly $100-$200/mo through Qsymia Advantage; the two ingredients filled separately as generics run about $50/mo with a discount card. ⚠ That is the list-price comparison, and it is not what most people pay. What you actually pay depends on whether your plan covers it, which formulary tier it sits in, and whether you have met your deductible — and for many people the honest comparison is between an insured copay and a cash-pay compounded alternative rather than between these two figures.
What does a compounded version of each actually cost?
Across the 556 sellers in this register, the cheapest standing monthly cash prices we hold are semaglutide from $79 a month. ⛔ A compounded preparation is not the approved product: no agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and the legal ground under compounding these molecules narrowed once the shortages closed. The price gap is real and so is the difference in oversight.
Can I switch from Wegovy to Qsymia?
Yes, with a prescriber. Expect to re-titrate from the bottom of the new drug's ladder rather than starting where you left off: these are different molecules and tolerance to one does not transfer to the other. Both the old drug's washout and the new drug's schedule apply.
Which one should I ask for?
That is a prescriber's call, and anyone answering it from a table is guessing. What a page like this can do is tell you what the trials measured, what the manufacturers charge, and where the evidence is still missing, so the conversation starts from the record rather than from an advertisement.
References
- 1.Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med. 2021. PMID: 33567185.
- 2.Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2012. PMID: 22051941.
- 3.Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). N Engl J Med. 2023. PMID: 37952131.
- 4.Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011. PMID: 21481449.
- 5.Novo Nordisk. WEGOVY (semaglutide) injection — FDA prescribing information. DailyMed (NIH/NLM). 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b
- 6.VIVUS LLC. QSYMIA (phentermine and topiramate extended-release) capsules — FDA prescribing information. DailyMed (NIH/NLM). 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=51c10ce8-c6a3-4c50-a380-9c83d7f1d6cd
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