Zepbound vs Trulicity: On-Label Obesity Drug Against Off-Label Use
Zepbound (tirzepatide, Eli Lilly) vs Trulicity (dulaglutide, Eli Lilly)
Last verified May 2026
The verdict
SURMOUNT-1 reported −20.9% at 72 weeks for Zepbound. Trulicity has no weight-loss trial at all; the 3–6% figure comes from off-label use. Zepbound is $349–$499 through LillyDirect Self Pay; Trulicity runs $891–$978 with no manufacturer cash program. There is no reading of the evidence or the pricing where Trulicity is the better weight-management choice — its case is diabetes control and its completed cardiovascular result.
Side-by-side comparison
| Field | Zepbound | Trulicity |
|---|---|---|
| FDA-approved indication | Chronic weight management (Nov 2023); OSA in obesity (Dec 2024) | Type 2 diabetes (Sept 2014); CV risk reduction in T2D |
| Mean weight loss (pivotal trial) | -20.9% at 72 weeks (SURMOUNT-1, 15 mg) | ~3-6% off-label (no weight-loss trial) |
| Mechanism | GIP + GLP-1 dual agonist | GLP-1 receptor agonist |
| Cardiovascular outcomes data | No dedicated CVOT (SURPASS-CVOT ongoing) | MACE reduction in T2D + CV risk (REWIND) |
| Dosing | 2.5-15 mg weekly subcutaneous | 0.75-4.5 mg weekly subcutaneous |
| Cash price (Lilly direct, monthly) | $349-$499 (LillyDirect Self Pay vials) | $891-$978 (no manufacturer cash program) |
| Nausea rate | ~29% (SURMOUNT-1) | ~21% (REWIND/pooled trials) |
| Boxed warning | Thyroid C-cell tumors (MTC/MEN 2 contraindication) | Thyroid C-cell tumors (MTC/MEN 2 contraindication) |
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.
Zepbound — tirzepatide
from $99 /mo
253 sellers publish a standing price; the median is $240 a month.
Trulicity — dulaglutide
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
Which works better for weight loss, Zepbound or Trulicity?
Zepbound recorded -20.9% at 72 weeks (SURMOUNT-1, 15 mg); Trulicity recorded ~3-6% off-label (no weight-loss trial). ⚠ These come from separate trials with different protocols and populations, so the gap between two numbers from two studies is weaker evidence than it looks. No head-to-head trial of this pair is on record here.
Are Zepbound and Trulicity the same drug?
No. Zepbound is tirzepatide and Trulicity is dulaglutide — different molecules, and they work differently: GIP + GLP-1 dual agonist against GLP-1 receptor agonist. Results with one do not predict results with the other.
Is Zepbound or Trulicity cheaper?
On the manufacturers' own cash pricing: Zepbound at $349-$499 (LillyDirect Self Pay vials), Trulicity at $891-$978 (no manufacturer cash program). ⚠ 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.
Does either one have better cardiovascular evidence?
Trulicity does. Zepbound: No dedicated CVOT (SURPASS-CVOT ongoing). Trulicity: MACE reduction in T2D + CV risk (REWIND). This matters more than it first appears — a drug with a completed outcomes trial has evidence about events that matter, not only about weight, and that is often what decides coverage.
How is each one taken?
Zepbound: 2.5-15 mg weekly subcutaneous. Trulicity: 0.75-4.5 mg weekly subcutaneous. Worth weighing honestly against your own habits — the best drug for you is partly the one you will still be taking in eight months, and a dosing routine that does not fit a life gets abandoned.
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 tirzepatide from $99 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 Zepbound to Trulicity?
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.Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity N Engl J Med. 2022. PMID: 35658024.
- 2.Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial Lancet. 2019. PMID: 31189511.
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See the full drug-vs-drug verdict index or provider rankings.