Zepbound vs Trulicity: Weight Loss Drug vs T2D Drug (2026)
Zepbound (tirzepatide, Eli Lilly) vs Trulicity (dulaglutide, Eli Lilly)
Last verified 2026-05-28
The verdict
These are different-indication drugs from the same manufacturer. Zepbound (tirzepatide) is FDA-approved for chronic weight management and obstructive sleep apnea, delivering -20.9% mean weight loss in SURMOUNT-1. Trulicity (dulaglutide) is FDA-approved for type 2 diabetes and cardiovascular risk reduction in T2D, with only modest (~3-6%) off-label weight loss. For weight loss, Zepbound is the clear choice. For T2D with established CV risk, Trulicity has REWIND outcomes data Zepbound lacks.
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) |
Frequently asked questions
Is Trulicity FDA-approved for weight loss?
No. Trulicity (dulaglutide) is FDA-approved only for type 2 diabetes and cardiovascular risk reduction in adults with T2D. Any weight loss with Trulicity is off-label and typically modest (~3-6%), far below Zepbound's -20.9% in SURMOUNT-1.
Why would a doctor prescribe Trulicity if Zepbound loses more weight?
Trulicity has REWIND cardiovascular outcomes data showing MACE reduction in patients with T2D and CV risk. Zepbound lacks a completed CVOT (SURPASS-CVOT is still running). For T2D patients whose primary goal is glycemic control plus cardiovascular protection, Trulicity has stronger outcomes evidence.
Are Zepbound and Trulicity made by the same company?
Yes. Both are manufactured by Eli Lilly. Zepbound is tirzepatide (also sold as Mounjaro for T2D); Trulicity is dulaglutide. They are different molecules with different FDA-approved uses.
Can I switch from Trulicity to Zepbound for weight loss?
Many patients with both T2D and obesity transition under medical supervision because tirzepatide produces substantially greater weight loss and also improves glycemic control. The switch usually requires a fresh prior authorization since the indication changes. Discuss timing and dose with your prescriber.
Why is Trulicity so much more expensive than Zepbound cash?
Trulicity has no manufacturer cash-pay program comparable to LillyDirect Self Pay vials for Zepbound ($349-$499/mo). Trulicity's WAC is $891-$978/mo and the business model assumes commercial insurance and PBM rebates rather than direct cash sales.
Do both drugs carry a thyroid cancer warning?
Yes. Both Zepbound and Trulicity carry FDA boxed warnings for thyroid C-cell tumors based on rodent data. Both are contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2).
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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