- The main prescription alternatives are other GLP-1 medicines, older weight-loss medicines and surgery. The largest average loss among medicines was with tirzepatide (Zepbound): 20.9% vs 3.1% on placebo in SURMOUNT-1.2
- There are now GLP-1 pills (Wegovy tablets, Foundayo) and generic liraglutide. Older pills such as phentermine-topiramate led to about 6% to 10% average loss in their main trials.3–7
- The trials differ in length and population, so the numbers are a rough guide, not a ranking. Which option fits, if any, is a decision for you and your prescriber.
Why people look for an alternative to Ozempic
Ozempic is semaglutide, approved in the US for type 2 diabetes. Wegovy is the same medicine approved for weight management. See Ozempic vs Wegovy vs Mounjaro vs Zepbound.
People search for alternatives for several reasons. During the shortages, many turned to compounded copies; the FDA declared the semaglutide shortage resolved on February 21, 2025, and the tirzepatide shortage on December 19, 2024.12 Others are looking at cost or insurance coverage (see Zepbound and Wegovy cost), side effects such as nausea (see GLP-1 side effects), a dislike of injections, or a medicine that did not work well enough for them.
Ozempic alternatives compared: what the trials found
| Medicine | Type, how taken | Main trial (who, how long) | Average weight change, drug vs placebo |
|---|---|---|---|
| Semaglutide 2.4 mg (Wegovy), for reference | GLP-1, weekly shot | STEP 1: 1,961 adults with obesity or overweight, no diabetes, 68 weeks | −14.9% vs −2.4% |
| Tirzepatide (Zepbound, Mounjaro) | GIP and GLP-1, weekly shot | SURMOUNT-1: 2,539 adults, no diabetes, 72 weeks | −20.9% (15 mg) vs −3.1% |
| Oral semaglutide 25 mg (Wegovy tablets) | GLP-1, daily pill | OASIS 4: 307 adults, no diabetes, 64 weeks | −13.6% vs −2.2% |
| Orforglipron (Foundayo) | GLP-1, daily pill | ATTAIN-1: 3,127 adults with obesity, no diabetes, 72 weeks | −11.2% (36 mg) vs −2.1% |
| Liraglutide 3.0 mg (Saxenda, generics) | GLP-1, daily shot | SCALE: 3,731 adults, no type 2 diabetes, 56 weeks | −8.4 kg vs −2.8 kg |
| Phentermine-topiramate (Qsymia) | Two older drugs combined, daily pill | CONQUER: 2,487 adults with 2+ weight-related conditions, 56 weeks | −9.8% (top dose) vs −1.2% |
| Naltrexone-bupropion (Contrave) | Two older drugs combined, pill | COR-I: 1,742 adults, 56 weeks | −6.1% vs −1.3% |
| Orlistat 120 mg (Xenical) | Blocks fat absorption, pill with meals | XENDOS: 3,305 adults with obesity, 4 years | −5.8 kg vs −3.0 kg |
| Phentermine | Appetite suppressant, pill | 28-week trial in adults with obesity | 46.2% lost 5% or more (15 mg) vs 15.5% on placebo |
Other GLP-1 medicines
Tirzepatide (Zepbound, Mounjaro). Tirzepatide acts on two gut-hormone receptors, GIP and GLP-1. In SURMOUNT-1, 57% of people on the 15 mg dose lost 20% or more of their body weight, vs 3% on placebo. Side effects were mainly in the gut and most common while the dose was being raised.2 See semaglutide vs tirzepatide.
Semaglutide as a pill (Wegovy tablets). As of November 2026, the US Wegovy label covers both the injection and a daily tablet, with 25 mg as the maintenance dose.14 In OASIS 4, gut side effects were reported by 74.0% on the pill vs 42.2% on placebo.3 See oral semaglutide weight loss.
Orforglipron (Foundayo). A daily GLP-1 pill that is a small molecule rather than a protein. In ATTAIN-1, 18.4% on the top dose lost 20% or more, vs 2.8% on placebo, and side effects led 5.3% to 10.3% to stop, vs 2.7% on placebo.4 See orforglipron weight loss.
Liraglutide (Saxenda, Victoza, generics). An older GLP-1 taken as a daily shot. In SCALE, 63.2% lost at least 5% of their weight, vs 27.1% on placebo.5 The FDA approved the first generic of Victoza, the diabetes version, on December 23, 2024.12 Teva announced FDA approval and launch of the first generic of Saxenda, the weight-management version, in August 2025.13 As of November 2026, DailyMed lists generic liraglutide from several makers.14 See also generic Ozempic.
Older weight-loss medicines that are not GLP-1s
Phentermine-topiramate (Qsymia) combines two older medicines in one extended-release capsule. In CONQUER, 70% on the top dose lost at least 5%, vs 21% on placebo. Common side effects included dry mouth, tingling, constipation, insomnia, dizziness and altered taste.6
Naltrexone-bupropion (Contrave) combines two older medicines that act on brain pathways that regulate body weight. In COR-I, nausea was the most common side effect, in 29.8% vs 5.3% on placebo. Only half of participants completed 56 weeks.7
Orlistat (Xenical) works in the gut, blocking some of the fat you eat from being absorbed. In XENDOS, it also lowered the four-year rate of type 2 diabetes from 9.0% to 6.2%.8 A lower-dose version is sold without a prescription as alli.14
Phentermine is also prescribed on its own. Its US label lists it as a Schedule IV controlled substance and approves it only as a "short-term (a few weeks)" add-on to diet and exercise for adults with a BMI of 30 or more, or 27 or more with other risk factors.14 That is the label's wording, not advice.
Alternatives for type 2 diabetes
If Ozempic was prescribed for type 2 diabetes, the comparison is different, because blood sugar, heart and kidney protection matter as much as weight. Other GLP-1 options include tirzepatide (Mounjaro), liraglutide (Victoza) and dulaglutide (Trulicity). Other drug classes include metformin, SGLT2 inhibitors and DPP-4 inhibitors, which work in different ways and generally lead to less weight loss. See GLP-1 vs SGLT2 vs DPP-4 vs metformin and GLP-1 weight loss in type 2 diabetes.
Metabolic and bariatric surgery
Surgery is the other main option for larger amounts of weight loss. The best-known long-term data come from the Swedish Obese Subjects study, which followed 4,047 adults with obesity. It was a prospective study, not a randomized trial: 2,010 people chose surgery and were compared with 2,037 matched people who received usual care.10
In the control group, weight changed by less than 2% over up to 15 years.10 The operations studied were gastric bypass, banding and vertical-banded gastroplasty; sleeve gastrectomy was not among them.
A 2022 joint statement from the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity recommends surgery for people with a BMI of 35 or more, and says it should be considered for people with metabolic disease and a BMI of 30 to 34.9. It suggests lower thresholds for people of Asian descent, offering surgery from a BMI of 27.5.11
Common questions
What is the best alternative to Ozempic?
There is no single best option; it depends on your health, goals and coverage, and is a decision for you and your prescriber. In trials in adults with obesity, the medicine with the largest average weight loss was tirzepatide (Zepbound): 20.9% on the highest dose vs 3.1% on placebo over 72 weeks in SURMOUNT-1.
Are there pills that work like Ozempic?
Yes. In the OASIS 4 trial in adults with obesity or overweight without diabetes, a daily 25 mg semaglutide pill led to 13.6% average weight loss vs 2.2% on placebo at 64 weeks. In ATTAIN-1, the daily pill orforglipron (Foundayo) led to 11.2% vs 2.1% at 72 weeks.
Is there a generic drug like Ozempic?
Generic liraglutide, an older daily GLP-1 injection, is available in the US. The FDA approved the first generic of Victoza on December 23, 2024, and Teva announced the first generic of Saxenda in August 2025. In the SCALE trial, liraglutide 3.0 mg led to 8.4 kg average weight loss vs 2.8 kg on placebo over 56 weeks.
What weight loss medications are not GLP-1s?
Older options include phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), orlistat (Xenical) and phentermine. In their main trials, phentermine-topiramate led to 9.8% average loss vs 1.2% on placebo over 56 weeks, and naltrexone-bupropion to 6.1% vs 1.3%.
Is bariatric surgery more effective than Ozempic?
The two have not been compared in the trials covered here. In the Swedish Obese Subjects study, a non-randomized study of 4,047 adults with obesity, people who had gastric bypass had lost 25% of their weight after 10 years, while weight in the control group changed by less than 2%.
Sources
- Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183 · PubMed
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038 · PubMed
- Wharton S, Lingvay I, Bogdanski P, et al. Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity. N Engl J Med. 2025;393(11):1077-1087. doi:10.1056/NEJMoa2500969 · PubMed
- Wharton S, Aronne LJ, Stefanski A, et al. Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment. N Engl J Med. 2025;393(18):1796-1806. doi:10.1056/NEJMoa2511774 · PubMed
- Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med. 2015;373(1):11-22. doi:10.1056/NEJMoa1411892 · PubMed
- 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;377(9774):1341-52. doi:10.1016/S0140-6736(11)60205-5 · PubMed
- Greenway FL, Fujioka K, Plodkowski RA, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010;376(9741):595-605. doi:10.1016/S0140-6736(10)60888-4 · PubMed
- Torgerson JS, Hauptman J, Boldrin MN, et al. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004;27(1):155-61. doi:10.2337/diacare.27.1.155 · PubMed
- Aronne LJ, Wadden TA, Peterson C, et al. Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults. Obesity (Silver Spring). 2013;21(11):2163-71. doi:10.1002/oby.20584 · PubMed
- Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741-52. doi:10.1056/NEJMoa066254 · PubMed
- Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356. doi:10.1016/j.soard.2022.08.013 · PubMed · Full text (PMC, Obes Surg version)
- US FDA: FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize; FDA approves first generic of once-daily GLP-1 injection (Victoza), December 23, 2024.
- Teva Pharmaceuticals. Teva announces FDA approval and launch of generic Saxenda (liraglutide injection), August 2025. Reported in Patient Care, August 29, 2025.
- US prescribing information on DailyMed (checked November 2026): WEGOVY injection and tablets (revised June 2026), ZEPBOUND, FOUNDAYO, SAXENDA, liraglutide (brand and generic), orlistat (XENICAL, ALLI), QSYMIA, CONTRAVE, phentermine hydrochloride tablets (section 1, revised June 2026).
