Ozempic/Wegovy Mounjaro and Zepbound- Most Potent Weight Loss Medications

Semaglutides Ozempic and. Wegovy and more recently Tirzepatides Zepbound and Mounjaro are   the newest weight loss drugs. They are in the family of Glucagon-like peptide 1 receptor agonists.  GLP-1RAs. They were  first developed for the treatment of diabetes. When treating diabetics there was not only  reductions in blood sugar but significant weight loss. This led to the discovery of several GLP-1 (and GIP) medications including most  liraglutide, semaglutide and more recently Tirzepatide  that produces greater weight loss effects that most anti-obesity medications including Qsymia and Phentermine.

The first of these GLP1’s  evaluated for weight loss properties was liraglutide. Once daily injections of  liraglutide  resulted in  37% of patients experiencing a 20% weight loss or more from starting weight vs. 7% for placebo. This is far above the average FDA requirement of 5% or more weight loss from baseline studies have been done to find the  mechanisms for the weight loss that often equals the weight reduction observed after bariatric surgery. These mechanisms include:

  1. Reduction in wish to eat
  2. Reduction in cravings and thinking about food
  3. Increase in fullness
  4.  Changes in food desires–alcohol, high carb foods, sweets and often fatty foods
  5. Reduced energy intake
  6. Increase in metabolism 

Ozempic for Diabetes vs.  Ozempic Weight Loss in Miami,  Reports Dr Lipman – Endocrinologist

When Ozempic is used for diabetic control and the patient is normal weight, the focus is on the blood sugar. Aim for A1c’s less than 6.3. For individuals without diabetes, Ozempic has potent weight loss properties. Dr Lipman has not observed any lowering of the blood sugar below normal in non-diabetics taking semaglutides.

The drawback of daily injections of liraglutide led to the search for other GLP-1 RA’s that could be administered by once a week injection and even taken orally. This led to the discovery of Ozempic for diabetes and the same drug, re-labelled  Wegovy for weight loss.   
In the last few months there has been development of Compounded Semaglutides that have equal weight loss and glucose control with less GI side effects.

wegovy and ozempic for weight loss

Semaglutide Shot: Wegovy and Ozempic and Tirzepatides Zepbound and Mounjaro- How They Work:

Semaglutide is a molecule that mimics the effects of  GLP‐1, which promotes weight loss by reducing energy intake, increasing satiety and satiation, and reducing hunger.  Many GLP‐1s have been approved for the treatment of  type 2 Diabetes- first liraglutide 3.0 mg daily  and latter  semaglutide.  Ozempic, the first semaglutides, was the first  marketed at doses levels of up to a 1 mg injection once a week or in the oral tablet form at a dosage of up to 14 mg a day. Over the past 6 years extensive studies have proven the safety and effectiveness of Ozempic not only for diabetic control, but for weight loss as a secondary effect. Recently the dose was increased to 2.0 mg.

The higher doses of semaglutide(marketed as Wegovy) from 1.7 to 2.4 mg a week as a subcutaneous injection we’re evaluated found to have equal safety and greater weight loss that he lower doses seen with Ozempic. Some  increase GI side effects we’re found. In the image below not the 4 different compound semaglutides choices. Weight loss seemed higher with the L-carnatine preparation and side effects lower with the Vitamin B 12 version.

The newer drugs in this class are call Tirzepatides and include Zepbound and Mounjaro. The have greater weight loss because of the added hormone  GIP and similar side effects.

Availability of  of Semaglutides for Weight Loss: Dr Lipman’s Experience Over 3 Years in Miami and Florida

Ozempic and Wegovy are the same chemical, the only differences being the dosage.  Ozempic and Compounded Semaglutides can replace Wegovy, especially for the lower doses of  0.25, 0.5 and 1 mg per week.  Ozempic, introduced for diabetes, has a maximal approved dose of 2.0mg and  Wegovy for obesity a most dose of  2.4 mg per week. Each dose is given as a subcutaneous injection with a pen injector once a week. To prevent GI side effects, starting and intermediate doses of 0.25 & 0 .5 mg are used to titrate up to these doses.  Dr Lipman encourages his patients to take the lowest dose that is effective always balancing weight loss against side effects.Both Ozempic and Wegovy are difficult to find. The compounded Semaglutides are available from many compound pharmacies and produce equal results. Sometimes with less side effects.

 Ozempic is Supplied in 2 Different Injection Pens:

  1. 1 mg pen—with injection points of 0.25 mg and 0.5 mg. To save money, we use the 4 mg pens since the price is the same.
  2. 4 mg pen—injection points at 1 mg intervals. You can lower doses by micro dialing
  3. Micro dialing by counting clicks lets you administer 0.25 mg(20 clicks) and 0.5 mg( 40 clicks). The 8 mg pen is the top dose which supplies 2 mg/week for a month.

Wegovy is supplied in 5 different pens strengths:  from 0.25 mg to 2.4 mg/pen. Each pen is used for the once-a-week injection and discarded. They are supplied in boxes of 4 pens, each box is enough for a month.

Ozempic self injector pen for weight loss

The cost of all the pens, both Wegovy and Ozempic are the same.

There is a 1:1 relation between dose and weight loss, with the 2.4 mg dose being the highest approved dose. I have seen significant weight loss at 1 mg/week. We have used Wegovy and Ozempic interchangeably  in the low doses, depending upon which pen is available. We have even taken 2 injections on the same day –one after another to arrive at our desired dose of 2.4 mg when only the Ozempic pen was available. Dr Lipman has also split doses  into 2 injections a week to lessen side effects with good results

Dr Lipman Discusses Why Substitute Ozempic for Wegovy?  It’s  The Cost and the Lack of Insurance Coverage

The purpose of using Ozempic instead of Wegovy is simply the cost The discounted cash price of Wegovy  thru Goodrx.com  is $1300/month. Each month’s supply is 4 pens starting at 0.25 mg/pen and going to four 2.4 mg pens per box. The prices of all of the doses are the same. The price of Ozempic in the US is $849 (for a single multi-dose pen of 4 mg pen). The price of Ozempic in Canada is $299  for the 4 mg pen (enough for 1 month and a week.)  Since the first month or two of Ozempic requires only 0.25 and  0.5 mg, the cost for the first 10 weeks 0f therapy  is the cost of 2- 4 mg pens. Dr Lipman has found significant weight loss (10-12 lb per month) in many patients taking these lower doses.

The greatest weight loss is seen at 2.4 mg injection once a week. However, significant weight loss is also seen at 1 mg per week or even less  Insurance covers Wegovy for  only a minority of obese people (usually depends  on the insurance contract,as well as the BMI > 30.  Ozempic is covered more often but only in uncontrolled diabetics. In Dr Lipman’s experience a 1/3 of the patients can reach their weight loss goals with the lower doses of 0.25 and 0.5 mg of Ozempic and Wegovy.

How We Substitute Ozempic for Wegovy

An Ozempic pen with 4 mg/3cc, this is a single pen meant to inject a dose of Ozempic of 1 mg a week for a month. This pen has set points at 1 mg as you click around the wheel. The lower doses are not marked, but achieved by counting clicks: 20 clicks on this pen delivers 0.25 mg, 40 clicks 0.50 mg—these are the intermediate doses used to start and to titrate up to  1 mg or the full 2.4 mg dose if using the Wegovy pens.  When  2.4 mg doses are needed using Ozempic, it might be cheaper to use the 2.4 mg Wegovy pen instead of multiple doses of Ozempic. Recently the arrival of the Compounded Semaglutides has offered another choice because of their lower price and somewhat lower side effect profile.

Semagluties, ozempic, Wegovy and Mounjaro

Standard Dosing of Ozempic to Titrate up to Wegovy Levels of 2.4 mg/week for Maximal Weight Loss

We start with 0.25 mg once a week for 4 weeks, then 0.5mg x 4 weeks, 1 mg x4—this is top dose for Ozempic. Each dose is once a week on same day. For doses levels seen with Wegovy, you would simple click beyond 1 mg to the desired dose by counting clicks when using the 4 mg pen.

For Wegovy in comparison: 0.25 x4 weeks, 0.5 mg x4, 1 mg x4,  1.7 mgx4, then 2.4 mg x4 weeks.  Again, each dose is injected once a week. You can stop anywhere in this titration with either drug because of side effects or because you are losing weight at an acceptable rate.  The Wegovy is supplied as box of 4 pens a month, each with the specific dose. The high dose Ozempic is supplied as a single 4mg delivering 1 mg increments for a month. The top dose in studies so far is 2.4 mg/week.                                                                                                                                  

 Ozempic/Wegovy/Mounjaro : Side Effects and Weight Loss

Ozempic, Wegovy and Mounjaro side effect are less than one would think. Only 5% of patients withdrew from studies. Most occur early and during the first few days after the injection, especially when escalating the dose. The most common side effects reported in ≥5% of patients treated are:

weogovy and ozempic side effects

Stomach side effects are most common when starting treatment but decrease over time in most patients.

Zofran 4 mg or 8 mg is a inexpensive treatment for nausea. It is a little tablet placed under your tongue. It’s used for chemotherapy nausea.

Despite being  a drug for diabetes, low blood sugars are not seen from the drug.

Significant weight loss is seen at doses less than 2.4 mg/week as would be encountered with Ozempic at standard doses, i.e. up to 1 mg/week.

 

Weight Loss with Semaglutide: Ozempic and Wegovy

Very variable, some weight loss with the 0.5mg, much more at 1.0 mg and still increasing with dose titration. See a graph showing weekly % weight loss on standard protocol. Note these are % of weight loss, not the actual weight loss. The first 8 weeks we’re the o.25/0.5 mg dose. Notice the weight loss at 10-12 weeks accounted for about 2/3 of total weight loss.

How to Increase Weight Loss with Wegovy/Ozempic without Increasing doses

1. Take the injections Saturday AM, these meds are more effective just after you take them, and many people eat more on the weekends.

2. Most individuals taking the drug find sweet and fatty foods very unpleasant. So why not simply avoid these. Exercise beginning in the 3rd week is always helpful.

Weight Loss with the Tirzepatides: Zepbound and Mounjaro

These newer versions of the semaglutides are distinguished by the addition of a second incretin hormone- GIP. This hormone adds to the effects of GLP-1 with even more reduction in cravings and hunger. The most recent report from early 2023 revealed a 25% weight reduction over 88 weeks vs 9.9% in the placebo group.