Every GLP-1 medication compared: the full matrix

Start with the job. Diabetes brands (Ozempic, Rybelsus, Mounjaro, Victoza, Trulicity) are approved to lower blood sugar; weight brands (Wegovy, Zepbound, Saxenda) are approved for chronic weight management. The weight effect follows the molecule and the dose, which is why diabetes brands are so often used off-label for weight.

Then read the form and the trial. A daily injection (Saxenda) is a different routine from a weekly one (most others), and a pill (Rybelsus) is different again. The landmark-trial column tells you where each brand's numbers come from, which matters because they are not measured against each other.

On averages, the rough order is tirzepatide first, then semaglutide, then liraglutide and dulaglutide. Zepbound (tirzepatide) reached about 21% in SURMOUNT-1; Wegovy (semaglutide) about 15% in STEP 1; Saxenda (liraglutide) about 8% in SCALE. The one true head-to-head, SURMOUNT-5, put tirzepatide ahead of semaglutide directly.

The honest caveat is large: these are group averages from different trials, and individual response distributions overlap heavily. Plenty of people on a lower-ranked drug out-lose the average person on a higher-ranked one. Your own logged trend is the only ranking that decides your case.

Form shapes adherence, which shapes results. Most of the field is a once-weekly injection. Saxenda and Victoza are daily injections, which some people find harder to sustain. Rybelsus is the only pill, taken daily on an empty stomach with strict timing rules that trade injection avoidance for a fussier routine.

None of these differences is small in practice: the medication you actually take on schedule beats the one that averaged better in a trial you are not enrolled in.

Beyond the approved eight, a wave of investigational drugs is in trials: retatrutide (a triple agonist with striking phase 2 numbers), oral tirzepatide and orforglipron (oral small molecules), CagriSema (cagrilintide plus semaglutide), and several GLP-1/glucagon dual agonists. None is approved or prescribable yet.

We cover each in its own guide. The practical point today is that the approved field above is what you can actually get, and the habits that make any of them work carry forward to whatever arrives.

The warnings are shared class-wide: severe persistent abdominal pain (pancreatitis territory), right-sided pain after fatty meals (gallbladder), vomiting past 24 hours (dehydration), low blood sugar when combined with insulin or a sulfonylurea, and the thyroid C-cell exclusion for a personal or family history of medullary thyroid cancer or MEN2. All are stopped before a planned pregnancy.

Our per-drug side-effect guides carry each brand's full numbers, timelines, and management steps.

Work the order reality imposes: your diagnosis and coverage first (they decide most cases), then form and routine you will sustain, then the desired effect size, then tolerability as lived rather than feared. Your prescriber weighs the cardiovascular and other outcome labels against your history.

Whichever you start, judge it on your own trend after reaching a therapeutic dose, and keep dose, side effects, and weight in one place so any future switch is a documented decision rather than a guess.