Can’t Fill Your Wegovy Prescription? Here Are 6 Wegovy Alternatives to Consider

Wegovy (semaglutide) belongs to a growing group of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. It was initially approved as a once-weekly injection for weight loss. Because Wegovy injections work well to help people lose weight, they were previously difficult to find due to shortages.

The Wegovy injection shortage is officially over. But some people may still have difficulty filling their prescription due to insurance coverage changes or other reasons. So, what are your alternatives? Below, we cover six Wegovy alternatives your prescriber may consider for you.

1. Wegovy pill

The most direct alternative to the Wegovy injection is the newly approved Wegovy pill. It contains the same active ingredient — semaglutide — and appears to lead to comparable weight loss. But instead of a weekly injection, the Wegovy pill is taken once daily. It offers a needle-free alternative for people who prefer oral medication.

Like the injectable form, the Wegovy pill is approved for weight loss and cardiovascular risk reduction for certain adults. However, it has more specific timing requirements. The pill must be taken on an empty stomach to help with absorption. The injection, though, can be used at any time of day, with or without food. For some people, this trade-off is worth it to avoid injections.

That said, the Wegovy pill isn’t approved for people under 18 years old. It also isn’t approved to treat metabolic dysfunction-associated steatohepatitis (MASH), a type of fatty liver disease. The Wegovy injection is approved to help children ages 12 and older with weight loss and to treat MASH, making it the only option in these situations.

2. Zepbound

Compared with the other Wegovy alternatives, Zepbound (tirzepatide) has a few similarities with Wegovy. It’s also a once-weekly injection, and it works in a similar but slightly different way. Wegovy mimics GLP-1, a gut hormone involved in digestion and appetite. But Zepbound also mimics a second hormone called glucose-dependent insulinotropic polypeptide (GIP).

Zepbound is likely the closest injectable alternative to Wegovy in terms of weight loss. In fact, results from a recent clinical trial showed greater weight loss with Zepbound compared to Wegovy. But these two medications are approved for different uses beyond weight loss. Your health history will help determine which one is right for you.

For example, Wegovy may be a better option if you have heart disease or MASH. Zepbound isn’t approved for these uses yet, but it could be in the future. However, Zepbound is approved for moderate-to-severe obstructive sleep apnea (OSA) while Wegovy is not.

Zepbound and Wegovy are both approved for adults. Wegovy injections are also approved for adolescents ages 12 and older. So, adolescents looking for a Wegovy alternative may need to consider a different option than Zepbound for now.

Similar to Wegovy, Zepbound comes in a single-use injection pen. But you can also access lower-cost Zepbound vials through options such as LillyDirect.

Wegovy or Zepbound? Test your knowledge!

2. Saxenda

Saxenda (liraglutide) is another injectable GLP-1 receptor agonist medication and Wegovy alternative. It works the same way as Wegovy, but Saxenda needs to be injected every day. And it doesn’t have the same cardiovascular risk reduction or MASH approvals. But like Wegovy, Saxenda is also approved for adults and adolescents ages 12 and older.

If you switch from Wegovy to Saxenda, keep in mind that the injection pens work differently. Wegovy comes in a single-use injection pen, while Saxenda comes in a multidose pen. That means you’ll use the Saxenda pen for multiple doses, instead of throwing it away after you use it.

With Saxenda, you may not lose as much weight as you might with Wegovy. In a study comparing the two medications, people receiving Saxenda lost about 6% of their starting body weight, while people receiving Wegovy lost close to 16%.

Saxenda and Wegovy are made by the same manufacturer. And while brand-name Saxenda is still in shortage, a lower-cost generic is now available.

3. Contrave

If you’re looking for a non-GLP-1 oral weight-loss option, your prescriber may consider Contrave. It’s an oral pill that contains two medications — naltrexone and bupropion — that work together to reduce hunger and manage cravings. Because of how it works, Contrave can be a good option if you experience emotional eating.

After the first week, you’ll take Contrave twice a day. The amount of weight loss people see with Contrave is usually 5% to 8% of their starting body weight. As with Wegovy, you may experience side effects such as nausea and vomiting, constipation, and diarrhea. But dry mouth, trouble sleeping, and higher blood pressure are also possible with Contrave.

Contrave may not be safe for certain people, including those with unmanaged high blood pressure and seizure disorders. Contrave can also interact with other medications, such as opioid medications used for pain. Review your full medication list and health history with your healthcare team before starting Contrave.

4. Qsymia

Another oral option is Qsymia (phentermine / topiramate ER). Qsymia is also a combination tablet. Each tablet contains phentermine (a stimulant) and topiramate (a seizure medication). Both of these medications lower your appetite to help you lose weight.

Qsymia is taken once a day in the morning. As with Wegovy, you’ll typically start at a low dose and work your way up. Depending on which dose they take long term, most people lose 5% to 10% of their body weight with Qsymia. This is similar to the potential weight loss with Contrave but less than with Wegovy.

Qsymia also has different side effects, risks, and interactions to consider. Common side effects include dry mouth, constipation, and feelings of numbness and tingling. You should typically avoid Qsymia if you have certain health conditions, including glaucoma or hyperthyroidism.

Qsymia is the only weight-loss medication with a mandatory risk management program. This is because it can harm a growing fetus. If you’re able to get pregnant, you need a negative pregnancy test before starting Qsymia. Monthly pregnancy tests and the use of effective birth control are also required to manage this risk.

Good to know: Phentermine, found in Qsymia, is also available on its own for weight loss (Adipex-P, Lomaira). But unlike Qsymia, it’s only approved for short-term use (up to 12 weeks).

5. Xenical

Xenical (orlistat) is an oral capsule that’s taken for weight loss. Xenical requires a prescription. But its active ingredient is also available over the counter (OTC) at a lower dose (sold as Alli).

Xenical helps people lose weight by blocking the body’s ability to absorb fat when you eat.

Because of this, it should be taken with meals that contain fat. Unfortunately, this also results in unpleasant side effects — such as loose, oily, or fatty stools; gas; and oily spotting on underwear.

One study found that after taking Xenical for one year, people lost an average of 8.5% of their starting body weight. Again, this is similar to the potential weight loss with other oral options but less than with Wegovy.

Since Xenical blocks fat absorption, it can interfere with your ability to absorb certain vitamins from your food. So, your prescriber may recommend adding a multivitamin. Xenical can also interact with other medications that you take by mouth, such as thyroid pills. In this case, you may need to take your other medications at a different time from when you take Xenical.

Which Wegovy alternative is right for you?

If you’re unable to fill your Wegovy injection prescription, there are still effective options available. The best alternative for you depends on several factors, including:

• Your health goals: Some medications, such as Zepbound, may also help with health conditions like OSA. Your prescriber can recommend options that align with your specific health needs.

• Your preferences: If you prefer pills over injections (or vice versa), this can help narrow down your options. Oral medications such as the Wegovy pill, Contrave, or Qsymia may be convenient for some. But weekly injections such as Zepbound may be easier for others to manage.

• Your medical history: Certain Wegovy alternatives may not be safe if you have health conditions such as heart disease, seizures, or hyperthyroidism. Your prescriber can help rule out options that may carry added risk.

• Your insurance and cost: Coverage varies by plan. Some medications may be preferred over others or require a prior authorization. Most Wegovy alternatives have copay savings cards available to help you save money. Saxenda, Qsymia, and Xenical have lower-cost generic versions available.

No matter which Wegovy alternative you consider, talk to your healthcare team before making a switch. They can help you determine which option fits your lifestyle, health needs, and treatment goals.

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Written by:

Hope Chang, PharmD, AAHIVP

Hope Chang is a freelance writer and content reviewer for GoodRx. She attended Howard University College of Pharmacy in Washington, D.C. and completed post-graduate residency training at the University of California, Davis Medical Center.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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