Can’t Fill Your Zepbound Prescription? Here Are 5 Zepbound Alternatives to Consider

Zepbound (tirzepatide) is one of several FDA-approved weight-loss medications. It’s currently also the only medication that’s approved to treat obstructive sleep apnea (OSA) for adults with larger bodies. This once-weekly injection mimics the effects of two natural gut hormones: glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). Taking Zepbound has led to significant weight loss for many people.

Zepbound quickly grew in popularity after its FDA approval, resulting in a shortage. This shortage has been resolved. But between pharmacies not having it in stock and insurance plans not always covering it, you may still have difficulty getting Zepbound. Plus, there’s currently no available generic for Zepbound. This has many people looking at other options.

But what’s available for chronic weight management? Below, we’ll review five Zepbound alternatives your prescriber may discuss with you.

1. Wegovy

Wegovy (semaglutide) is very similar to Zepbound. It’s also a once-weekly injection that can provide significant weight loss. But Wegovy only acts like one gut hormone: GLP-1. Zepbound is currently the only FDA-approved weight-loss medication that acts like both GLP-1 and GIP.

This difference in how each works means that Zepbound may provide greater weight loss than Wegovy for some people. A head-to-head clinical trial found that people using Zepbound lost more weight than those using Wegovy (20% versus 14% of your starting body weight).

Keep in mind that Wegovy isn’t approved for OSA. So if you’re using Zepbound to manage this condition, you may not be able to switch to Wegovy.

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Wegovy has a few notable differences from Zepbound. Beyond weight loss, it’s also approved to lower the risk of serious cardiovascular problems for adults considered to be overweight or obese and who also have heart disease. Zepbound’s cardiovascular benefits are still being studied. If you also have heart disease, your prescriber may switch you to Wegovy for its added heart benefits. It may also be more likely to be covered by insurance for this reason.

Wegovy also has the advantage of being approved for adults and adolescents ages 12 and older. Zepbound is still being studied for use in children, so it’s currently only approved for adults.

When prescribed for weight loss alone, Wegovy has similar insurance coverage issues as Zepbound. And because Wegovy is also a popular medication, pharmacies may not have it readily available either. So while this could be the most ideal Zepbound alternative for you, it may be difficult to fill a prescription for it.

Good to know: You can access Wegovy through NovoCare Pharmacy for $499 per month and have the medication shipped directly to you. This may be an option if you’re having trouble filling your prescription at your local pharmacy, or if your insurance doesn’t cover it.

Wegovy or Zepbound? Test your knowledge

2. Saxenda

Saxenda (liraglutide) is another weight-loss injection. It belongs to the same class as Wegovy and acts like the gut hormone GLP-1 in the body. But unlike Zepbound and Wegovy, you’ll need to inject Saxenda once a day.

Similar to Zepbound, Saxenda doesn’t have proven cardiovascular benefits. But Saxenda isn’t approved for OSA. However, it is approved for weight loss in adolescents ages 12 and older with larger bodies.

Based on individual clinical trials, Zepbound may cause more weight loss than Saxenda. People taking Zepbound for 72 weeks (16.5 months) in clinical trials lost an average of 15% to 20% of their starting body weight. People taking Saxenda for 56 weeks (almost 13 months) lost an average of 8% of their body weight. But keep in mind that these medications haven’t been compared directly in a head-to-head clinical trial.

If you switch from Zepbound to Saxenda, be aware that their injection pens are different. Zepbound’s pen comes with a needle already attached to it and is meant for a single use. You will discard the pen in a sharps container after you inject it. Saxenda’s pen, however, is meant for multiple uses. So before each Saxenda dose, you will attach a fresh pen needle.

EXPERT PICKS: WHAT TO READ NEXT

• Compare options: Zepbound and Wegovy have a few notable differences. Read more about how they compare for weight loss.

• How it works: Zepbound mimics the effects of two gut hormones, which helps promote weight loss. Read about how Zepbound works here.

• Standard dosages: To limit side effects, it’s recommended to start with a low Zepbound dose and gradually raise it. Read more about the typical Zepbound dosage schedule.

Currently, there’s a shortage of Saxenda. So it could be tough to find a pharmacy who has it in stock.

3. Contrave

Contrave is a potential oral Zepbound alternative. Contrave is a tablet that contains two medications: naltrexone and bupropion. These active ingredients work together to help lower your appetite and reduce food cravings. It may be helpful if you experience emotional eating.

After the first few weeks of taking Contrave, the standard dosage is 2 pills twice a day. In general, people typically lose less weight with oral weight-loss medications than injections, such as Zepbound. On average, people taking Contrave in studies lost between 5% and 8% of their starting body weight.

Contrave has different risks and side effects than Zepbound. For instance, both can cause stomach upset and diarrhea. But Contrave can also cause trouble sleeping and higher blood pressure. You may not be able to take Contrave if you have a history of seizures or an eating disorder. Contrave also has unique interactions to consider.

If you’re changing from Zepbound to Contrave, it’s a good idea to review your full medical history and medication list with your prescriber. They can use this information to let you know if you can safely make the switch.

Currently, there’s no shortage of Contrave, and it seems to be more readily available than injectable weight-loss medications. So you might have an easier time finding a pharmacy that has it in stock.

4. Qsymia

Qsymia (phentermine / topiramate ER) is another oral Zepbound alternative. Like Contrave, it’s a combination pill. The two medications — phentermine and topiramate — work together to reduce your appetite.

Qsymia’s typical dosage may be more convenient for some people than Contrave’s. You typically take 1 pill once a day in the morning. As with other oral options, you may lose less weight with Qsymia than with Zepbound. Most people lost about 8% to 10% of their starting body weight while taking Qsymia in clinical trials.

You and your prescriber should discuss Qsymia’s side effects, risks, and interactions before switching to it. This medication commonly causes numbness or tingling, constipation, and dry mouth.

Qsymia can also cause severe birth defects. Because of this, there’s a mandatory risk management program for the medication. If you’re able to get pregnant, you’ll have to take a pregnancy test before starting Qsymia, and then subsequently once a month for as long as you’re taking it. You’ll also need to use an effective form of birth control while taking Qsymia.

There’s no shortage of Qsymia right now. So it should be readily available. But because of Qsymia’s risk management program, pharmacies must be certified through the FDA to dispense it. So not all pharmacies may be able to fill a prescription for it.

5. Xenical

Another oral Zepbound alternative to consider is Xenical (orlistat). Its active ingredient is also available over the counter in lower doses under the brand name Alli.

Xenical works differently than the other Zepbound alternatives discussed above. It blocks your body from absorbing fat from the foods you eat. But in order for it to be effective, you need to take Xenical 3 times daily with meals that contain fat. On average, people lost about 8.5% of their starting body weight when taking Xenical in clinical trials.

Xenical can cause some uncomfortable side effects. These include:

• Loose or oily stools

• Stomach pain

• Gas with oily spotting

Xenical can also prevent your body from absorbing certain vitamins from your diet. It’s common for prescribers to recommend taking a multivitamin if you’re also taking Xenical. It can also interfere with how your body absorbs other medications you’re taking.

Similar to the oral weight-loss medications listed above, there’s no shortage of Xenical. It should be readily available for pharmacies to order and dispense.

Is there a Zepbound shortage?

No, the FDA determined that the Zepbound shortage ended in October 2024. This decision was initially challenged. But the agency upheld their decision in December 2024.

But just because the Zepbound shortage is over, that doesn’t mean it’s always easy to find. Some pharmacies may still have problems keeping up with the high demands. It’s a good idea to call your pharmacy at least 1 week ahead of when you’ll need to refill your Zepbound prescription. This will give them more time to order it for you.

Eli Lilly (the manufacturer) offers vials of Zepbound directly through their website (called LillyDirect). This can help ensure that your medication is available when you need it. And it can help lower costs if your insurance plan doesn’t cover Zepbound. Lower-cost single-dose vials are available through LillyDirect for $349 (2.5 mg) and $499 (5 mg, 7.5 mg, and 10 mg) per month.

Can you use Ozempic or Mounjaro instead of Zepbound?

It depends on what health conditions you have. Ozempic (semaglutide) and Mounjaro (tirzepatide) are approved for adults to manage Type 2 diabetes. Ozempic is also approved to lower the risk of:

• Serious cardiovascular problems for adults with Type 2 diabetes and heart disease

• Worsening kidney function, kidney failure, and cardiovascular death for adults with Type 2 diabetes and chronic kidney disease

If you also have Type 2 diabetes, you may qualify to use Ozempic or Mounjaro. And your insurance plan may cover them differently than Zepbound.

Both Ozempic and Mounjaro can cause significant weight loss. But they’re not approved for this use. However, some healthcare professionals may prescribe them off-label for weight loss.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed 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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