Mounjaro vs Trulicity (tirzepatide vs dulaglutide)

Which is better, tirzepatide or dulaglutide?

Tirzepatide wins on direct evidence: a larger HbA1c and weight effect in a randomized phase 2 comparison, and cardiovascular noninferiority to dulaglutide in the SURPASS-CVOT outcomes trial, a comparator that itself reduced events in REWIND. It also carries weight management and sleep apnea indications that dulaglutide lacks. Both are FDA approved with human_rct evidence; dulaglutide still fits children 10 and older, people who tolerate GLP-1 only therapy better, and formularies that prefer it. [1] [2] [3] [4] [5]

How do tirzepatide and dulaglutide compare?

Tirzepatide and Dulaglutide compared by dimension
Dimension	TirzepatideFavored	Dulaglutide
Cardiovascular outcomes (direct trial) [1] [3]	SURPASS-CVOT: major adverse cardiovascular events in 12.2% on tirzepatide up to 15 mg weekly (hazard ratio 0.92, 95.3% CI 0.83 to 1.01); noninferior, not statistically superior.	SURPASS-CVOT: 13.1% on dulaglutide 1.5 mg weekly. In the earlier placebo controlled REWIND trial dulaglutide reduced events (hazard ratio 0.88) over a median 5.4 years.
Glucose and weight (direct trial) [2]	Phase 2 (316 adults, 26 weeks): HbA1c minus 1.73 to minus 1.94 points at 5 to 15 mg; weight change up to minus 11.3 kg.	HbA1c minus 1.21 points and weight minus 2.7 kg on dulaglutide 1.5 mg in the same trial.
Mechanism [4] [5]	Single peptide that activates both GIP and GLP-1 receptors, half life about 5 days.	GLP-1 receptor agonist only: two GLP-1 analog chains fused to an IgG4 Fc fragment, half life about 5 days.
FDA labeled indications [4] [5]	Mounjaro for type 2 diabetes; Zepbound for chronic weight management and moderate to severe obstructive sleep apnea with obesity.	Trulicity for type 2 diabetes in adults and children 10 and older, plus cardiovascular risk reduction in adults with type 2 diabetes. No weight management indication.
Gastrointestinal side effects [1] [2] [3] [5]	Dose related: gastrointestinal events in 32.7% to 66.0% at 5 to 15 mg in the phase 2 trial; more gastrointestinal events than dulaglutide in SURPASS-CVOT.	Gastrointestinal events in 42.6% at 1.5 mg in the phase 2 trial; the most common reason for stopping in REWIND.
Note: Both labels carry the thyroid C-cell tumor boxed warning and the medullary thyroid carcinoma and MEN 2 contraindication.
Label dosing [4] [5]	2.5 mg weekly for 4 weeks, then 2.5 mg steps every 4 weeks to 5, 10, or 15 mg maintenance.	0.75 mg weekly, increased to 1.5 mg, then 3.0 and 4.5 mg after at least 4 weeks at each dose.
Regulatory and compounding status [5] [6] [10] [11]	FDA approved (Mounjaro 2022, Zepbound 2023). Shortage resolved December 19, 2024; routine compounding ended February 18 (503A) and March 19, 2025 (503B).	FDA approved (Trulicity 2014). FDA listed dulaglutide injection as in shortage in its October 2024 to February 2025 GLP-1 updates, with all presentations available; it is not listed in FDA's shortage database as of September 27, 2026. Not available in bulk form, so not a compounded product.
Typical cost [5] [7] [8] [9]	Zepbound list about 1,059 USD per month; manufacturer vials roughly 349 to 499 USD per month; about 25 USD with coverage and a savings card.	Trulicity list 1,006.93 USD per month (from 389 USD self-pay through the manufacturer pharmacy); often 25 USD with commercial coverage; covered by Medicare Part D for diabetes.
Note: Prices at the verification date change often; see the cost pages.

Evidence grade and regulatory status

Pulled from each peptide’s own record, so it stays in step with the peptide pages.

Tirzepatide and Dulaglutide: grade, status, and cost
Attribute	Tirzepatide	Dulaglutide
Class	Dual GIP and GLP-1 receptor agonist (39 amino acid peptide, acylated for once weekly dosing)	GLP-1 receptor agonist (two modified GLP-1 analogs fused to a human IgG4 Fc fragment, once weekly)
What it is	FDA approved weekly GIP and GLP-1 drug with 20.9% average weight loss at 15 mg in a 72 week randomized trial; beat semaglutide head to head.	FDA approved weekly GLP-1 drug for type 2 diabetes that cut heart attacks, strokes, and heart deaths by 12% over 5.4 years in REWIND; not for weight loss.
Evidence	Evidence: Human RCT evidence	Evidence: Human RCT evidence
FDA status	Regulatory: FDA approved	Regulatory: FDA approved
Compounding	FDA approved products (Mounjaro May 2022, Zepbound November 2023). FDA declared the tirzepatide shortage resolved on December 19, 2024; compounding by 503A pharmacies had to stop by February 18, 2025 and by 503B outsourcing facilities by March 19, 2025, except for a documented patient specific clinical need. FDA has warned about unapproved compounded and counterfeit tirzepatide products. On April 30, 2026 FDA proposed not to include tirzepatide on the 503B bulks list; that proposal was not final as of September 2026. Adding a vitamin such as B12 or niacinamide does not by itself make a compounded GLP-1 different from the approved drug. Under FDA's April 1, 2026 policy update, such a combination may be treated as essentially a copy when the strengths are within 10% of approved products and the route is the same, unless a prescriber documents a real difference for the individual patient. A September 2026 FDA warning letter applied this to semaglutide and tirzepatide vitamin combinations, said high production volume suggested the claimed differences were a pretext, and questioned significant-difference statements picked from preset menus on prescribing platforms.	FDA approved product (Trulicity, September 2014; 3.0 mg and 4.5 mg doses added in 2020; pediatric indication in 2022; cardiovascular risk reduction indication based on REWIND). Because dulaglutide is a component of an approved drug, 503A pharmacies may compound it only for a documented patient specific need and may not produce essentially a copy of the commercial product. Dulaglutide is not available in a bulk powder form suitable for compounding. FDA listed dulaglutide injection as in shortage in its October 2024 to February 2025 GLP-1 updates, with all presentations available; it is not listed in FDA's shortage database as of September 27, 2026.
WADA	WADA: Not WADA prohibited	WADA: Not WADA prohibited
Routes	Subcutaneous injection once weekly (pen or single dose vial)	Subcutaneous injection once weekly (single dose pen)
Typical cost	Manufacturer list price is up to 1,086.37 USD per fill for Zepbound and 1,112.16 USD for Mounjaro (checked 2026-09-22). Manufacturer self-pay Zepbound vials and KwikPen cost 299 USD per month at 2.5 mg, 399 at 5 mg, 499 at 7.5 mg, and 699 at 10 mg and above, with a 449 USD on-time refill offer for the 7.5 mg and higher KwikPen through 2026. With commercial insurance a savings card can bring a covered prescription to 25 USD, and eligible Medicare Part D enrollees pay 50 USD per month for the Zepbound KwikPen under the Medicare GLP-1 Bridge (July 2026 to December 2027). A study published in 2025 found compounded tirzepatide advertised at a median 330 USD for the first month during the shortage; compounding is now limited to patient specific needs.	Trulicity list price is 1,006.93 USD per month for four pens at any strength; the manufacturer's self-pay pharmacy sells it from 389 USD per month. With commercial insurance and a manufacturer savings card a covered prescription is often 25 USD per month. Medicare Part D covers it for type 2 diabetes. No generic is available as of the last verified date.
Last verified	Sep 27, 2026	Sep 27, 2026

Has tirzepatide been tested directly against dulaglutide?

Direct comparisons of Tirzepatide and Dulaglutide
Study	Design and population	Outcome	Grade
Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes (SURPASS-CVOT)2025 PMID 41406444	Randomized, double blind, active comparator cardiovascular outcomes noninferiority trialn = 13,165 Adults with type 2 diabetes and atherosclerotic cardiovascular disease	Cardiovascular death, myocardial infarction, or stroke in 12.2% with tirzepatide versus 13.1% with dulaglutide 1.5 mg (hazard ratio 0.92, 95.3% CI 0.83 to 1.01); noninferior, not superior	Evidence: Human RCT evidence
Efficacy and safety of LY3298176, a novel dual GIP and GLP-1 receptor agonist, in patients with type 2 diabetes: a randomised, placebo-controlled and active comparator-controlled phase 2 trial2018 PMID 30293770	Randomized, double blind, placebo and active comparator controlled phase 2 trial, 26 weeksn = 316 Adults with type 2 diabetes	HbA1c minus 1.73 to minus 1.94 points with tirzepatide 5 to 15 mg versus minus 1.21 with dulaglutide 1.5 mg; weight up to minus 11.3 kg versus minus 2.7 kg	Evidence: Human RCT evidence

What do tirzepatide and dulaglutide cost?

Typical cost of Tirzepatide and Dulaglutide
Dimension	Tirzepatide	Dulaglutide
Typical cost	$275 to $1,112 per month	$389 to $1,007 per month
Price detail	Tirzepatide price by channel	Dulaglutide price by channel

Where a price index exists, the range is the cash price per month across branded, compounded, and telehealth channels, without insurance. The cost pages give each channel separately with its sources. Otherwise the typical cost from the peptide record is shown. Legal access depends on your state: see peptide legality by state.

Frequently asked questions

Has tirzepatide been compared directly with dulaglutide?

Yes, twice. A 26 week phase 2 trial found larger HbA1c and weight reductions with tirzepatide 5 to 15 mg than with dulaglutide 1.5 mg, and the SURPASS-CVOT outcomes trial found tirzepatide noninferior to dulaglutide for cardiovascular death, heart attack, or stroke. [1] [2]

Is tirzepatide better for the heart than dulaglutide?

It is at least as good. In SURPASS-CVOT, events occurred in 12.2% on tirzepatide and 13.1% on dulaglutide (hazard ratio 0.92), which met noninferiority but fell just short of statistical superiority. Dulaglutide itself had reduced events versus placebo in REWIND. [1] [3]

Which causes more weight loss?

Tirzepatide. In the phase 2 comparison weight fell by up to 11.3 kg on tirzepatide versus 2.7 kg on dulaglutide 1.5 mg over 26 weeks, and only tirzepatide (as Zepbound) is approved for chronic weight management. [2] [4]

Can children use either drug?

Dulaglutide (Trulicity) is FDA approved for type 2 diabetes in children 10 and older. Tirzepatide's labels are for adults. [4] [5]

Which has more side effects?

Tirzepatide at higher doses. In the phase 2 trial gastrointestinal events rose from 32.7% at 5 mg to 66.0% at 15 mg, versus 42.6% with dulaglutide, and SURPASS-CVOT also reported more gastrointestinal events with tirzepatide. [1] [2]

Conditions studied

Sources

Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.

Cite this page

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APA style: PeptideAgent. (2026, September 27). Tirzepatide vs dulaglutide: evidence, cost, and legality. https://peptideagent.ai/compare/tirzepatide-vs-dulaglutide
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