Semaglutide
High-efficacy weight loss with cardiovascular outcome benefit demonstrated in selected people with obesity and established cardiovascular disease.
- Watch
- Nausea, vomiting, gallbladder disease, dehydration and delayed gastric emptying.
Obesity pharmacotherapy
Weight-loss medicines changed. The need for long-term care did not.
Compare injections, new tablets, older medicines, expected weight loss, health outcomes, side effects, access and what happens after stopping.
Compare the options
Weight
Average, range and durability
Health
Diabetes, heart, liver, sleep
Safety
GI, gallbladder, surgery
Access
Price and subsidy
Maintenance
Long-term plan
Not one market
Diabetes and obesity labels are not interchangeable
The same molecule may have different brands, doses, indications and reimbursement rules. Semaglutide and tirzepatide are used across diabetes and obesity, but a diabetes subsidy does not automatically cover weight management.
Meaningful outcomes include mobility, sleep apnoea, blood pressure, diabetes prevention, cardiovascular events and quality of life, not only kilograms lost.
Approved and emerging
The medication landscape
Availability and approval differ by country.
Tirzepatide
Among the largest average losses in approved pharmacotherapy and strong glucose effects.
- Reality
- GI tolerance, supply, cost and continued treatment matter.
Semaglutide tablet
Oral semaglutide exists for diabetes; higher-dose obesity tablets entered the US market in 2026. Labels differ internationally.
- Dosing
- Peptide absorption requires strict fasting and water instructions.
Orforglipron
FDA-approved in 2026 for chronic weight management as Foundayo. No injection or peptide fasting requirement.
- Unknowns
- Long-term comparative outcomes and global reimbursement continue to develop.
Liraglutide
Established daily injection with less average weight loss than newer weekly options, but substantial clinical experience.
Phentermine / topiramate
Effective in eligible adults; stimulant effects, mood/cognitive issues and major pregnancy precautions require care.
Naltrexone / bupropion
Acts on appetite and reward pathways. Avoid with opioid use and consider seizure and blood-pressure risk.
Orlistat
Reduces fat absorption. Modest average effect; oily stools and fat-soluble vitamin issues commonly limit use.
Triple agonists and amylin combinations
Retatrutide, cagrilintide combinations, once-monthly agents and muscle-preserving approaches remain under evaluation until approved.
Reading the percentages
Average loss is not a promise
Trial populations, adherence, dose and diabetes status change results.
Often about 3–9% beyond placebo
Orlistat and older combinations vary widely. Lower price may improve real-world value.
Roughly low-to-mid teens
Some lose much more, some little. Cardiovascular evidence is a major distinction.
Often mid-to-high teens or more
Dose and population matter; direct comparisons are preferable to separate headline trials.
After stopping
Trials show that sudden discontinuation of semaglutide or tirzepatide commonly leads to regain of roughly one-half to two-thirds of lost weight within a year. Maintenance may involve ongoing medication, a lower effective dose, surgery, structured support or close monitoring; evidence for intermittent strategies is still developing.
Safety before a procedure
Tell the anaesthetist what you take
Delayed gastric emptying
Residual stomach contents can increase aspiration concern. Current guidance uses an individual plan based on symptoms, dose escalation, drug and procedure; higher-risk patients may need a liquid diet or full-stomach precautions.
Persistent vomiting is not “normal”
Seek advice for dehydration, severe abdominal pain or inability to eat. Protect protein, micronutrients and resistance exercise to reduce lean-mass loss.
Plan before conception
Weight-loss drugs are generally not used during pregnancy. Product-specific washout and contraception advice matter; tirzepatide can affect absorption of oral contraceptives during escalation.
Compounded and counterfeit products
Use regulated supply chains. Wrong salts, concentration errors and counterfeit pens can cause serious harm.
Coverage gap
The price can determine the outcome
Public systems often cover diabetes more readily than obesity.
PBS criteria generally relate to diabetes indications; obesity access and private prices differ. Check current PBS and TGA status.
PBSCash programmes, employer insurance, Medicare rules and formularies produce very different monthly costs.
MedicareNICE criteria and specialist pathways govern NHS access; local capacity may affect waiting time.
NICEProvincial coverage and private plans differ; approval does not guarantee reimbursement.
CDA-AMCConnected guides
Metabolic treatment network
A-Z medicine appendix
Generic names, brands and safety information
Patient summaries sit beside complete official labels. Trial-only medicines are marked clearly.
Experimental access normally means a clinical trial. Never buy a purported research medicine online.