metaboliqOne receptor or two
Ozempic's semaglutide acts on the GLP-1 receptor. Mounjaro's tirzepatide acts on GLP-1 and on GIP, a second gut hormone receptor. Both slow stomach emptying, increase fullness and help the body handle blood sugar.
The head-to-head trial
SURMOUNT-5 compared the highest tolerated strength of each, tirzepatide against semaglutide 2.4 mg, for 72 weeks. Average body-weight reduction was 20.2% with tirzepatide and 13.7% with semaglutide.
In the first Indian cohort study, results at about six months were smaller than trial averages for both, and larger with tirzepatide.
Approved uses in India
Mounjaro is approved in India for type 2 diabetes in adults and for chronic weight management in adults. Ozempic is approved for type 2 diabetes in adults; the semaglutide approved in India for chronic weight management is Wegovy, 2.4 mg.
The regulator has asked states to keep these products to their approved uses and labelling.
Side effects compared
Both cause the same kind of stomach side effects, mainly nausea, diarrhoea, vomiting and constipation, most often in the first weeks and after each step up. The serious risks listed on both labels are the same family: pancreatitis, gallbladder problems and dehydration.
Who decides, and how it is started
It is prescription-only in India, and a doctor decides whether it fits you after reading your history, your blood tests and anything else you take.
It is started at a low strength and stepped up every four weeks or so, because stepping up slowly is what keeps the stomach side effects manageable.
Sold outside an authorised pharmacy, a pen can be fake, wrongly stored or the wrong strength; the regulator has asked states to keep these products to authorised channels and their approved uses.
Sources: [7]
Why muscle matters
Body weight falls as fat and as lean tissue together. In the STEP 1 body-composition substudy, roughly 40% of the total lost was lean mass.
Muscle is what keeps blood sugar handled well, keeps you strong as you age and keeps your daily energy use up. So the plan around any treatment protects it: protein at every meal, strength training two or three times a week, and body composition measured rather than the scale alone.
Sources: [8]
What happens when it is stopped
These work while they are taken. One year after semaglutide was stopped in the STEP 1 extension, people had regained about two-thirds of what they had lost; in SURMOUNT-4, people switched from tirzepatide to placebo regained about 14% of body weight.
That is why the habits built alongside treatment, and a plan for maintenance, matter as much as the treatment itself.
Side effects
Common, and usually easing with time
- Nausea, most often in the first weeks and after each step up.
- Diarrhoea or constipation.
- Vomiting, indigestion, burping and bloating.
- Feeling full early, and less appetite.
- Tiredness, and headache.
Serious, and rare
- Pancreatitis: severe, lasting pain in the upper abdomen that may spread to the back, with or without vomiting.
- Gallbladder problems, including gallstones, which are more likely when body weight falls quickly.
- Dehydration from vomiting or diarrhoea, which can strain the kidneys.
- Low blood sugar, mainly when it is combined with insulin or a sulfonylurea.
- Allergic reactions, rare but serious.
- A history of medullary thyroid cancer or MEN 2 in you or your family is a reason it is not used.
Stop and get medical help at once for severe abdominal pain, repeated vomiting, signs of an allergic reaction, or sudden changes in vision. Tell the doctor about pregnancy plans first: these are not used in pregnancy.