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Zepbound/Mounjaro: Most Potent Weight Loss Medication

by Richard Lipman M.D. Endocrinology: Reviewed and Updated March 26 15, 2026

Mounjaro and tZepbound are the most potent and effective FDA-approved weight-loss medications ever developed, with average weight loss of more than 23% of starting weight. Zepbound /Mounjaro(they are exactly the same medication, with different names to indicate approved use)  are the first and only dual GIP/GLP-1 receptor agonist hormones that control both insulin and glucagon secretion. GIP stands for glucose-dependent insulinotropic polypeptide. In addition, these GIP hormones regulate lipid metabolism and fat deposition in the body. They are given by self-injection weekly.

GLP-1 and GIP  the Two Hormones Act as One

The two hormones in the once-a-week injection work together as a single molecule. Acting in the brain and stomach. pancreas and bowel, Zepbound/Mounjaro control appetite, fullness, and metabolism. Mounjaro weekly weight loss injection from Lilly is marketed as a treatment for type 2 diabetes. Zepbound, the same drug, is approved now for weight loss. Read more about them in Spanish. 

Zepbound/Mounjaro, like Ozempic and Wegovy, has potent weight loss properties due to the medication’s effect on appetite and metabolism centers in the brain. The FDA approved Mounjaro for obesity treatment in November 2023 and renamed it Zepbound. Both drugs are identical. Clinical trials show not only decreased appetite but also reduced cravings, especially for sweet and fatty foods. Zepbound/Mounjaro treatment results in the most significant loss of any weight loss drug. Read more about these new medications in Dr Lipman’s new book. It is available on Smashwords and many other book sites. Telemed patients can buy the book at most book stores.

 

In addition, like Ozempic and Wegovy, it delays gastric emptying, producing fullness for many hours. Greater weight loss and better glucose control, along with fewer side effects, are observed with Zepbound/Mounjaro compared to Ozempic and Wegovy because it contains 2 active hormones acting together. When comparing Ozempic vs. Zepbound/Mounjaro, one finds fewer side effects and greater weight loss.

Newest information!   In the most recent trial of Zepbound/Mounjaro 36.2% of participants in the 15-mg group had weight reduction of 25% or more. This compares to weight loss with bariatric surgery of approximately 25 to 30% at 1 to 2 years and far exceeds the results seen with older anti-obesity drugs of 4 to 8% weight loss after a year.

How Does Zepbound/Mounjaro Weekly Weight Loss Injections Produce Such Profound Weight Loss?

1. It directly reduces appetite and increases metabolism by action in the brain.
2. It reduces glucagon secretion, which is the hormone that increases hunger.
3. It causes individuals to eat fewer carbs and fatty foods often by its mechanisms in reducing food noises.
4. It increases insulin production, but only when blood sugar is high—which makes the risk of low blood sugar minimal.
5. Decreases the liver’s production of sugar and increases uptake of sugar by muscle tissue.
6. It slows down the speed at which the stomach empties food into the intestine. This produces weight loss and is also responsible for the gastrointestinal side effects.

 

Research Results Confirm Significant Weight Loss with Zepbound/Mounjaro Weekly Weight Loss Injection

The most recent SURMOUNT-1 study consisted of 2,539 participants with an average starting body weight of 231 pounds over 72 weeks:

1. At the lowest dose—5 mg—participants lost 15% of their body weight
2. At higher doses—10 and 15 mg—participants lost 20% of their body weight. More than half of the participants taking the higher dose lost 20% of their body weight compared to only 1.3% taking a placebo. Average weight loss = 52 lbs.
3.Most Mounjaro research results suggest Mounjaro is more effective than Ozempic or even Wegovy for weight loss. Gastrointestinal side effects are lower with Mounjaro than the other drugs.

Comparison of Weight Loss with Ozempic, Wegovy, and Mounjaro   (and also Zepbound)

The four new GLP-1 medications for weight loss are compared below. Note that Ozempic is available in both 1 mg and 2 mg doses. The 2 mg dose is from the Wegovy data. In other studies, Wegovy produced a mean weight loss of 18% of the starting weight. Be careful to recognize differences in study lengths, starting weights, and, most importantly, the presence of diabetes among some study subjects.
In the graph below,  Mounjaro and Zepbound are the same drug..

How to Take Injections of the GLP-1 medications

Zepbound and Mounjaro weekly weight loss injections are supplied in a box of 4 self-injectable pens, enough for a month. Each pen is used for a single injection once a week on the same day. Doses start at 2.5 mg and increase in 2.5 mg increments. For patients that have Gastrointestinal sensitivity, I suggest micro-dosing, starting with doses that are a third or half of the minimal 2.5 mg dose. Weight loss starts after taking the 2.5 mg pen for several weeks. New side effect that’s recently been reported has been allodynia. Allodynia is a skin sensitivity to GLP-1s, characterized by itching and redness in the arms and legs, which gradually disappears when reducing the dose or stopping the medication. It’s often seen early in the course of treatment. Researchers believe that allodynia may be related to hypersensitivity of the nerve endings in the skin.

Microdosing post-menopausal patients with even lower doses of GLP-1’s.

I have observed in my office that post-menopausal patients may be even more sensitive to the gastric side effects of these drugs. These patients should be micro-dosed at even lower doses. And doses should be slowly raised and only if absolutely necessary.

Variable Doses of GLPs depending upon metabolic sensitivity and side effects.

Some people can lose all he weight they need on low doses of 5 or 7.5 mg, while others need to increase doses by 2.5 mg per month gradually. The highest dose is seen at 15 mg weekly. Injections are taken at the same day of the week. Usually Saturday or Friday morning is a good time.  Some patients take it at bedtime to lessen nausea. The reason for Saturday morning is that most people eat more on the weekends and the medication is more effective early in the week. Dr. Lipman has developed a specific weight loss plan  for semaglutides that maximizes the weight loss and reduces side effects

Semaglutide  Diet Plan: The Best Foods and Drinks to Maximize Weight Loss

Dr Lipman has adapted his low-carb diet to the unique properties of these drugs. This includes limiting liquids when eating, lowering alcohol, and eliminating a few foods such as nuts, oils, and seeds, and foods high in carbs or fat, which are not digested well with this drug.

How to Get Zepbound and  Mounjaro for Weight Loss

Mounjaro can be  purchased at any pharmacy with a prescription from a licensed physician, including Dr Lipman with a personal office or a Telemed visit.

Side Effects of Zepbound/Mounjaro(Similar to Ozempic and Wegovy): What to Do About Them

Non Specific Side Effects found in all Mounjaro Reviews
Fatigue, lack of energy, and tiredness are common side effects of all three of these drugs. There are several causes, including skipping meals, which often results in hypoglycemia late in the afternoon,too much food reduction, vitamin deficiency from rapid weight loss, and, most importantly, a lowering of blood sugar. Blood sugar reduction would not be unexpected because diabetics use these medications to lower their blood sugar. Much of the fatigue is avoided by not skipping meals and having a protein snack late in the afternoon.

Gastrointestinal Side Effects-The most common:
GI side effects are common in people taking these drugs. (72.9%). They included nausea (43.9%), diarrhea (29.7%), vomiting (24.5%) and constipation (24.2%). Less common are heartburn, burping and non specific abdominal pain.

Dose Escalation causes increased frequency of GI side effects especially in the first 2 days of the adjustment. The GI side effects are mostly transient (except for constipation), not serious (99.5%), and mild-to-moderate in severity (98.1%). The GI side effects fall into 2 groups: the specific and more serious side effect and the much more common, mild gastrointestinal pains.

1. Specific GI side Effects: Rare, but on Occasion Could be Serious:

Constipation is On Going Problem in many patients: Constipation may last longer than other GI side effects, consistent with the more chronic nature of this
condition and the fact it’s often due to other factors. Most commonly, it’s due to the marked reduction in the intake of food, especially fatty foods and oils.

Pancreatitis and Gall Bladder Attacks: Acute pancreatitis has been reported in patients treated with these medications. Patients should be observed for any
signs and symptoms of acute pancreatitis (e.g. persistent severe abdominal pain). Trials have not shown an increased risk of pancreatitis with these medications.

Cholelithiasis (gallstones) may occur with rapid weight loss with any diet, and an increased incidence has been reported in patients treated with
Ozempic/Wegovy for weight management.

Thryoid tumors related to Mounjaro and other Semaglutides have been found in rats but not humans many Mounjaro reviews.

2. Non- Specific Side Effects Related to Dosing, Food, Eating Patterns

A. Treating GI Side Effects  by Changing Foods

No foods are strictly “off-limits” when taking these medications—in other words, there’s nothing to worry about that could prevent the medication from working normally. However, there are a few guidelines you’ll want to keep in mind to maximize weight loss and minimize side effects. This includes limiting fatty, fried, and high-sugar foods. Eating slowly and avoiding large meals are other key strategies for preventing GI side effects.

B. Treating GI Side Effects with OTC or Prescription Medications- Depends on Type of Symptoms

Nausea: Nausea is clearly the most common GI side effect. It’s often seen in the very beginning and during dose escalation, but for most people it gets less and less significant as time passes. Studies have shown it’s due to the delayed gastric emptying, direct effect of these drugs in the brain, and eating fast or eating large meals, especially full of fat and carbs. The secret is to eat smaller meals, more frequently, and try to stop before you feel full. Rx: OTC meds like Gas-X, Pepto- Bismol, Imodium and prescription Zofran orally or Compazine by injection.

GERD-Heartburn-reflux: There is a transient worsening or new onset of gastro-oesophageal reflux disease (GERD; a known complication of obesity) during treatment for many patients. Rx: Omeprazole, Prilosec- once or even twice a day, for breakthrough pain H2- blockers such as Pepcid AC, Tagamet, Protonix, Prevacid.

Constipation: One of the most common side effects due to the medication or even more likely the change of food. Treatment includes the usual treatment of constipation. Rx: Fiber such as Metamucil capsules 2-3 twice a day with several glasses of water, stool softeners and/or Miralax.

Vomiting: This less common side effect is usually transitory and occurs more in the initial phase rather than with higher doses. Often treatment for GERD like symptoms can stop the vomiting. If severe, then the anti-emetics. Rx: OTC products: Dramamine, Bonine, Gravol, Pepto-Bismol, Emetrol, prescription products include Zofran, Compazine, Phenergan

Other Non- Related Causes

Clinicians should also consider whether any existing or recently initiated concomitant prescription or non-prescription medications could be responsible. An example is Metformin that can cause GI side effects of nausea, pain and cramping.

C. Treating GI Side Effects By Lowering the Doses 

Given the dose-dependent nature of these GI side effects, lowering the dose and/or delaying the escalation is considered for patients unable to tolerate the medications, with the aim of achieving a dose that enables patients to gain at least some of the benefits with minimal GI side effects.

If GI symptoms occur and dose escalation is paused or reduced, it might be retried once the patient is symptom-free at the lower dose. Slower dose escalation reduces side effects. Many patients with GI side effects reach full dose by extending the titration time table. If patients experience GI side effects with other drugs of this class and are unable to tolerate them, despite best efforts to alleviate the symptoms, treatment is stopped. Switching to a different class of obesity pharmacotherapy could be considered.

Plateaus and Slow Weight Loss with Semaglutides How to Increase Weight Loss with Mounjaro, Wegovy, Ozempic and Zepbound

1. Take the injections Saturday AM. These medications are more effective just after you take them, and many people eat more on the weekends.
2. Increase the dosage faster if side effects of nausea are not a problem. You still need to reach 1 mg/week for significant weight loss to start, and you need a three-week period for the full dose in your blood. (Steady State).
3.Most individuals taking the drug find sweet and fatty foods very unpleasant. So why not simply avoid these. Exercise beginning in the 3^rd week is always helpful.
4. Avoid large meals or eating too fast because this ends up filling the stomach up quickly, which leads to faster emptying, less fullness, and less weight loss. This occurs when skipping meals. Need 3-4 small meals over the day.
5. Avoid drinking water, especially carbonated drinks, during the meal because a lot of fluid causes premature emptying of the stomach and defeats the effect of the medications. The best idea is to avoid fluids 30 minutes before and 30 minutes after a meal. Oils and alcohol have similar effects and are high in calories.
6.Avoid eating dense, high-calorie snacks like nuts, seeds, nut butters, and granola. These foods are consumed in tiny portions that can easily slip out of the stomach and be absorbed. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189979/
Chaotic eating, grazing, skipping meals. This is often the behavior that caused the weight gain in the first place. Need structure, eating times spaced throughout the day, allowing time for breakfast, lunch, snack, and dinner. After 4-6 weeks of taking any of these medications, the dieter often starts skipping meals because the medication produces a sense of fullness and reduced appetite, especially during the day. Eventually, the dieter ends up with a large evening meal, which can lead to premature stomach emptying and reduced weight loss.
9. Alcohol causes disinhibited eating and failure to lose weight rapidly.

Who Should NOT Take Zepbound/Mounjaro?

Weight Loss drugs, like any other effective medications, have contraindications and potential risks. You should not take them if:
1. A history or family history of thyroid cancer—specifically medullary thyroid ca (MTC).
2. A history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
3. A history of allergies to any of the ingredients

Prescription Cost of  Zepbound/Mounjaro Weekly Weight Loss Injection? (Price of all doses are the same)

Recently, several compounding pharmacies around the country have released a compounded form of Mounjaro that sells for about25-50% of the brand, depending on the dosage. At low doses, the generic, compounded preparation is reasonable. However, unlike the prescription self injecting pens, the compounded Mounjaro price is dependent on the dose–almost rippling from low to high doses.

Retail cash price is about $1100/month
GoodRx coupon may reduce it.

 

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