What are less expensive alternatives to Wegovy (semaglutide) for weight loss?

Less Expensive Alternatives to Wegovy for Weight Loss

Phentermine is the most cost-effective first-line alternative to Wegovy, costing approximately $3-$43 per month compared to Wegovy's $1,619 monthly cost, though it provides more modest weight loss of approximately 7-8%. 1

Cost Comparison of Weight Loss Medications

The following medications represent viable alternatives with significantly lower costs than Wegovy 1:

Most Affordable Option

• Phentermine (generic): $3-$43 per month for 37.5 mg daily dose 1
  • Achieves approximately 7.4% greater weight loss at 24 months with long-term use (>12 months) 1
  • Important caveat: FDA-approved only for short-term use as monotherapy, though long-term data shows safety over 3 years with no increased cardiovascular risk or death 1
  • May cause elevated heart rate 1

Moderately Priced Options

• Orlistat 60 mg (over-the-counter): $58 per month 1

  • Achieves 4.65 kg weight loss over 24 weeks 1
  • Demonstrated lower cardiovascular event risk in 6-year follow-up study 1
  • Common side effects include mild gastrointestinal issues (loose stools, oily spotting) 1

• Phentermine/Topiramate ER (Qsymia): $237 per month 1

  • More effective than phentermine alone, with moderate-to-large magnitude weight loss 1
  • Critical contraindication: Pregnancy due to oral cleft risk from topiramate; requires contraception and regular pregnancy testing in women of childbearing potential 1

• Naltrexone/Bupropion ER (Contrave): $750 per month 1

  • Achieves 5-9% body weight reduction over 56 weeks 1
  • Cardiovascular safety confirmed with no increased major adverse cardiovascular events (2.7% vs 2.8% placebo) 1
  • Contraindications: Seizure disorders, uncontrolled hypertension, chronic opioid use 1

Clinical Decision Algorithm

For patients who successfully lost weight on Wegovy:

1. If cost is the primary barrier and patient needs maximum affordability: Start phentermine 37.5 mg daily 1

   • Monitor heart rate and blood pressure monthly 1
   • Consider long-term use if tolerated, despite short-term FDA approval 1

2. If patient can afford moderate cost ($200-300/month): Use phentermine/topiramate ER 1

   • Provides closer efficacy to GLP-1 agonists than other alternatives 1
   • Requires pregnancy prevention counseling for women of childbearing age 1

3. If patient has cardiovascular disease or metabolic syndrome: Consider orlistat or naltrexone/bupropion ER 1

   • Both have demonstrated cardiovascular safety 1
   • Orlistat reduces LDL-C and provides cardiovascular protection 1

Important Monitoring Considerations

All weight loss medications require assessment of effectiveness and safety 1:

• Monthly monitoring for first 3 months 1
• Quarterly monitoring thereafter 1
• Early response predicts long-term success: ≥5% weight loss after 3 months indicates likely benefit from continuing therapy 1
• If <5% weight loss at 3 months, consider switching medications or intensifying treatment 1

Critical Caveat About Weight Regain

Sudden discontinuation of any weight loss medication results in significant weight regain 1:

• Patients regain one-half to two-thirds of lost weight within 1 year of stopping 1
• This applies to all pharmacologic weight loss treatments, not just GLP-1 agonists 1
• Plan for long-term therapy from the outset, using the lowest effective dose 1

When Alternatives May Not Be Sufficient

If the patient has established cardiovascular disease, heart failure, or chronic kidney disease, the cardiovascular benefits of semaglutide (20% reduction in cardiovascular death) may justify exploring patient assistance programs, compounding pharmacies, or tirzepatide as a potentially more cost-effective GLP-1 alternative rather than switching to non-GLP-1 medications 1, 2. Tirzepatide costs $1,017-$1,272 per month and may be more cost-effective than injectable semaglutide in some analyses 1, 2.