Ozempic vs Saxenda – What’s Better for Weight Loss?

Recent data highlights a trend, with GLP-1 receptor agonist prescriptions for overweight or obese adults experiencing a nearly 587% surge between 2019 and 2024. For individuals without diabetes, this increase was even more pronounced, reaching a staggering 1,961%.

Ozempic (semaglutide) and Saxenda (liraglutide) have emerged as two of the most recognized and popular prescription options for weight loss. While their primary regulatory approvals differ, both belong to the same class of medications and have demonstrated considerable impact on weight reduction. The substantial commercial interest, with anti-obesity medication sales projected to reach $100 billion by 2030, aligns with the new hope these drugs offer to patients who have long struggled with excess weight.

Understanding Ozempic and Saxenda?

What is Ozempic?

Ozempic is a brand-name injectable prescription medication that contains the active ingredient semaglutide. It is classified as a glucagon-like peptide-1 (GLP-1) receptor agonist, a class of drugs that mimics a natural hormone in the body. Ozempic holds several key FDA approvals, primarily for adults with type 2 diabetes.

While it is not FDA-approved specifically for weight loss, it frequently leads to substantial weight reduction as a beneficial effect of its mechanism of action. This observed weight loss has led to its widespread “off-label” prescription for weight management.

What is Saxenda?

Saxenda is an injectable prescription medicine that contains the active ingredient liraglutide. Similar to Ozempic, it is also a GLP-1 receptor agonist. A key distinguishing feature of Saxenda is its direct FDA approval for chronic weight management. It is indicated for adults with excess weight.

Additionally, Saxenda is approved for adolescents aged 12-17 years who have a body weight above 132 pounds (60 kg) and obesity.

How Do GLP-1 Receptor Agonists Work?

The mechanism of action involves several interconnected pathways that contribute to both blood sugar regulation and weight reduction:

• Slowing Gastric Emptying: A significant effect of GLP-1 agonists is their ability to slow down the rate at which food moves from the stomach into the small intestine. This delayed gastric emptying helps individuals feel fuller for a longer period.
• Suppressing Appetite and Increasing Satiety: By activating GLP-1 receptors in the brain, these medications help to regulate appetite and reduce food cravings. This leads to a decreased caloric intake and, consequently, weight loss.
• Stimulating Insulin Release: When blood sugar levels increase after a meal, GLP-1 agonists prompt the pancreas to release more insulin. This insulin helps to transport glucose from the bloodstream into cells, thereby lowering blood sugar levels.
• Reducing Glucagon Production: These medications also decrease the production of glucagon by the liver. Glucagon is a hormone that raises blood sugar, so its reduction further contributes to improved glycemic control.

Clinical Effectiveness: What Does the Research Say?

Weight Loss Results with Saxenda

Clinical trials, particularly those within the SCALE program, have consistently demonstrated Saxenda’s effectiveness for weight loss.

In a notable 56-week study involving 3,731 patients who did not have type 2 diabetes, individuals treated with Saxenda achieved an average weight loss of 6.4% of their initial body weight.

A substantial majority of adult patients, specifically 85% in a 1-year study, achieved a clinically meaningful weight loss of ≥5% of their baseline body weight.18 Patients who completed the study on Saxenda experienced a mean weight loss of 21 pounds.

Weight Loss Results with Ozempic

While Ozempic is primarily approved for type 2 diabetes, its active ingredient, semaglutide, has shown more substantial weight loss results in clinical trials, particularly those conducted within the STEP (Semaglutide Treatment Effect in People with Obesity) program.

Participants using semaglutide, often at higher doses (e.g., 2.4 mg per week, which is the dose found in Wegovy), in combination with a reduced-calorie diet and exercise interventions, lost an average of 14.9% to 16% of their initial body weight after 68 weeks. Notably, some individuals achieved over 20% weight reduction, especially when higher doses were used alongside lifestyle modifications.

Approximately 2% of body weight loss was observed after four weeks of semaglutide at 0.25 mg, and about 4% by week eight at 0.5 mg.

Direct Comparison in Clinical Trials – (Which medication has shown greater weight loss in studies?)

A pivotal randomized controlled trial conducted in 2022 directly compared once-weekly 2.4 mg semaglutide (the dose approved for weight loss in Wegovy) with daily 3 mg liraglutide (the maximum dose for Saxenda) in individuals with obesity. 

The results were striking: participants in the semaglutide group lost 15.8% of their body weight, whereas those in the liraglutide group lost 6.4%. This demonstrates that at these respective doses, semaglutide was nearly three times more effective for weight loss.

Role of Diet and Exercise

Research indicates that combining GLP-1 receptor agonists with supervised exercise programs can lead to greater weight loss maintenance and improved body composition.

The S-LiTE study, for instance, demonstrated the superiority of liraglutide combined with a supervised exercise program for weight maintenance and improved body composition.

The weight-reducing effects of these medications appear to depend on continued usage; weight regain is common upon discontinuation if lifestyle changes are not sustained. For example, two-thirds of the weight loss achieved with semaglutide was regained during a one-year off-treatment period.

Dosage and Administration

Ozempic Dosage and Frequency

Ozempic is administered as a once-weekly subcutaneous injection using a pre-filled pen. Patients can inject it in the abdomen, thigh, or upper arm.

The typical dosing schedule for Ozempic begins with a low starting dose, which is gradually increased over several weeks.

• Weeks 1-4: 0.25 mg once weekly. This initial dose primarily aids in tolerance development rather than significant blood glucose reduction.
• Weeks 5-8: 0.5 mg once weekly.
• Weeks 9-12: 1 mg once weekly (optional, depending on response and tolerability).
• Week 13 and beyond: 2 mg once weekly (optional, representing the maximum dose for Ozempic).

Saxenda Dosage and Frequency

Saxenda is administered as a once-daily subcutaneous injection using a pre-filled pen. It can be injected in the abdomen, thigh, or upper arm at any time of day.

Similar to Ozempic, Saxenda requires a gradual dose escalation over several weeks.

• Week 1: 0.6 mg per day.
• Week 2: 1.2 mg per day.
• Week 3: 1.8 mg per day.
• Week 4: 2.4 mg per day.
• Week 5 and after: 3 mg per day (this is the recommended maintenance dose).

Note: If a dose is missed, it should be skipped, and the next dose should be taken as scheduled the following day; no extra or increased doses should be taken to compensate, as this can increase the risk of serious side effects.

Convenience and Ease of Use

Ozempic is administered as a once-weekly injection, whereas Saxenda requires daily injections. Many patients find the once-weekly schedule of Ozempic to be considerably more convenient and easier to adhere to, particularly those with busy lifestyles.

Both medications are supplied in pre-filled, multi-use pen injectors, designed for straightforward self-administration, which generally makes the injection process itself relatively easy for patients.

Side Effects, Safety, and Boxed Warning

Common side effects for both drugs

Both Ozempic and Saxenda, as members of the GLP-1 receptor agonist class, share a similar profile of common side effects:

• Nausea: This is the most common side effect for Ozempic and is reported in 39.3% of Saxenda users. It is a very common occurrence with GLP-1 agonists.
• Vomiting
• Diarrhea
• Constipation
• Abdominal (stomach) pain

Serious Risks and Boxed Warning

Both Ozempic and Saxenda carry a Boxed Warning, which is the most serious warning issued by the FDA. This warning pertains to the potential risk of thyroid C-cell tumors, including medullary thyroid carcinoma (MTC).

Beyond the boxed warning, both medications are associated with other serious but less common risks such as Pancreatitis, Hypoglycemia, gallbladder problems, serious allergic reactions, etc.

Patient Experience and Tolerability

A randomized controlled trial found that a smaller percentage of participants in the semaglutide group (3.2%) discontinued treatment due to side effects, compared to a significantly higher percentage in the liraglutide group (12.6%).

Another source indicates that up to 30% of Saxenda participants tend to stop the medication due to adverse effects, whereas the discontinuation rate for Ozempic is lower, around 12-13%.

Who Is a Candidate for Each Medication?

FDA-approved uses

• Ozempic (semaglutide): This medication is FDA-approved primarily for adults with type 2 diabetes.
• Saxenda (liraglutide): In contrast, Saxenda is FDA-approved specifically for chronic weight management in adults and adolescents aged 12-17 years.

Eligibility Criteria

• Ozempic (semaglutide): Its indications include improving blood sugar control and reducing the risk of major cardiovascular events in those with type 2 diabetes and established heart disease.
• Saxenda (liraglutide): For adults, it is indicated for those with a Body Mass Index (BMI) of ≥30 kg/m² (obesity) or a BMI of ≥27 kg/m² (overweight) who also have at least one weight-related comorbidity.

When to Choose One over the Other

Consider Ozempic if:

• The patient has type 2 diabetes, especially if they also have established cardiovascular disease or chronic kidney disease.
• Greater weight loss is the primary objective, as semaglutide (Ozempic’s active ingredient) has generally demonstrated higher efficacy.
• The convenience of a once-weekly injection is highly preferred for ease of integration into daily life.
• Ozempic has been associated with lower rates of discontinuation.

Consider Saxenda if:

• The primary goal is chronic weight management, and the patient meets the specific BMI and comorbidity criteria, particularly if they do not have type 2 diabetes.
• A daily injection routine is preferred or better tolerated by the patient.
• The patient is an adolescent aged 12-17 years who meets the specific weight and obesity criteria.
• If Ozempic is not covered by insurance for weight loss.

Switching Between Saxenda and Ozempic

Why Switch?

The decision to switch is often driven by the individual’s experience with their current medication and their evolving health goals. Some common reasons include:

• Effectiveness
• Side Effects
• Convenience
• Insurance Coverage/Cost

How to Switch Safely

Transitioning between Ozempic and Saxenda requires careful planning and should always be conducted under the strict supervision of a healthcare provider.

Timing and Washout Periods

• From Saxenda (daily injection) to Ozempic (weekly injection): Patients can typically start Ozempic the day after their last Saxenda dose.
• From Ozempic (weekly injection) to Saxenda (daily injection): A longer washout period is generally recommended due to semaglutide’s extended half-life. Patients should wait 7 days after their last Ozempic dose before starting Saxenda.

Dose Adjustment: When initiating the new medication, it is typically started at the lowest available dose and gradually titrated upwards according to a scheduled escalation.

Medical Supervision and Monitoring: Close monitoring for side effects, changes in blood sugar levels (especially for patients with diabetes), and overall treatment response is crucial throughout the transition period.

Risks and Precautions

Do not use both drugs together: It is imperative that Ozempic and Saxenda are never taken simultaneously. Both medications are GLP-1 receptor agonists, and combining them can lead to intensified side effects.

Cost and Insurance Coverage in the USA

Average monthly costs

• Ozempic: Without insurance, a one-month supply of Ozempic typically costs approximately $995 to $1,000.
• Saxenda: The manufacturer’s list price for Saxenda is around $1,350 for a 30-day supply.

Insurance and savings programs

Ozempic: Most commercial prescription plans generally cover Ozempic when it is prescribed for its FDA-approved indications. However, it is rarely covered for weight loss because this is considered an “off-label” use, meaning it’s not an FDA-approved indication for the drug.

Novo Nordisk, the manufacturer, offers an Ozempic Savings Card for commercially insured patients, which can reduce the monthly out-of-pocket cost to as little as $25 for up to 48 months.

Saxenda: Commercial health insurance plans might cover Saxenda for weight management, but this often comes with specific requirements, such as meeting certain BMI criteria and obtaining prior authorization.

A Saxenda Savings Card may allow eligible commercially insured patients to pay as little as $25 or save up to $200 per prescription.

Financial considerations for patients

Given the high list prices of Ozempic and Saxenda, patients must carefully evaluate the financial implications of long-term treatment. Even with commercial insurance, individuals may still face substantial out-of-pocket costs due to high co-pays, deductibles, or co-insurance, as these drugs are frequently classified as Tier 3 or specialty medications, which typically incur higher patient responsibility.

Key Differences at a Glance (Table)

The following table summarizes the key distinctions between Ozempic and Saxenda for quick reference: