7 Alternatives to Semaglutide: What Works When You Can’t Get Ozempic or Wegovy?

Semaglutide became a hot topic for anyone looking to lose weight or manage type 2 diabetes. But with shortages, high prices, and tough insurance hurdles, a lot of people are scrambling for other options. You might be surprised to learn there’s more out there than just waiting on your prescription refill or trying to score a coupon for Ozempic or Wegovy.

The cool thing? New medications, custom pharmacy blends, and old-school pills are all in the mix. Each one works a bit differently and comes with its own pros and cons, from how effective it is to issues with side effects and cost. I’ll break down what really matters for each pick—helping you decide which one could actually fit your needs instead of just wishing for that perfect shot of semaglutide.

Let’s jump into your options and dig into the details you actually need, starting with compounded semaglutide—the main workaround people are using when shelves go empty.

• Compounded Semaglutide
• Tirzepatide
• Liraglutide
• Dulaglutide
• Exenatide
• Metformin
• Orlistat
• Choosing the Right Alternative

Compounded Semaglutide

When pharmacies and clinics talk about compounded semaglutide, they mean a version that’s mixed up fresh by pharmacists, instead of coming straight from the big-name drug manufacturers. This usually happens because of supply shortages—basically, when popular brands like Ozempic or Wegovy are impossible to find. You still get semaglutide as the active ingredient, but it isn’t exactly the same as the FDA-approved stuff. It’s not made by Novo Nordisk, for one thing, and the rules around it are way less strict.

The main draw is that compounded semaglutide can be way easier to get when the regular products are backordered. Plus, for some folks, dosing can be tweaked a little more to fit their needs. But if you go down this route, you should absolutely ask your pharmacy questions—like where they source their raw materials and how often they test what they’re mixing. The FDA hasn’t signed off on these versions, so quality can jump around a lot from one batch to the next. Some places might even add other ingredients just to stretch supplies, which is not exactly confidence-inspiring.

Pros

• May improve accessibility when Ozempic and Wegovy are out of stock at your local pharmacy.
• Allows for personalized dosing, which can help some people fine-tune their treatment.
• Uses the same semaglutide mechanisms as the big brands, so benefits and side effects are generally similar—if quality is good.

Cons

• Uncertain potency and quality—you never really know that you’re getting the real deal every single time.
• Legal grey zones and insurance is rarely (if ever) going to cover it.
• No big clinical trials backing up compounded versions, so the risks are less understood.

Just to put things in perspective, in early 2024, over one in four people using a GLP-1 medication said they’d tried compounded versions because pharmacies were out of stock. That shows how big the demand is—even with all the unknowns. If you’re thinking about it, talk openly with both your doctor and pharmacist. Make sure you’re not swapping safety for convenience.

Tirzepatide

Tirzepatide is edging its way into the spotlight as a powerful semaglutide alternative. You might know the brand name Mounjaro. It’s FDA-approved for type 2 diabetes and is being studied (and used off-label) for weight loss, which puts it in direct competition with semaglutide options like Ozempic and Wegovy.

Tirzepatide stands out because it targets two pathways instead of one. It acts on both GLP-1—just like semaglutide—and GIP receptors, which helps control blood sugar and appetite. This dual action could mean even better weight loss results for some people.

In a recent clinical study (SURMOUNT-1, 2022), people lost up to 22% of their body weight after 72 weeks on tirzepatide, which is slightly more than what’s usually seen with semaglutide. Here’s a quick comparison based on large clinical trials:

This gets a lot of people interested, especially those who feel stuck or hit a plateau with other meds. Doctors are starting to prescribe tirzepatide for weight loss, even though insurance coverage can be hit or miss without a diabetes diagnosis.

Pros

• May lead to more weight loss than semaglutide in clinical trials
• Also lowers blood sugar for people with diabetes
• Once-a-week injection, just like Ozempic and Wegovy
• May curb appetite and cravings even more for some users

Cons

• Insurance often won’t cover it for weight loss unless you have diabetes
• Possible side effects: nausea, diarrhea, sometimes constipation
• Not everyone responds the same—some see lots of weight off, others less
• It’s still new, so long-term safety for weight loss is less clear

Bottom line: If you need something that does a bit more than what semaglutide offers, tirzepatide is worth considering. But cost and access might be a headache.

Liraglutide

Liraglutide has been on the scene way before semaglutide alternatives became a buzzword. You’ve probably heard of it as Saxenda (for weight loss) or Victoza (for diabetes). It’s a daily injection that works like semaglutide by mimicking GLP-1, a hormone that helps control blood sugar and cuts down on hunger. The FDA approved Saxenda for weight management back in 2014, so it's a tried-and-true option for people who can’t get their hands on Ozempic or Wegovy.

What’s cool about liraglutide? There are years of solid data behind it. In real-life studies, people on Saxenda lost an average of 5% to 10% of their body weight after a year. This isn’t some sketchy internet hack—this stuff has a legit track record, especially if you combine it with a healthy diet and regular activity.

Pros

• FDA-approved for both diabetes (type 2) and weight loss.
• Known safety profile with plenty of long-term data.
• Can help lower blood sugar, control appetite, and support steady weight loss.
• Available in most pharmacies, even when semaglutide is backordered.
• Covered by some insurance plans with prior authorization.

Cons

• Requires daily injections, which can be annoying compared to once-weekly shots like semaglutide.
• Weight loss isn’t usually as dramatic as with more potent semaglutide alternatives, like tirzepatide.
• Common side effects: nausea, vomiting, and upset stomach (especially during the first few weeks).
• May not be covered by all insurance plans for weight loss—some only approve it for diabetes.

Here’s a quick comparison for perspective on how liraglutide stacks up against semaglutide for weight loss results:

While liraglutide might not be the flashiest pick, it’s a solid, proven alternative if you’re serious about managing your weight or blood sugar. Just keep in mind: results depend on sticking to your routine, especially with those daily injections.

Dulaglutide

Dulaglutide (brand name Trulicity) is another semaglutide alternative that works as a GLP-1 receptor agonist. It’s FDA-approved for type 2 diabetes management and, just like semaglutide, it helps your body make more insulin after eating and slows down how fast the stomach empties. People often ask if it helps with weight loss, and the answer is: yes, but usually not as much as semaglutide. Still, it offers a decent shot at lowering both blood sugar and weight, without needing a daily pill.

One cool thing is that dulaglutide is taken as a once-weekly shot, so you’re not poking yourself every day. For most, it’s super easy to use thanks to its prefilled, single-use pen. Studies show that people lost an average of about 5–7 pounds over several months—lower than semaglutide, but better than nothing, especially if you can’t access Ozempic or Wegovy.

Pros

• Taken only once a week—major convenience factor.
• Proven to help lower A1C and curb weight for type 2 diabetes.
• Prefilled pen is easy, even if you hate needles.
• Less nausea compared to some other GLP-1 meds.
• May help lower risk of major heart events, based on clinical trials.

Cons

• Not FDA-approved specifically for weight loss, so insurance usually won’t cover it just for that.
• Average weight loss is less than semaglutide or tirzepatide.
• Some people notice stomach issues (nausea, bloating)
• Can be pricey if you don’t have coverage—think several hundred dollars per month.
• Not for people with a personal or family history of certain thyroid cancers.

If you need a solid semaglutide alternative for diabetes or mild weight loss, dulaglutide is worth considering—especially if weekly dosing fits your lifestyle better than daily meds.

Exenatide

If you’re looking for semaglutide alternatives, exenatide is one you’ll hear about a lot. Brand names like Byetta and Bydureon have been around since 2005—way before the Ozempic craze hit. Exenatide is a GLP-1 receptor agonist, which is just a fancy way of saying it mimics the hormone that tells your brain you’re full while also lowering blood sugar. It’s taken as an injection either twice a day (Byetta) or once a week (Bydureon), so you have options based on what fits your lifestyle.

One thing that sets exenatide apart is its long history. Doctors are super familiar with it, and the safety data is pretty robust. For weight loss, it’s not quite as strong as semaglutide or even tirzepatide, but it still helps most people drop a meaningful amount of weight—usually around 5% of total body weight if you stick with it for several months. Not too shabby! For blood sugar, it’s great at lowering A1c numbers, especially in folks with type 2 diabetes.

Here’s a quick look at what research has shown about exenatide’s outcomes:

The cost is a little more reasonable compared to newer drugs. Generic versions exist and many insurances are more likely to cover exenatide than they are semaglutide right now. That’s a big win if price is driving your choices!

On the downside, nausea and stomach issues hit up to 30% of users, especially when starting out. And you need to get comfortable giving yourself (or asking someone to do it) a subcutaneous shot. Byetta needs to be dosed twice a day, which can be tough for folks who just want one-and-done weekly shots. Also, if you have severe kidney problems, exenatide may not be recommended.

Pros

• Long track record and lots of safety data
• Comes in both daily and weekly injection forms
• Covered by more insurance plans than newer drugs
• Helps with weight loss and blood sugar control together
• Generics keep costs lower for many people

Cons

• Weight loss is usually less than with semaglutide or tirzepatide
• Common stomach side effects, especially at first
• Twice-daily dosing (for Byetta) can be a hassle
• Not recommended for people with severe kidney issues

If you want something tried-and-true or you’re having insurance or supply trouble with newer meds, exenatide could be a solid pick. Just make sure you talk with your doctor about the dosing schedule and side effects so you know what to expect.

Metformin

Metformin has been around forever—or at least since the 1950s—and it’s still a top pick for treating type 2 diabetes. Even though it doesn’t get as much hype as semaglutide alternatives like GLP-1 agonists, folks often end up on metformin first when they’re diagnosed with diabetes. But here’s the interesting part: some doctors use it off-label for weight loss, especially when newer meds like Ozempic or Wegovy aren’t an option.

This pill works by lowering how much sugar your liver makes and helping your cells use insulin better. In simple terms: it keeps your blood sugar stable and can also help drop a few pounds, though not in a dramatic way. Large studies show that on average, you might lose 5 to 10 pounds over several months. That’s not nothing—especially if you’re pairing it with diet tweaks and exercise.

Pros

• Very affordable, even without insurance. A month’s supply often costs less than $10.
• Decades of safety data. This drug isn’t some risky new kid on the block.
• Can improve insulin sensitivity and lower blood sugar effectively.
• Fewer scary side effects compared to newer weight loss medications.
• Some evidence it lowers risk of heart attack and stroke in people with diabetes.

Cons

• Weight loss is pretty modest compared to newer GLP-1 drugs like semaglutide and tirzepatide.
• Most common side effects are gut-related: nausea, diarrhea, and stomach pain—especially when starting out.
• Not everyone is a candidate: people with really bad kidney problems can’t take it.
• Needs to be taken daily, which can be a pain if you forget your meds.

If you’re all about results, the rockstar weight loss medications will outpace metformin hands down. But if you’re looking for something tried, true, and cheap, this old standby is worth a look. And for anyone who wants numbers, here’s a quick side-by-side of metformin versus semaglutide in terms of weight loss and cost:

Metformin won’t win any awards for dramatic drops on the scale, but it’s hard to beat for the price and dependability. If you can’t get a GLP-1 drug, it’s a practical plan B for blood sugar and moderate weight loss.

Orlistat

If you’re after a semaglutide alternative that doesn’t require a doctor’s prescription (at least for the lower dose), Orlistat might catch your eye. It’s one of the oldest FDA-approved weight loss medicines out there, first getting the green light in 1999. You may know it by the brand names Alli (over-the-counter, 60mg) or Xenical (prescription, 120mg). What’s cool is you can actually buy Alli in most pharmacies without jumping through hoops.

Orlistat works totally differently from the newer hormonal drugs. Instead of messing with your appetite, it blocks about 25-30% of the fat you eat from being absorbed in your gut. That means if you take Orlistat with a meal, less fat actually makes it into your system—the rest heads for the toilet. For the record, Orlistat is approved for adults with a BMI of 27 or higher and is supposed to be used alongside a lower-calorie, low-fat diet.

Here’s a fun stat: Clinical trials show people taking Orlistat can lose roughly 5-10% of their starting weight over a year when they pair it with diet changes. The effect is a bit milder compared to the GLP-1 drugs, so expect moderate weight loss instead of a total transformation.

Pros

• Easy to access—get the low dose without a prescription at most drugstores.
• Doesn’t mess with your appetite or blood sugar, so fewer hormonal risks.
• Can be combined with most other diabetes or weight loss meds if your doctor says it’s okay.
• Lots of safety data—over 20 years of real-world use behind it.

Cons

• Can cause embarrassing digestive issues, especially if you eat fatty foods (think oily stools or diarrhea — not fun).
• Less effective than semaglutide alternatives like GLP-1 medications for most people.
• Needs to be taken every time you eat a meal with fat—so it’s three times a day if you’re sticking to the plan.
• Can block absorption of some key nutrients, like vitamins A, D, E, and K—so a daily multivitamin is a good idea.

If you don’t want to use a hormone-based weight loss drug or can’t get your hands on semaglutide, Orlistat is still worth thinking about. Just know your cheeseburger days are kind of over if you want to avoid those legendary bathroom surprises.

Choosing the Right Alternative

Navigating the world of semaglutide alternatives isn’t simple—there’s no such thing as a one-size-fits-all choice. The truth is, your best option depends on your medical history, goals, how much weight you want to lose, side effect tolerance, and even your budget. Some drugs are better for blood sugar, others hit harder on appetite, and insurance coverage is all over the place.

If you’re mainly after weight loss, some GLP-1 agonists like tirzepatide or liraglutide get close to semaglutide’s results, but they work differently in the body and have their own list of possible side effects—think nausea or stomach issues. Metformin and orlistat don’t deliver that wild weight drop, but they’re easier to get and way cheaper, so for steady progress or folks with certain health needs, they’re still worth a look.

Insurance companies make this even trickier. In the US, naming a drug “for weight loss” can mean jumping through extra hoops or battling high out-of-pocket costs. If cost matters, ask your prescriber for assistance programs, look into compounded meds (carefully), or try older treatments with a proven record—for example, Metformin is super affordable and generally covered.

Want a quick head-to-head? Here’s a straight-up comparison you can use to weigh the main points:

Here are quick tips if you’re choosing an alternative to semaglutide:

• Always talk to your doctor before switching. Even similar drugs can react differently with your body or other meds.
• Don’t skip the side effect talk—read up and ask what to expect so you’re not blindsided later.
• Look at practical stuff: Are you okay with daily injections or would you stick better to a weekly shot or a pill?
• Don’t chase miracle results—if something sounds too good to be true, it probably is. Look for real clinical data.
• Ask your pharmacy or doctor about insurance and assistance programs. Some brands sneakily roll out new coupons every few months.

If you can’t get semaglutide, you’ve got options, each with quirks, benefits, and drawbacks. Your doctor can help narrow it down so you don’t waste time or money.