Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Today we are addressing a very important question, which is, should I switch my GLP medication? This is a question that I am asked almost every single day that I’m in clinic or release having some shared decision making, the patient and I, of is the medication that you’re on right now, is it the best option for you? Should we be considering doing something different? Whether that means adjusting the dose or thinking about another medication. And I think this question is becoming more and more relevant as we have more and more options on the table. It has been wild. It is April of 2026, and I feel like over the last couple of months, we’ve just been inundated with new options on the market. And so I want you to be able to think about, especially with oral Wegovy now available, with the oral orforglipron called Foundayo with these new options on the market in combination with some of our older options like Wegovy, Ozempic, Zepbound, Mounjaro, how are you deciding which medication to take and should we be changing up our medication regimen?

So let’s dive into it. And first I want to talk about with all of these changes that we’ve had, what are the options on the table and what’s the difference between them? So we’ve had GLP medications around for a while, but we’ve really seen an explosion in the last five to six years of these medications. First we had Ozempic, which is the semaglutide for the treatment of type two diabetes. It came out a couple of years later as Wegovy. So Ozempic and Wegovy are the exact same medication. Wegovy is for the indication of weight reduction. It has traditionally been available as an injection and just earlier this year has been available also as a pill form. So we have Ozempic injection, Wegovy injection, and Wegovy pill. Now all is options for taking semaglutide medication, as well as some people who are using things like compounded semaglutide, but all of those fall in the same category.

On the other hand, we have tirzepatide medications. The first one was Mounjaro. This is FDA-approved for the treatment of type two diabetes. The exact same medication, Zepbound is FDA-approved for the treatment of weight reduction and also sleep apnea, for example. So we’ve got Mounjaro, we’ve got Zepbound. These are tirzepatide medications. Now trizepatide, Zepbound is a little surprising because it’s available in a few forms. Wegovy, you’ve got just the single dose injector pen, but the Zepbound, we have autoinjectors, which are single use pens. We have QuickPen, which is a multi-dose pen, and we have vials. So there’s lots of different offerings even though it is the exact same medication. And then the newest kit on the block is orforglipron, which is brand name Foundayo. So this was just FDA-approved at the beginning of April this year, which is really exciting. And this is a once a day oral GLP pill.

And so this has been a really big holdback for a while is that there were people interested in these medications and there were only the injectables available, but it’s been in the last couple of months now we saw the Wegovy pill and now we see the Foundayo pill. So we’ve got some different options that are available as a pill form, which is really exciting. So you might be looking at all of this and thinking, oh my gosh, should I be switching medications? Well, let’s talk about the effectiveness of these different medications. On average, when we look at Wegovy for weight reduction, most people on average will see between 13 and 15% total body weight reduction, depending on which clinical trial you’re looking at. And this is usually in a year or a little bit over a year. When we look at the Zepbound medication, people on average on the top dose of this medication lose about 21% of their body weight.

If they are on lower doses of medication, that might be in the 15 to 19% range. And then with the orforglipron or Foundayo medication, the average weight loss on this medication was about 12% for people who completed the clinical trial. So we see these three different medications all falling sort of overlapping with one another, but generally I think we would put their toceepatide medications like Zepbound as the most potent. This is a GLP and a GLP receptor agonist. So while it’s often talked about in combination of all of these, it is targeting two receptors where all of the other medications are just single GLP receptors. We’ve got Wegovy as the next most potent option, averaging about 13 to 15% total body weight. And that’s true whether we’re talking about the injection or whether we’re talking about the pill form of that medication. And then we’ve got Foundayo, which is a little bit less effective, but also that once per day pill version.

So couple of different options that are available to us here and people are wondering, should I be switching medications? So let’s talk about why we would be thinking about switching medications. And this comes up for a lot of reasons, whether it’s because of side effects, insurance coverage, maybe it’s because of effectiveness of the medication, like you’ve hit a weight plateau, for example, but sometimes it’s also just curiosity about other medications. Someone in your life is using one of the other forms and you’re like, hmm, I wonder if that would be a good option for me. So let’s talk about this from a side effects perspective. This is often one of the first reasons that we’ll consider switching medications. If someone is taking the medication and they’re having really significant side effects and we’re like, “You know what? I think you might do better on a different medication.” Now it will certainly depend on which medication that they’re on and side effects are often very manageable.

A lot of times when we’re starting medications, side effects do come up with these medications, but for most people, side effects are mild and will decrease over time. However, there are people for whom the side effects that they’re having are intolerable and we’re absolutely going to be thinking about switching. Now, before you think about switching medications, the first thing I’m always thinking about is have we given it enough time? You don’t want to just do a single month and say, “Okay, I’m done with this medication. Let me switch to something else.” Now that does happen. I mean, I’ve certainly had patients for whom side effects have been significant enough that they’re like, “Dr. Stombaugh, I am not going to continue on this medication.” But for most people, we’re going to give it a few months trial. We’re going to think about a really slow titration.

So whether any of these medications that you’re talking about, you should start at the lowest dose of the medication and then every four weeks or every month, depending on what we’re talking about, you can consider increasing from there. However, if someone is having significant side effects, I will never increase them to the next dose until we feel like those are well managed. It doesn’t mean that that side effect has to go away completely, but we do have to feel like we have it under control. So very common one, for example, is lower GI side effects like diarrhea and constipation. Constipation is incredibly common with these medications. And while it may still present, do we feel like we have a good routine for someone? So are they on fiber? Are they getting plenty of hydration? Are they exercising? Do we need to use laxatives like MiraLax or Senna or magnesium?

Are there other things that we need to be doing? And does the person feel like if they do have constipation, that they have the tools up their sleeve to manage it? So it’s not necessarily that the side effects are going to go away, but that we find that they’re not creating issues for you, that when you have them, that you’re able to manage them, that is going to be the most important part. But if you’re having those side effects, we’re not going to be aggressively titrating medication. We’re going to be titrating medication based on the effectiveness. So how is it feeling in your body? What is the number on the scale? How is it feeling both in terms of effectiveness as well as in terms of side effects? And from there, we’re deciding to move the dose up as long as we’re meeting all of those different criteria.

So a lot of times when side effects are coming up, we can manage that, but it does come up where people are like, “You know what? I have pretty significant side effects and I’d like to consider another medication.” So very commonly the GLP receptor agonists tend to be more constipating compared to the GLP/GIP medications like tirzepatide. So it is common that I might switch someone from Wegovy, for example, to Zepbound, and they might find that they have less constipation on that medication. Now Zepbound can also absolutely cause constipation, so it’s not like it’ll necessarily go away, but I do find patients for whom they tolerate the Zepbound medication better from a side effects profile standpoint. On the other hand, if someone’s having explosive diarrhea and sorry to say that’s kind of gross, we might be thinking about a medication like Wegovy that is a little bit more of a constipating medication.
So from a side effects profile standpoint, we might be thinking about switching for that reason, and that’s often one of the first things that comes up. A very another common reason is that insurance coverage changes. So there may be people who have insurance coverage for weight loss medications, which is really exciting if that’s the case. However, they still may not have equal coverage across all of the medications. One thing we saw in July of 2025 was that many insurers with CVS Caremark said that Zepbound was no longer a preferred agent, that Wegovy would be the preferred agent for patients in the weight loss journey. So one of the really challenging situations we found ourselves in was that there were many patients who when Zepbound and Wegovy were considered equal, we had started them on Zepbound for a myriad of reasons. And then July 1st of 2025 rolled around and there was not going to be coverage for the Zepbound medication because they had never done a trial of the Wegovy medication.

So in that situation, while there were patients who decided to stay on Zepbound as a cash pay option, I had many patients for whom we wanted to have insurance coverage of these medications. And so we switched them over to Wegovy for a period of time or long-term if it’s been going well, but switched them over to Wegovy and that was what was required by their insurance. So sometimes that can be incredibly frustrating. It feels very out of your control when the insurance company is dictating that, but it’s very common that insurance coverage will change. Maybe you change jobs and have different coverage together. So we’re thinking about even beyond the GLP medications, maybe there’s no coverage, the cash pay options for these medications are out of reach. Are there other options we can consider? And there absolutely are. There’s phentermine, there’s Qsymia, there’s Contrave. There are other medications that are older oral pill form medications that can be used on their own or even in combination with some of these medications, but they are much, much more affordable.

And so it may make sense for us to switch patients to some of these other medications if they lose their GLP medication coverage. So coverage unfortunately is a very common reason that we’re thinking about switching medications. Now, weight plateaus also come up, and it can be very common that someone loses weight and maybe even has lost a significant amount of weight, but when you look at their health goals, we know that losing further weight would be beneficial to them. So when this is the case, we’ll look at, okay, which medication are you on and should we be switching things or changing things? So for example, in head-to-head trials of Sermount five, they looked at Zepbound versus Wegovy for weight loss. And they saw that patients taking Zepbound lost 20.2% of their total body weight in 72 weeks where patients taking Wegovy lost 13.7% of their total body weight.

So Zepbound was 47% more effective compared to the Wegovy medication. So let’s say maybe someone’s insurance prefers them to be on Wegovy. They’re doing fine on it. We have them lose 13% of their body weight or 13.7% of their body weight on average on Wegovy over a 72-week study period, and they’re doing well, but they’re still having maybe pain in their knees from their arthritis. They’re still having elevated blood pressure. Even though we’ve seen health improvements, we know that they could get additional health benefit from additional weight loss. So at that point, we may consider, okay, let’s switch from Wegovy to Zepbound. Even for someone, if they have Wegovy coverage, we can often petition for Zepbound coverage even if it’s not a preferred agent, but that is a very common reason that we might switch. And we might see this across our other medications as well in terms of, “Hey, I’m looking for additional benefit. Let me step up to something more potent.”

We know that we have more potent medications coming down the pike. I think the one everyone’s most excited about is retatrutide, which should be available sometime next year. And retatrutide is a triple receptor agonist. It’s targeting GLP, GIP, and a third receptor called glucagon, and it is incredibly effective and will be a step up even from the Zepbound medication. So we can take this layered approach where we start with an option that’s maybe more tolerated or less effective, but then if we max that out, it might make sense for us to switch to a more potent medication. And I think, as I’m saying that, I think one of the big drivers here will likely be insurance coverage. Do we see better insurance coverage for some of those older agents or some of those less effective agents with the newer or more effective agents being a reserved for people who’ve not had the full benefit as intended with the less effective agents?
So we may see stuff like that happening from an insurance coverage perspective. So we look at all these different things. We might also look at someone who’s lost their ideal amount of weight and is losing more weight than intended to or desires to switch to some sort of maintenance option. So for example, the new orflipron medication, the Foundayo, this is a medication that they actually even studied on patients who were using Wegovy and patients who are using Zepbound had reached a goal weight and were working on maintaining. They studied this medication for maintenance. So there may be people for whom they’ve achieved their goal weight. They’re looking at something that’s maybe more affordable, maybe it’s a pill option, and so they’re thinking of switching for that reason, which absolutely makes sense. Now, a lot of times we get really caught up in the hype of social media or just in social circles.

One of our family members or our friends or something we see on social media talks about a different medication option and it can be really exciting, especially as we hear like, “Oh, this thing’s approved and that thing’s approved.” And so what I will encourage you to do, if you’re hearing about all these other things, bring it to a doctor’s appointment, whoever’s prescribing your GLP medication for you at your next appointment, say like, “Hey, I heard this thing on social media or, hey, I heard this medication was approved, would that be a good option for me? ” So if you are excited about it, get the answer exactly from your prescriber because maybe yes and maybe no, but it’s absolutely worthwhile a conversation because as newer agents have rolled out, we have absolutely switched patients. As the oral Wegovy pill rolled out, for example, I had patients who were taking Ozempic or patients who were taking Wegovy, and it was kind of a pain because they were traveling, for example. And so the idea of being able to have a oral pill and people who were traveling for long periods of time, sometimes I have patients who travel for a month at a time, and it was not convenient for them to have to take their injections with them, try to keep them cold, for example. And so being able to just bring along pills became a very easy option that they could consider. And so there may be other considerations like that where you’re like, “Okay, it’s a pill. I could take it every single day. It can stay at room temperature. I don’t have to think about refrigeration or anything.” So there absolutely may be other factors at play that we are considering or maybe you’ve had side effects to the oral Wegovy and you’re excited about the new oral fundeo pill. We could absolutely consider making a transition like that, for example.

So lots of different reasons that we could consider switching. Now, there’s reasons that we think about switching that aren’t always that great of reasons. And so this I want to talk to you because a lot of times these may come up and we want to make sure that we’re addressing, is switching appropriate in a situation or do we need to just take a beat, think about it and see if this is the right choice for you? I think one of the things that comes up is sometimes we have really high expectations. We have gained weight over a long period of time, but as we’re losing weight, we want to see that weight come off rapidly. A lot of times we see it comes off rapidly, especially at the beginning and we’re excited to keep up with that. There can be this momentum, this excitement, and the weight loss will start to slow down.

If you’re dealing with that, make sure to check out last week’s episode where we talked about slowing down of weight loss and how that can absolutely be normal, but when you should be concerned about it. But a lot of times we want to review expectations. And are you as a patient concerned? Is your doctor concerned together when you’re having a conversation? Is the trajectory that you’re on still making sense or is the current medication actually working perfectly fine? Switching medications can be absolutely a hassle. And so I don’t want you to feel like you’re in a situation where you’re switching medications, trying to get more benefit when actually your current medication’s working out just fine. So there’s no reason that we need to rush things. I also want to say, have you optimized your current dose of medication? I think this comes up really frequently where patients may be at a low dose of medication and they need to be titrated up.

So they’re not feeling effectiveness from the medication and they need just the next dose. The next best option is for them to increase their dose of medication. And so have you been appropriately titrated on your medication? And that goes both ways. So we were talking about it from a side effects standpoint. If you are having significant side effects, can you look back and say, “Was my titration appropriate?” If you are having severe and significant side effects, you should not move to the next dose of medication. And so you might bring that up with your prescriber. I’ve run across patients for whom they’ve been prescribed just like every month they go on the higher and higher dose, and so they’ve been titrated up really quickly on these medications and feel miserable. They’re having significant side effects. And so if you recognize looking back over your journey that, “Oh my gosh, every month I’ve been on a higher and higher dose and I’m feeling miserable,” that is not the goal.

We could bring you back on a dose or even a couple of doses depending on what dose you’re on. So when we’re thinking about titration, there’s this just rightness that we want to happen. So not too fast, not too slow. We’re titrating when the medication, the side effects are well managed, when we feel like the way it’s working in the body, we feel the effectiveness of it, and then we see the effectiveness in terms of numbers and the scale, or certainly other non-scale victories as well, like losing fat mess while gaining muscle mass, changing clothing sizes, other things beyond just the number and the scale, but we’re seeing the effectiveness of the medication. Because switching medications, like I said, it’s not a big deal. I mean, it’s not that big of a deal at all, but it can be a little bit of a hassle.

There’s the timing of things. If you’re switching from a weekly medication to a daily medication or vice versa, trying to just decide what that’ll look like, the logistics of filling the medication, you might be getting it at a different pharmacy, and so you’re setting up a new profile perhaps, or maybe you’re having it shipped to you as opposed to picking up at a pharmacy. There can be some different logistics in that way. When we think about equivalent doses, this has not been particularly well studied. What we do have for good or for bad is a lot of anecdotal data. So a lot of doctors like myself will convene in forums to say, “Okay, when I switched this patient to this medication from this dose, this is the dose I chose and why, what would you do in this situation?” And we’ve run into whether it’s because of medication coverage issues, because of shortage issues for all these different reasons, it is common that we almost have to switch patients across medications.

And we’ve developed really good sort of internal guidelines of if you’re on medication A and switching to medication B, how do you do that without feeling like you have to start over? Because especially if you are on an intermediate or high dose of a medication, if you’re switching to something new, you do not want to be starting over from square one. You want to come in also at some sort of intermediate dose, but your body’s sort of adjusting to that, whether it’s just the new medication in terms of effectiveness, in terms of side effects, there can be an adjustment period, and sometimes this can be really frustrating because if you’ve undershot your transition, sometimes it feels like you’ve taken a step back. Even if you’re choosing a more potent or sort of better medication, if you’re at a lower, less effective dose of that medication, you may feel that effect of the medication and see that over a month or so it feels like nothing’s happening or maybe you’re more hungry or having more cravings and that can really get frustrating.

And so while switching medications absolutely makes sense in certain situations, it’s a conversation that you want to take really logically. So I want you to have an appointment with your prescribing physician. If you’re thinking about switching medications, bring up the reasons that you are thinking about it and what you’re concerned about. Have we optimized our current dose? Is there something differently I should be doing on this current dose of medication? Is there anything differently I should be doing lifestyle-wise to optimize the way my current medication is working for me? Is there another medication that’s covered for me? Is there another medication that I can afford? Is there another medication that would be better for me? Is there a medication we should layer on? We’re not going to go into too much depth, but sometimes we use multiple medications together, not necessarily multiple GLP medications, but a GLP medication in combination with some of the older pill versions, for example.

So lots of different things that we can consider because switching might make sense, but doesn’t always. If you are looking for someone to help you in your healthcare journey, I would love to be that person. I see patients by telemedicine in the states of Illinois, Tennessee, and Virginia, as well as in person in Charlottesville, Virginia, in my downtown Charlottesville clinic. If you are outside of the states, my GLP guide is an online program to answer all the questions that you have as you’re starting a GLP medication. I have videos that address all of the most common side effects, address all of the medications that are available, and it is the go-to resource if you are starting or using a GLP medication. To learn more about that, go to www.sarahstombaughmd.com/glp. Thanks for joining me for today’s episode. See you all next time.