Tirzepatide vs Dulaglutide: SURPASS-CVOT and SWITCH
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[GLP-1 · Comparison]

Tirzepatide vs dulaglutide: what did the head-to-head trials show?

SURPASS-CVOT · SURPASS-SWITCH · Label dosing · Half-life

Short answer: Both are weekly injections for type 2 diabetes. In SURPASS-CVOT (13,165 adults with diabetes and heart disease), tirzepatide was non-inferior to dulaglutide for heart attack, stroke or cardiovascular death: 12.2% vs 13.1%.1 In SURPASS-SWITCH, moving to tirzepatide lowered HbA1c and weight more than raising the dulaglutide dose.2

Tirzepatide (Mounjaro, Zepbound) and dulaglutide (Trulicity) are both Lilly drugs, and Lilly used dulaglutide as the comparator in two of its tirzepatide trials. That makes this one of the few GLP-1 pairs with large head-to-head data. For switching from semaglutide instead, see Switching from semaglutide to tirzepatide: is there a conversion?.

How do tirzepatide and dulaglutide compare side by side?

From the current US labels (Mounjaro, Zepbound, Trulicity) unless noted. Checked October 2026.
Tirzepatide (Mounjaro, Zepbound)Dulaglutide (Trulicity)
MechanismGIP and GLP-1 receptor agonist3GLP-1 receptor agonist4
Approved usesMounjaro: type 2 diabetes (adults and children 10+) and cardiovascular risk reduction in type 2 diabetes. Zepbound: weight management, sleep apnea35Type 2 diabetes (adults and children 10+) and cardiovascular risk reduction in type 2 diabetes. Not approved for weight management4
Label dosing schedule (adults)Mounjaro: 2.5 mg weekly, then up by 2.5 mg after at least 4 weeks on each dose; maximum 15 mg30.75 mg weekly; after 4 weeks may go to 1.5 mg, then up by 1.5 mg at least 4 weeks apart; maximum 4.5 mg4
Half-lifeabout 5 days (label: about 5 days)3about 5 days (label: about 5 days)4
Time to peak (Tmax)Median 24 hours, range 8 to 72 hours5about 2 days at steady state, range 24 to 72 hours4
Dosing frequencyOnce weeklyOnce weekly, any time of day, with or without food4
Pen strengthsPens or vials 2.5, 5, 7.5, 10, 12.5 and 15 mg3Single-dose pens 0.75, 1.5, 3 and 4.5 mg4
Missed dose (label)Take within 4 days (96 hours)5Take if at least 3 days (72 hours) remain before the next dose4
Notable label warningsBoxed thyroid C-cell tumor warning; pancreatitis, gallbladder disease, kidney injury, severe GI reactions, hypoglycemia with insulin or sulfonylureas3Boxed thyroid C-cell tumor warning; pancreatitis, kidney injury, severe GI reactions, hypoglycemia with insulin or sulfonylureas4

Reviewed . Half-life figures are shown only where the value Dose Track uses agrees with the cited source.

What did SURPASS-CVOT find?

SURPASS-CVOT was a double-blind trial in adults with type 2 diabetes and atherosclerotic cardiovascular disease. People took weekly tirzepatide (up to 15 mg) or dulaglutide 1.5 mg, a drug already shown to reduce cardiovascular events.1

  • Size: 6,586 on tirzepatide and 6,579 on dulaglutide (modified intention-to-treat). Mean age 64, mean HbA1c 8.4%, mean diabetes duration about 15 years.1
  • Main result (cardiovascular death, heart attack or stroke): 12.2% vs 13.1%, hazard ratio 0.92. That met the bar for non-inferiority but not for superiority (P = 0.09).1
  • Side effects: overall similar, with more gastrointestinal side effects on tirzepatide.1

The Mounjaro label now includes reducing the risk of major cardiovascular events in adults with type 2 diabetes at high risk, an indication Trulicity also has.34

What did SURPASS-SWITCH find?

SURPASS-SWITCH asked a practical question: if someone on dulaglutide 0.75 or 1.5 mg is not at goal, is it better to raise the dulaglutide dose or switch to tirzepatide? 282 adults were randomized for 40 weeks; it was open label.2

  • HbA1c: −1.44% on tirzepatide (15 mg or maximum tolerated) vs −0.67% on dulaglutide (4.5 mg or maximum tolerated).2
  • Weight: −10.5 kg vs −3.6 kg.2
  • Serious adverse events: 7.2% vs 7.0%. Nausea and diarrhea were most common.2
  • Starting dose: tirzepatide started at 2.5 mg weekly and rose by 2.5 mg every 4 weeks, with no credit for the earlier dulaglutide dose.6

Do they stay in the body the same length of time?

Roughly. Both labels give a half-life of about 5 days, which is why both are weekly.34 Dulaglutide reaches steady state in 2 to 4 weeks of weekly doses.4 The missed-dose windows differ: up to 4 days late for tirzepatide, and only if 3 or more days remain before the next dose for dulaglutide.

Switching from semaglutide to tirzepatide: is there a conversion?What the labels and trials say about starting doses Semaglutide vs tirzepatide: what did the head-to-head trial show?SURMOUNT-5 results, label titration, half-life Retatrutide vs tirzepatide: how do they compare?Triple vs dual agonist, TRIUMPH results, status

Frequently asked questions

Is tirzepatide better than dulaglutide for the heart?+
In SURPASS-CVOT, tirzepatide was non-inferior to dulaglutide 1.5 mg: 12.2% vs 13.1% had cardiovascular death, heart attack or stroke. The difference was not large enough to call tirzepatide superior.1
Should I switch from Trulicity to Mounjaro?+
That is a decision for you and your prescriber. In SURPASS-SWITCH, people not at goal on lower dulaglutide doses lowered HbA1c by 1.44% after switching to tirzepatide vs 0.67% after raising dulaglutide, and lost 10.5 vs 3.6 kg.2
What tirzepatide dose do you start at when switching from dulaglutide?+
In SURPASS-SWITCH everyone started tirzepatide at 2.5 mg weekly, the label starting dose, regardless of their dulaglutide dose.63
Is dulaglutide approved for weight loss?+
No. Trulicity is approved for type 2 diabetes and cardiovascular risk reduction. Tirzepatide is approved for weight management as Zepbound.45
Can I track tirzepatide and dulaglutide in Dose Track?+
Yes. Both are built in, with their half-lives, so you can log each weekly shot and see estimated levels on one chart, including during a switch.

Sources

  1. Nicholls SJ, et al. Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes (SURPASS-CVOT). N Engl J Med. 2025;393:2409-2420.
  2. SURPASS-SWITCH: switching from dulaglutide to tirzepatide in type 2 diabetes. Ann Intern Med. 2025;178:609.
  3. Mounjaro (tirzepatide) prescribing information. DailyMed, revised August 2026.
  4. Trulicity (dulaglutide) prescribing information. DailyMed, revised June 2026.
  5. Zepbound (tirzepatide) prescribing information. DailyMed, revised August 2026.
  6. SURPASS-SWITCH trial record (NCT05564039). ClinicalTrials.gov.

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