Switching between semaglutide and tirzepatide in obesity Management: an expert-consensus framework for approximate clinical Efficacy-matched switching doses.

Authors

Eyal Schwartzberg, Erez Berman, Segev Shani, Carmil Azran, Raz Hagoel, Talia Diker-Cohen, Idit Dotan

Published in

Expert opinion on pharmacotherapy. Oct 29, 2026. Epub Oct 29, 2026.

Abstract

Currently, there are no available guidelines for switching from semaglutide to tirzepatide, since the mechanisms of action and pharmacokinetics differ, thus posing a challenge for continuous treatment of obesity.
A narrative review of PubMed, Embase, and ClinicalTrials.gov (to May 2026) evaluated trials and cohorts comparing semaglutide (0.25-7.2 mg) and tirzepatide (2.5-15 mg). We synthesized indirect treatment comparisons to outline dose-response relationships and develop approximate Efficacy-matched switching doses bands.
Estimation of clinical Efficacy-matched switching doses is more practical than mandatory lowest-dose initiation, which naturally risks a 'therapeutic gap' and subsequent weight regain. Until prospective switching trials validate exact conversions, clinicians should utilize the proposed equivalence bands and the 5-step clinical decision algorithm to guide seamless transitions, titrating doses every 4-8 weeks based on individual tolerability and metabolic outcomes.

PMID:
42952336
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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