Wegovy vs Saxenda: how they differ and how the doctor chooses

Active substance and administration: daily liraglutide versus weekly semaglutide

The most important practical difference is the frequency: Saxenda is a daily injection, Wegovy a weekly one. Both substances mimic the gut hormone GLP-1, suppress appetite, slow gastric emptying and lower blood sugar. Semaglutide has a half-life of about a week, liraglutide of about 13 hours; that is why Saxenda has to be injected daily.

Both medications are registered by the European Medicines Agency (EMA) for weight management in adults with a BMI of 30 or higher, or of 27 with a weight-related condition, in addition to a reduced-calorie diet and more physical activity. Both are also registered for young people aged 12 and over with obesity.

Wegovy is the newer of the two: Saxenda has been authorised in Europe since 2015, Wegovy since 2022. Both are prescription medicines that you can only get through a doctor and a recognised pharmacy.

What do the studies say about weight loss results?

There is one study that compares the two medications directly: STEP 8, published in JAMA in 2022. In it, 338 adults with overweight or obesity without diabetes received weekly semaglutide 2.4 mg, daily liraglutide 3.0 mg or placebo for 68 weeks, alongside lifestyle support.

The result: an average weight loss of 15.8 percent with semaglutide, 6.4 percent with liraglutide and 1.9 percent with placebo. Losing at least 10 percent was achieved by 70.9 percent of semaglutide users and 25.6 percent of liraglutide users. These figures are averages from research; how you respond varies from person to person and also depends on your eating pattern and physical activity.

What the study does not say: that Saxenda does not work. An average weight loss of more than 6 percent is already a health gain for many people, and some people respond particularly well to liraglutide.

Side effects compared

The side effects of Wegovy and Saxenda are very similar: nausea, diarrhoea, constipation, vomiting and a full feeling, especially in the build-up phase. In STEP 8, 84.1 percent of semaglutide users and 82.7 percent of liraglutide users reported stomach and bowel complaints. The difference was in sticking with it: 13.5 percent stopped semaglutide, compared with 27.6 percent who stopped liraglutide.

Rare serious side effects occur with both: inflammation of the pancreas, gallstones and, in people with diabetes, a worsening of existing eye damage. A daily injection also means more injections with Saxenda, and therefore more chance of injection site reactions.

The full overviews are in our articles on Wegovy side effects and Saxenda side effects.

Dosing schedule and maintenance dose for both medications

You build up both medications step by step to limit side effects, but the pace differs: Wegovy in four steps of 4 weeks, Saxenda in four steps of 1 week.

The schedules for each medication are in our articles on Wegovy dosage and Saxenda dosage.

Want to know which medication the doctor would consider in your situation? In a few minutes you will know whether medical weight loss could be right for you; the doctor then assesses your application. Eligibility check →

Costs and reimbursement: what do you pay yourself?

When used for weight loss, you pay for Wegovy yourself in the Netherlands; Saxenda is only reimbursed if you meet strict conditions. In 2022, Zorginstituut Nederland (the Dutch National Health Care Institute) advised reimbursing liraglutide for adults without type 2 diabetes with a BMI of 35 or higher combined with cardiovascular disease, sleep apnoea or osteoarthritis, or a BMI of 40 or higher, who have already followed a recognised combined lifestyle intervention (gecombineerde leefstijlinterventie, GLI) for a year without sufficient results. Treatment stops if you have not lost at least 5 percent after 3 months on the maintenance dose.

For Wegovy, the institute issued a negative advice on Wegovy in July 2024: it did not consider reimbursement from the basic package justified, because of uncertainty about the long-term health gain and the budget risk. So if you use Wegovy to lose weight, you pay the pharmacy price yourself.

You can read the pharmacy prices and the current reimbursement status for each medication in our articles on Wegovy price, Saxenda cost and whether Saxenda is covered by insurance. With us, the monthly price of a programme depends on the medication: €250 with semaglutide (Ozempic), €350 with tirzepatide (Mounjaro) and €850 with liraglutide (Saxenda), plus a one-off €400 support fee. We do not offer Wegovy.

For whom does the doctor consider Wegovy, and for whom Saxenda?

The doctor does not choose on the basis of "the best medication", but on the basis of your situation: health, previous use of medication, reimbursement situation, preference for daily or weekly injections and how you respond to a medication. Broadly speaking:

• Saxenda is more likely to be considered if you meet the reimbursement conditions, if you previously responded well to liraglutide, or if a daily routine actually gives you structure.
• Semaglutide (Wegovy or Ozempic) is more likely to be considered if a weekly injection suits you better, if a larger average effect is needed, or if you did not tolerate Saxenda or lost too little weight with it.
• A third option is tirzepatide (Mounjaro), with an even larger average effect in research; that too is a decision for the doctor.

With us, the doctor assesses in the consultation whether medical weight loss is right for you and which medication goes with it. That conversation is part of the medical weight loss with injections programme.

Switching from Saxenda to Wegovy: how does it work?

Switching from Saxenda to Wegovy is possible, but only through the doctor and always with a new build-up. You stop the daily liraglutide injections and start semaglutide on the lowest step of 0.25 mg per week, not on a "comparable" dosage. The two substances cannot be converted one to one.

The most common reasons to switch are insufficient weight loss on Saxenda, side effects that do not go away, or wanting to move from daily to weekly injections. The doctor decides on the timing and keeps a closer eye on you in the first weeks after the switch, because the stomach and bowel complaints of the build-up phase then return.

Prefer to lose weight with your own doctor who guides the choice and the switch? The doctor assesses whether medical weight loss is right for you and tailors the medication to you. Medical weight loss with injections →

Frequently asked questions about Wegovy and Saxenda

Can you switch from Saxenda to Wegovy?

Yes, through the doctor. You stop Saxenda and start Wegovy on the lowest step of 0.25 mg per week, with a new build-up of 16 weeks. The doses cannot be converted; the doctor guides the switch.

What are the disadvantages of Wegovy?

The main disadvantages are the costs (no reimbursement from the basic package for weight loss), the stomach and bowel complaints in the build-up phase and the chance of weight gain after stopping without a plan. Rare serious side effects are pancreatitis and gallstones.

What does Wegovy cost per month?

The pharmacy price differs per strength and per pharmacy; for weight loss, you pay for Wegovy yourself. The current amounts are in our article on the Wegovy price. With us, the monthly price of a programme depends on the medication; we do not offer Wegovy.

Is there a cheaper alternative to Saxenda?

Since the patent expired, there are generic liraglutide brands with the same active substance, often at a lower price. For people who do not meet the reimbursement conditions, the doctor can also consider semaglutide; its monthly pharmacy price is lower than that of liraglutide at the maintenance dose. The doctor assesses which medication is suitable.

What works best, Wegovy or Mounjaro?

In separate studies, tirzepatide (Mounjaro) gave a larger average weight loss than semaglutide (Wegovy). You can read a direct comparison and how the choice is weighed per situation in our article Wegovy vs Mounjaro.

Which is better, Ozempic or Wegovy?

Both contain semaglutide. Ozempic is registered for type 2 diabetes and goes up to 2 mg; Wegovy is registered for weight management and goes up to 2.4 mg. The differences are in our article Wegovy vs Ozempic. You will find the comparison of Saxenda with tirzepatide in Mounjaro vs Saxenda.

<!-- klant:eind -->