Mounjaro (tirzepatide) alternatives: What can I take instead of Mounjaro?

Compare Mounjaro alternatives | Other GLP-1 receptor agonists | Oral biguanides | SGLT2 inhibitors | DPP4 inhibitors | GLP-1 receptor agonists for weight loss| Natural alternatives | How to switch meds

Diet and exercise alone aren’t enough to control Type 2 diabetes. Fortunately, drug therapy for diabetes has come a long way. Metformin has long been the first-line therapy for Type 2 diabetes. Still, more recently, Glucagon-like peptide-1 receptor agonists (GLP-1-RA) have become the first-line treatment for those patients with established atherosclerotic coronary vascular disease (ASCVD). Heart disease risk factors such as high blood pressure are important indicators for starting preventive treatment early.  GLP-1 receptor agonists are a form of incretin mimetics that act as incretin hormones and stimulate the body to release more insulin. This increase in insulin lowers blood sugar levels and helps to control diabetes. This class of diabetes drugs has been linked to decreasing appetite, and because of that, patients taking incretin mimetics can lead to weight loss. Some drugs in this class are FDA-approved to aid in weight loss and management. Mounjaro (tirzepaptide), manufactured by Eli Lilly Inc.,  is unique from other GLP-1-RA drugs because it is also a gastric inhibitory polypeptide (GIP) agonist.  GIP agonists decrease appetite while also increasing energy expenditures. This is why we see more weight loss with Moujaro than with other similar drugs.

While Mounjaro does not carry an approved indication for weight loss, it is commonly used off-label for this effect in prediabetic patients looking to avoid a diabetes diagnosis and obese patients looking to lose a significant amount of weight. Unfortunately, insurance companies generally won’t cover Mounjaro for unapproved indications like weight loss. These drugs can get expensive, costing several hundreds of dollars a week for treatment if not covered by insurance. Some third-party payors will only choose to cover one of the drugs in the class, leaving an out-of-pocket cost if an alternative is chosen.

Mounjaro is also linked to many potential side effects; some adverse events can be severe. Gastrointestinal effects such as nausea, vomiting, abdominal pain, indigestion, diarrhea, or even constipation may occur. Mounjaro has also been linked to acute cases of pancreatitis and gallbladder disease. Speak to a healthcare provider immediately if severe stomach pain or changes in bowel movements that don’t improve quickly are experienced.

RELATED: What to do during the Mounjaro shortage

What can I take in place of Mounjaro?

There are other choices for Mounjaro, whether it is being used to treat diabetes or help lower body weight (or both). Other GLP-1 receptor agonists may be an acceptable alternative and are covered by insurance. In treating diabetes, oral biguanide metformin remains a safe and effective first-line treatment for Type 2 diabetes. Sodium-glucose co-transporter 2 (SGLT2) and dipeptidyl peptidase 4 inhibitors (DPP4i) drugs are highly effective oral diabetic treatments. If looking for an alternative to Moujaro as a weight loss medication, there are GLP-1 receptor agonists with FDA approval for weight loss, such as Wegovy (semaglutide).

GLP-1 receptor agonists are relatively new on the U.S. drug market, and as of the production of this article, there are no Food and Drug Administration (FDA) approved generic forms in this drug class. They are currently available as brand-name drugs only. Mounjaro and other drugs in this class come at a premium price. Due to their efficacy in diabetes treatment and the significant weight loss experienced with this class of drugs, Moujaro, and other drugs are in high demand and sometimes hard to locate in stock at the pharmacy. 

Most GLP-1 receptor agonist drugs are subcutaneous daily or weekly injections. Some patients may experience an injection site reaction that is bothersome. This can be avoided by changing the injection site with each administration. The risk of low blood sugar and hypoglycemia is low with Mounjaro and other GLP-1 agonists, but one must observe the maximum dose limits and not go over them. For these reasons and others, seeking an alternative to Monjauro for either diabetes treatment or weight loss makes sense.

Below is a  list of possible alternatives to Mounjaro. This is not medical advice. Talk to a healthcare professional before stopping Mounjaro. 

Other alternatives to Mounjaro

• Bydureon Bcise (exenatide)
• Byette (exenatide)
• Saxenda (liraglutide)
• Adlyxin (lixisenatide)
• Actos (pioglitazone)
• Avandia (rosiglitazone)
• Prescose (acarbose)

Top 5 Mounjaro alternatives

The following are some of the most common alternatives to Mounjaro. Many of these drugs can be taken in combination with each other for more resistant or complicated cases of diabetes, so one may already be on medication in one or more of these classes. 

1. Other GLP-1 receptor agonists (with indication for diabetes)

If the price of Mounjaro or insurance coverage is not sustainable, the first move might be to find a GLP-1 drug with a lower price tag or better coverage on an insurance plan. There are several options in the class, and while none are considered cheap, some are cheaper than Mounjaro without insurance. All GLP-1 agonists today are injectable drugs except for Rybelsus, the only oral option. Verifying coverage of this class with the insurance company first and discussing that option with a prescriber might be the best way to get started with deciding the best GLP-1 alternative.

Examples: Ozempic (semaglutide), Trulicity (dulaglutide), Victoza (liraglutide), Bydureon Bcise (exenatide), Byette (exenatide), Saxenda (liraglutide), Adlyxin (lixisenatide), Rybelsus (semaglutide oral)

2. Oral biguanides

Metformin has been a long-standing first-line treatment for Type 2 diabetes. As an oral biguanide, it reduces glucose absorption in the intestines and improves insulin sensitivity. It is available as an immediate-release and extended-release tablet. It has been available generically on the market for quite some time and is affordable, even without insurance. A 30-day supply of metformin can be purchased for less than $5 at most participating pharmacies with a SingleCare coupon.

Examples: Glucophage (metformin), Riomet (metformin), Glucophage XR (metformin ER)

3. SGLT2 inhibitors

SGLT2 inhibitors are a class of medications that block proteins in the kidneys responsible for glucose absorption into the bloodstream. This results in better glucose control, lowering weight, and improving blood pressure. Unlike insulin therapy, this class of drugs carries a low risk of hypoglycemia or blood glucose that is too low. There are generic options available in this class, making them relatively affordable with prescription drug insurance.

Examples: Jardiance (empagliflozin), Invokana (canagliflozin), Farxiga (dapagliflozin), Steglatro (ertugliflozin)

4. DPP4 inhibitors

DPP4 inhibitors also work relative to the GLP-1 hormone. Still, they slow the breakdown of GLP-1 so that it can linger in the gastrointestinal tract longer and remove more glucose from the system. The risk of hypoglycemia is also low with this class of drugs. There are also generic options available in this class, making the likelihood of insurance cost-sharing better.

Examples: Januvia (sitagliptin), Tradjenta (linagliptin), Onglyza (saxagliptin), Nesina (alogliptin)

5. Other GLP-1 receptor agonists (with indication for weight loss)

Some manufacturers have sought and accomplished FDA approval for the indication of weight loss for GLP-1 receptor agonists. With this FDA approval and appropriate documentation (body mass index (BMI) above a threshold set by the insurance company), the prescriber and pharmacist may have more success getting these products covered by insurance for non-diabetic patients seeking weight loss aid. One may notice that the active ingredient in Wegovy is semaglutide, the same active ingredient in Ozempic and Rybelsus for diabetes. Novo Nordisk Inc. produces all three products. The manufacturer performed additional clinical trials to market the active ingredient as a weight-loss drug.

Examples: Wegovy (semaglutide), Victoza (liraglutide)

Natural alternatives to Mounjaro

There are no “natural” GLP-1 receptor agonists. Some evidence suggests that certain supplements and foods may boost the body’s production of GLP-1, such as curcumin, cinnamon, and soybean. High protein diets have also been linked to higher production of GLP-1. If one’s diabetes is advanced and there is a chance of kidney damage, talk to a healthcare provider about a high-protein diet before beginning a GLP-1. Before starting any supplements, speak to a doctor or pharmacist to discuss the effects and interactions with current medications.

Some supplements have been linked to a positive outcome with blood glucose levels, though the jury is still out on whether there is a truly significant effect. There are limited clinical studies evaluating these effects.

Lifestyle changes such as a low-sugar diet and regular exercise remain a staple in treating and managing diabetes and obesity. It is important to maintain regular, healthy food intake when taking diabetes medications to keep the risk of hypoglycemia low. Avoiding food is not a healthy method of blood sugar control.

RELATED: 20 Natural Remedies for Diabetes | Does exercise lower blood sugar?

How to switch to a Mounjaro alternative

If Mounjaro is not the right medication for cost or other reasons, speak to a healthcare provider before discontinuing it. Blood sugar levels will increase without appropriate treatment. Be prepared to have an open conversation with a provider about any personal experience with Mounjaro, including side effects, blood glucose readings, insurance coverage, and any other factors influencing a final decision. 

If the main concern is price or insurance coverage, the insurance company or pharmacist can help answer questions about Mounjaro or any alternatives being considered. A SingleCare prescription discount card can help ensure one gets the lowest possible price on any prescription medications for diabetes or weight loss.