Trulicity vs Ozempic: Head-to-Head Trial, Doses, Cost and How They Differ (2026)

Short answer: Trulicity (dulaglutide, Eli Lilly) and Ozempic (semaglutide, Novo Nordisk) are both weekly GLP-1 injections approved for type 2 diabetes, and both are approved to lower the risk of heart attack, stroke and cardiovascular death in certain adults with type 2 diabetes.^[1][2] In SUSTAIN 7, the head-to-head trial, semaglutide lowered HbA1c and body weight more than dulaglutide at both dose pairs tested: HbA1c −1.8 vs −1.4 points and body weight −6.5 vs −3.0 kg at the higher doses, over 40 weeks.^[3] Neither is approved for weight management; semaglutide is sold for that as Wegovy.^[4]

Which one suits a person is a decision for that person and their prescriber, and either works best alongside eating well on a smaller appetite, the subject of our guide to what to eat when you're eating less. General information, not medical advice. Everything below comes from the FDA labels, the published trials and the makers' own price pages, as of November 13, 2026.

Trulicity vs Ozempic at a glance

	Trulicity	Ozempic
Maker and molecule	Eli Lilly; dulaglutide[1]	Novo Nordisk; semaglutide (the same molecule as Wegovy and Rybelsus)[2]
Class	GLP-1 receptor agonist[1]	GLP-1 receptor agonist[2]
First FDA approval	September 18, 2014[5]	December 5, 2017[6]
Blood sugar control in type 2 diabetes	Adults and children 10 and older[1]	Adults only[2]
Heart risk approval	Adults with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors (February 21, 2020)[1][5]	Adults with type 2 diabetes and established cardiovascular disease (January 16, 2020)[2][6]
Kidney approval	None[1]	Lowering the risk of kidney decline, kidney failure and cardiovascular death in adults with type 2 diabetes and chronic kidney disease (January 28, 2025)[2][6]
Label dose range	Starts at 0.75 mg; 1.5 mg after 4 weeks; up in 1.5 mg steps to a maximum of 4.5 mg (1.5 mg for children)[1]	Starts at 0.25 mg for 4 weeks; maintenance 0.5, 1 or 2 mg; maximum 2 mg[2]
Form	Weekly single-dose pen[1]	Weekly pen[2]
Head to head (SUSTAIN 7, 40 weeks, higher doses)	Dulaglutide 1.5 mg: HbA1c −1.4 points; body weight −3.0 kg[3]	Semaglutide 1 mg: HbA1c −1.8 points; body weight −6.5 kg[3]
Most common digestive adverse reactions (label, drug vs placebo)	1.5 mg: nausea 21.1% vs 5.3%; vomiting 12.7% vs 2.3%; diarrhea 12.6% vs 6.7%; abdominal pain 9.4% vs 4.9%[1]	1 mg: nausea 20.3% vs 6.1%; vomiting 9.2% vs 2.3%; diarrhea 8.8% vs 1.9%; abdominal pain 5.7% vs 4.6%[2]
Boxed warning	The same on both: risk of thyroid C-cell tumors, seen in rodents, human relevance unknown. Not for anyone with a personal or family history of medullary thyroid carcinoma or with MEN 2.[1][2]
Maker's self-pay price (November 2026)	From $389 a month at every dose through LillyDirect[7]	$349 a month for 0.25 to 1 mg, $499 for 2 mg[8]

The adverse reaction rows come from each drug's own placebo trials, in different people, so they are not a ranking; SUSTAIN 7 is the like-for-like comparison. Semaglutide in all its forms has its own reference page, semaglutide (Ozempic, Wegovy, Rybelsus), and every GLP-1 medicine is mapped in GLP-1 medications explained.

Is Trulicity the same as Ozempic?

No. They belong to the same class and work the same basic way, but they are different molecules from different companies. Both activate the GLP-1 receptor, which raises insulin release when blood sugar is high, lowers glucagon and slows stomach emptying.^[1][2] Dulaglutide is a GLP-1 analogue fused to part of an antibody, which makes it last a week; semaglutide is a GLP-1 analogue that binds to albumin in the blood for the same purpose.^[1][2] Both have a half-life of about 5 days to a week.^[1][2]

A naming point: "Ozempic" now covers a tablet too. The newer semaglutide tablets for type 2 diabetes (1.5, 4 and 9 mg) are labeled Ozempic tablets, alongside Rybelsus.^[9] This page compares the weekly Ozempic injection. Trulicity has no tablet.^[1]

What did SUSTAIN 7, the head-to-head trial, find?

SUSTAIN 7 put the two side by side in adults with type 2 diabetes. It was published in The Lancet Diabetes & Endocrinology in 2018 and funded by Novo Nordisk, the maker of semaglutide.^[3]

• Who took part: 1,201 adults with type 2 diabetes on metformin, with HbA1c of 7.0% to 10.5%, at 194 sites in 16 countries.^[3]
• Design: phase 3b and open-label, so participants and investigators knew who was on which drug.^[3]
• Doses: four arms, once a week for 40 weeks: semaglutide 0.5 mg vs dulaglutide 0.75 mg (the low pair) and semaglutide 1 mg vs dulaglutide 1.5 mg (the high pair).^[3]

SUSTAIN 7 result at 40 weeks	Semaglutide 0.5 mg	Dulaglutide 0.75 mg	Semaglutide 1 mg	Dulaglutide 1.5 mg
Average change in HbA1c	−1.5 points	−1.1 points	−1.8 points	−1.4 points
Average change in body weight	−4.6 kg	−2.3 kg	−6.5 kg	−3.0 kg
Any digestive adverse event	43%	33%	44%	48%

Source: the paper.^[3] Both differences in HbA1c and body weight were statistically significant at each dose pair; semaglutide's advantage was about 0.4 points of HbA1c and 2.3 to 3.6 kg of body weight.^[3]

How to read it. Three limits matter. The trial was open-label and sponsored by the maker of the drug that came out ahead. It ran for 40 weeks, so it says nothing about the longer term. And it tested only the lower doses: Trulicity's 3 mg and 4.5 mg doses, approved in September 2020, and Ozempic's 2 mg dose were not part of it, and no trial has compared those.^[5][3] In Trulicity's own 36-week dose trial, 4.5 mg lowered HbA1c by 1.8 points and body weight by 4.6 kg, against 1.5 points and 3.0 kg on 1.5 mg.^[1] That is a different trial, so it cannot be lined up against SUSTAIN 7.

Which is better, Trulicity or Ozempic?

On HbA1c and body weight at the doses tested in SUSTAIN 7, semaglutide came out ahead.^[3] "Better" for one person depends on more than that, and these are the label and cost points a prescriber weighs:

• Heart risk. Trulicity's cardiovascular approval covers adults with established heart disease or multiple risk factors; Ozempic's covers adults with established cardiovascular disease.^[1][2]
• Kidneys. Only Ozempic is approved to lower the risk of kidney decline and kidney failure in type 2 diabetes with chronic kidney disease.^[2]
• Age. Only Trulicity is approved for children, from age 10.^[1][2]
• Tolerability. Individual responses vary, and a dose that is not tolerated does not help.
• Coverage and cost, which differ by plan and are set out below.

What the heart and kidney trials found

Trial	Who took part	Result
REWIND (Trulicity 1.5 mg)	9,901 adults with type 2 diabetes aged 50 or older, about a third with established heart disease; median follow-up 5.4 years	Heart attack, stroke or cardiovascular death in 12.0% vs 13.4% on placebo (hazard ratio 0.88)[1]
SUSTAIN 6 (Ozempic 0.5 or 1 mg)	3,297 adults with type 2 diabetes and high cardiovascular risk; at least 2 years	Heart attack, stroke or cardiovascular death in 6.6% vs 8.9% (hazard ratio 0.74)[2]
FLOW (Ozempic 1 mg)	3,533 adults with type 2 diabetes and chronic kidney disease; median 41 months	Major kidney events or cardiovascular death in 18.7% vs 23.2% (hazard ratio 0.76)[2]

These are separate trials with different people, lengths and event definitions, so their percentages are not comparable with one another. No trial has compared Trulicity and Ozempic on heart or kidney outcomes.

Trulicity and Ozempic dosing: what the labels say

Both start low and step up to reduce digestive reactions. The schedules are reproduced so you can see what each label says, not so you can follow them yourself.

What the FDA labels say — not dosing advice; your prescriber sets your dose.^[1][2]

	Trulicity (weekly)	Ozempic (weekly)
Starting dose	0.75 mg	0.25 mg for 4 weeks
Steps	1.5 mg after 4 weeks; then up by 1.5 mg after at least 4 weeks on each dose	0.5 mg after 4 weeks; then 1 mg and 2 mg, each after at least 4 weeks
Maximum	4.5 mg (1.5 mg for children)	2 mg
Missed dose	Take it if at least 3 days remain before the next dose; otherwise skip it	Take it within 5 days; after that, skip it
Timing	Any time of day, with or without food	Any time of day, with or without meals

Trulicity vs Ozempic side effects

Digestive reactions are the most common on both, and most reports come while the dose is being raised.^[1][2] SUSTAIN 7 is the one place they were counted in the same trial:

Adverse event, SUSTAIN 7 (40 weeks)	Semaglutide 0.5 mg	Dulaglutide 0.75 mg	Semaglutide 1 mg	Dulaglutide 1.5 mg
Nausea	22.3%	13.0%	21.0%	20.1%
Diarrhea	14.3%	7.7%	13.7%	17.7%
Vomiting	10.0%	4.0%	10.3%	9.7%
Decreased appetite	8.3%	3.0%	9.0%	10.4%
Constipation	5.3%	3.3%	4.7%	5.0%

Source: the posted results on ClinicalTrials.gov, 299 to 301 people per arm.^[10] At the higher doses the rates were close; at the lower doses dulaglutide 0.75 mg had fewer digestive events. The paper reports digestive disorders as the most common reason for stopping either drug.^[3] With no placebo group, the table cannot say how much of each figure is the drug.

From the labels, against placebo:

• Stopping because of a digestive reaction: 1.3% on Trulicity 0.75 mg and 3.5% on 1.5 mg vs 0.2%;^[1] 3.1% on Ozempic 0.5 mg and 3.8% on 1 mg vs 0.4%.^[2]
• Higher doses: on Trulicity 1.5, 3 and 4.5 mg, nausea was reported by 13.4%, 15.6% and 16.4%;^[1] on Ozempic, digestive reactions were reported by 34% on 2 mg vs 30.8% on 1 mg.^[2]
• Heart rate: Trulicity raised resting heart rate by 2 to 4 beats a minute on average.^[1]
• Shared warnings: pancreatitis, low blood sugar with insulin or a sulfonylurea, serious allergic reactions, kidney injury from dehydration, severe digestive reactions (neither is recommended with severe gastroparesis), diabetic eye complications, gallbladder disease and breathing in stomach contents under anesthesia.^[1][2]
• Pregnancy: the Ozempic label says to stop at least 2 months before a planned pregnancy, because semaglutide takes that long to clear.^[2]

How much do Trulicity and Ozempic cost?

Prices change often. These are the makers' own figures, read on November 13, 2026.

• Trulicity list price: $1,006.93 for a month's supply of four pens, the wholesale price as of January 1, 2026.^[11]
• Trulicity, self-pay: from $389 a month at every dose, 0.75 mg to 4.5 mg, through LillyDirect with a prescription.^[7]
• Trulicity, with commercial insurance: as little as $25 for up to a 3-month prescription with Lilly's savings card, with savings capped at $150 a month and $1,950 a year; the card ends December 31, 2026 and excludes Medicare and Medicaid.^[12] Lilly says about 70% of people with Medicare pay $0 per prescription, from its own analysis of 2024 data.^[11]
• Ozempic, self-pay: $349 a month for 0.25, 0.5 or 1 mg and $499 for 2 mg; new patients pay $199 a month for their first two fills of 0.25 or 0.5 mg, through December 31, 2026.^[8]
• Ozempic, with commercial insurance that covers it: as little as $25 a month with Novo's savings card, up to $100 a month in savings.^[8]
• Ozempic list price: Novo Nordisk will cut the list price of Ozempic to $675 a month from January 1, 2027, and said the change does not affect self-pay prices.^[13]

At the doses most people use, self-pay Ozempic ($349) costs less than self-pay Trulicity (from $389); at Ozempic's 2 mg dose it costs more ($499). For anyone with coverage, the plan's formulary, prior authorization rules and which brand it prefers usually matter more than either price.

Switching from Trulicity to Ozempic, or back

Neither label has instructions for switching from the other drug, and neither gives a dose conversion. Each label's schedule begins at its own starting dose, 0.75 mg for Trulicity and 0.25 mg for Ozempic.^[1][2] Both drugs stay in the body for some time: dulaglutide's half-life is about 5 days, and semaglutide is present for about 5 weeks after the last dose.^[1][2] The timing and the dose of any switch are your prescriber's decision.

What to eat on either one

Both labels pair the drug with diet and exercise, and neither names a specific diet.^[1][2] The 2025 joint advisory from four US medical and nutrition societies sets the same priorities for every GLP-1 medication: protein first, small nutrient-dense meals, fiber from food, deliberate fluids and strength training to protect lean mass.^[14] Our pages go one question at a time:

• What to eat on Wegovy or Ozempic: a sample small-appetite day, with amounts.
• What to eat on a GLP-1, by meal, for any of these medicines.
• How much protein on a GLP-1, and the protein calculator.
• What to eat on queasy days, for the weeks after a dose step.
• For weight management rather than diabetes, semaglutide's two forms are compared in Wegovy pill vs injection, and Lilly's alternative in Zepbound vs Wegovy.

For transparency about why this page exists on our site: we make one product, Zornava Replenish, a lemon-lime daily hydration and nutrient powder for lighter appetite days, including for people on GLP-1 medications. It is a dietary supplement, not a medication, and it does not replace or imitate any medicine on this page. It is not on sale yet; early access opens February 9, 2027, and the early-access list is open now.