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If you have old vials, the worst likely outcome is reduced effectiveness rather than toxicity, but the economic waste and suboptimal results make using expired peptides a poor choice

Effectiveness varies Tirzepatide shows slightly higher weight loss percentages in clinical trials

Semaglutide tends to be the better fit when: the goal is a 10 to 15 percent weight reduction, the patient has documented cardiovascular disease or is at high cardiovascular risk and wants the medication with the most outcomes data, cost or access constraints favor it, or the patient has tolerated single-pathway GLP-1s well in the past

In contrast, the concordance of benchmarking results for all outcomes, including mortality, in the SURPASS-CVOT emulation study comparing tirzepatide to dulaglutide provided support for the validity of evaluating these outcomes in expanded study populations