Xultophy Vs Ozempic: Analyzing Two Blockbuster Medicines

Xultophy Vs Ozempic

Xultophy Vs Ozempic” compares these two blockbuster diabetes medicines. This is an indirect comparison rather than any clinical trial or research article.

The decision to use any specific medicine is a decision taken by your doctor considering your condition and preferences.

Introduction to Xultophy and Ozempic:

Xultophy is a fixed-dose combination of Insulin Degludec and Liraglutide, a very potent GLP-1 agonist. Ozempic is a long-acting GLP-1 agonist, Semaglutide, that is very identical to the endogenous GLP-1.


Basal Insulin

GLP-1 analog


Both Xultophy and Ozempic are potent FDA-approved diabetes medications. A higher dose formulation of Ozempic, Wegovy, has also been approved for weight loss.

Treatment with Xultophy (10/3.6) is started with 16 units daily as a subcutaneous injection and then titrated up twice weekly in small increments of just 1 unit.

Ozempic, on the other hand, is administered once a week, in a fixed dose of 0.25 mg for four weeks, followed by 0.5 mg for four weeks, and 1 mg thereafter (if higher doses are indicated).

The maximum dose of Xultophy 100/3.6 is  50 units daily which is equivalent to 50 units of insulin degludec and 1.8 mg of Liraglutide.

The usual maximum dose of Ozempic is 1mg weekly, however, a higher dose of 2 mg weekly has also been approved.

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How Do Xultophy and Ozempic Work?

Xultophy and Ozempic both have a GLP-1 agonist. However, Xultophy also contains insulin degludec.

GLP-1 agonists, Liraglutide and Semaglutide, act in glucose-dependent mechanisms. These drugs enhance insulin release when the blood glucose is high.

Both Semaglutide and Liraglutide suppress hunger, delay gastric emptying, and make a person feel full all the time.

Thus, all GLP-1 agonists, and Ozempic and Victoza in particular, are potent weight loss drugs when used in high doses.

Xultophy also has Insulin Degludec, a long-acting insulin. Thus, when compared to insulin degludec or Liraglutide, it is better in lowering A1C and fasting blood glucose.

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Xultophy Vs Ozempic: Comparing Efficacies

Xultophy has been proven in clinical trials to be more effective in lowering A1C compared to Insulin Glargine (Lantus), Insulin Degludec (Tresiba), and Liraglutide (Victoza).

Ozempic has also been proven to be more effective in lowering A1C compared to insulin Glargine (Lantus) and Liraglutide (Victoza). It has also been found more effective for controlling blood glucose and A1C compared to Sitagliptin (Januvia), Exenatide (Byetta), and Dulaglutide (Trulicity).

An indirect comparison of Xultophy Vs Ozempic is given in the table below:

A1C Reduction  


Ozempic 0.5 mg

Ozempic 1 mg

Vs Insulin Glargine-0.51%-0.3%-0.6%
Vs Insulin Degludec-0.89%
Vs Liraglutide-0.95%-0.69% Vs Liarglutide 1.2 mg) [Ref]
Vs Januvia-0.6-0.8
Vs Placebo-1.2-1.4
Vs Exenatide ER 2 mg-0.5
Vs Dulaglutide [Ref]-0.41% (Vs Dulaglutide 0.75mg)-0.4% (Vs Dulaglutide 1.5mg)

From the table above, it can be concluded that Ozempic and Xultophy are superior to Glargine and Liraglutide in lowering A1C.

Xultophy is probably better than Ozempic 0.5 mg but has a comparable A1C reduction compared to Ozempic 1 mg Vs Glargine.

Similarly, the A1C lowering effect of Xultophy is probably superior to Ozempic 1 mg by -0.26% vs Liraglutide.

Xultophy has not been studied against Januvuia, Trulicity, and Exenatide. The overall A1C lowering effect of Xultophy seems similar to Ozmepic 1 mg but is probably better than Ozempic 0.5 mg.

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Xultophy Vs Ozempic: Comparing Safety

The Liraglutide component of Xultophy and Ozempic (Semaglutide) are GLP-1 analogs. The most common side effects of these drugs are related to the GI system.

These side effects include Nausea, Vomiting, diarrhea, bloating, abdominal pain, constipation, and GERD.

Xultophy also has insulin Degludec and therefore hypoglycemia is also a common side effect of Xultophy. However, in comparison to insulin Glargine, Degludec, and sulfonylureas, the incidence of hypoglycemia is very low.

Here is a table comparing the common side effects of Xultophy Vs Ozempic:

Side effects



Hypoglycemia0.3 – 0.5%0
Nausea7.8%15.8 – 20.3%
Diarrhea7.5%8.5 – 8.8%
Injection-site reactions2.6%0.2%
Cholelithiasis+1% (liraglutide 3 mg)0.4 – 1.5%
Cholecystitis+0.4% (liraglutide 3 mg)
cancers7 cancer
Papillary thyroid cancer6

From the table above, it can be observed that GI side effects such as nausea and diarrhea are more common with Ozempic Vs Xultophy while the incidence of hypoglycemia, injection-site reactions, and the incidence of cancers were commonly observed with Xultophy Vs Ozempic.

Retinopathy is a side effect of all GLP-1 analogs but somehow it is more common with Ozempic.

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Choosing Between Xultophy and Ozempic

When choosing between Xultophy Vs Ozempic, you may need to consider the following factors, however, your doctor is the best judge to decide which drug is best for you.

  • Daily injections Vs Weekly Injections:

Ozempic is administered weekly while Xultophy has to be administered daily. Most people find it easy to administer once weekly, as on weekends, and Ozmepic is a better option for most people compared to Xultophy.

  • Risk of Hypoglycemia:

Xultophy use carries the risk of hypoglycemia as it has insulin Degludec. Therefore, people who are at risk of developing hypoglycemia such as those with renal dysfunction or liver disease are best candidates for Ozempic rather than Xultophy.

  • GI side effects:

Ozempic is associated with more GI side effects. People who are intolerant to Ozempic because of the GI side effects like nausea, vomiting, diarrhea, constipation, and bloating, may try using Xultophy.

Although Xultophy use is also associated with some GI side effects, people may be able to tolerate Xultophy well. This is also because one can adjust the dose of Xultophy by very small increments.

  • Weight gain or weight loss:

Xultophy has been observed in clinical trials to cause slight weight gain. It has been associated with a weight gain of about 2 kg (4.4 lbs).

Ozempic is best known for its weight loss effects. In fact, it is commonly misused for its weight loss effects by non-diabetic obese individuals.

Thin and lean people may try Xultophy while Ozempic is best for obese and overweight individuals.

  • Retinopathy:

Retinopathy is common with both Xultophy and Ozempic, however, Ozempic is associated more commonly with retinopathy.

Diabetics who have background retinopathy or new onset of visual blurring are best candidates for Xultophy rather than Ozempic.

  • Cost comparison of Xultophy Vs Ozempic:

Xultophy and Ozempic are both costly medicines with an estimated monthly cost of $1000 USD. The total monthly cost of Ozempic without insurance is $892 USD while that of Xultophy is $1314 USD.

However, the cost may vary from one pharmacy to another. In addition, the total daily or weekly dose may also be one factor.

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Key Differences: Xultophy Vs Ozempic:

Here is a summary of the key differences between Xultophy and Ozempic:

Key differences



DrugsInsulin Degludec + LiraglutideSemaglutide
EfficacyHighly effectiveHighly effective
Effect on Body WeightWeight gainWeight loss
GI side effectsLessMore
Injection-site reactionsMoreLess
RetinopathyMinimal riskIncreased risk
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What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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