Switching between semaglutide and tirzepatide in obesity Management: an expert-consensus framework for approximate clinical Efficacy-matched switching doses

INTRODUCTION: Currently, there are no available guidelines for switching from semaglutide to tirzepatide, since the mechanisms of action and pharmacokinetics differ, thus posing a challenge for continuous treatment of obesity. AREAS COVERED: A narrative review of PubMed, Embase, and ClinicalTrials.gov (to May 2026) evaluated trials and cohorts comparing semaglutide (0.25-7.2 mg) and tirzepatide (2.5-15 mg). We synthesized indirect treatment comparisons to outline dose-response relationships and develop approximate Efficacy-matched switching doses bands. EXPERT OPINION: Estimation of clinical Efficacy-matched switching doses is more practical than mandatory lowest-dose initiation, which naturally risks a 'therapeutic gap' and subsequent weight regain. Until prospective switching trials validate exact conversions, clinicians should utilize the proposed equivalence bands and the 5-step clinical decision algorithm to guide seamless transitions, titrating doses every 4-8 weeks based on individual tolerability and metabolic outcomes.