Stopping Wegovy, Ozempic or Zepbound in Canada: what does the guideline say about long-term use?

What does Canada’s guideline say about long-term use?

It says to keep going when the medicine works. Obesity Canada recommends long-term use, alongside changes in habits, to avoid weight regain and losing the health benefits.¹

The guideline is the Canadian Adult Obesity Clinical Practice Guideline. Its medicines chapter was last updated on 11 August 2025.¹

It treats obesity like type 2 diabetes or high blood pressure: a long-term (chronic) disease. Its message for patients is plain: “Stopping medication can lead to weight regain and a loss of the health benefits you’ve experienced.”¹

The recommendation covers Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide 10 or 15 mg), among others. Both are rated at the guideline’s strongest level of evidence (Level 1a, Grade A).¹

Canadian doctors made the same case to Canada’s Drug Agency. Experts and clinician groups said Wegovy should be continued indefinitely, likening it to a statin.¹⁴

Is there a rule for when to stop?

Not a fixed one. The guideline notes the old 5%-at-3-months check, then says health gains can come whatever the amount of weight lost.¹

Its exact words: “Regulatory agencies have traditionally recommended discontinuing pharmacotherapy for weight management if weight loss of ≥ 5% has not been achieved after three months on a therapeutic dose. However, substantial health improvements and goals of therapy may be realized regardless of the magnitude of weight loss.”¹

For a 90 kg (198 lb) person, 5% is 4.5 kg (about 10 lb) (our arithmetic).

The Canadian Wegovy label is closer to a checkpoint. It says to reassess after 12 weeks on the 2.4 mg dose, or the highest dose you can tolerate. People who show no progress by then are less likely to benefit from carrying on.⁷ It also says to stop if 1.7 mg can’t be tolerated.⁷

If goals aren’t met, the guideline suggests looking at reasons such as cost, dose and side effects. It says to consider adding or switching to another medicine or treatment.¹

A lower dose may be enough. “Some individuals may achieve their treatment goals with doses lower than the maximum dose,” the guideline says.¹ If weight falls too far, it says the dose should be lowered, and in some cases the medicine stopped.¹

How much weight comes back after stopping?

Much of it, within a year, in the trials the guideline cites. On average, people stayed somewhat below their starting weight.^1,2

Semaglutide 2.4 mg (STEP 1 extension). 327 people were followed for a year after treatment ended. The group included every eligible participant from the trial’s Canadian sites.² They had lost 17.3% by week 68, regained 11.6 points, and ended 5.6% below their start.² The authors call that two-thirds of the loss.² For a 90 kg person, that is about 16 kg lost, then about 10 kg back (our arithmetic).

Semaglutide 2.4 mg (STEP 4). After 20 weeks, 803 people had lost 10.6%. Those switched to a dummy injection (placebo) regained 6.9% over 48 weeks; those who carried on lost 7.9% more.¹ The Canadian Wegovy label notes the switched group still weighed less at the end than at the start.⁷

Tirzepatide 10 or 15 mg (SURMOUNT-4). 670 people had lost 20.9% by week 36. On the dummy injection, they regained 14.0% of their weight over 52 weeks; those who kept taking tirzepatide lost 5.5% more.^1,3 Even so, 70 in 100 of the switched group were still at least 5% below their starting weight, against 97 in 100 who stayed on it.³

In kilos, the switched group averaged 85.8 kg at week 36, against 107.3 kg at the start.³ A 14% gain takes 85.8 kg to about 98 kg (our arithmetic).

In all three trials, the guideline notes, weight was still rising when the trial ended.¹ More detail, and what may help, is in Guide 9: Stopping and the long term.

What happens to blood sugar and other health markers?

They tend to drift back. The STEP 1 authors found most heart and sugar measures moved back towards where they started within a year.²

Prediabetes. The guideline reports two trials where people with prediabetes stopped. After 17 weeks off tirzepatide, 8 new cases of type 2 diabetes appeared, alongside weight regain.¹ After 28 weeks off semaglutide 2.4 mg (STEP 10), fewer people kept normal blood sugar.¹

Type 2 diabetes. A 2025 review pooled trials in which people with type 2 diabetes stopped a GLP‑1 medicine. Average HbA1c (a blood test of sugar over about 3 months) rose 0.65 points, with results varying widely between trials.⁸ For someone at 7.0%, that is about 7.65% (our arithmetic). The review covered GLP‑1 medicines as a group, not only semaglutide or tirzepatide.⁸

The medicine also leaves slowly. Semaglutide stays in the blood for about 5 weeks after the last Ozempic dose, and about 7 weeks after the last 2.4 mg Wegovy dose, the Canadian labels say.^5,7 Tirzepatide’s half-life (the time for half of it to leave the blood) is about 5 to 6 days.³

When can stopping be the right call?

Canadian clinician groups listed several reasons in their input to Canada’s Drug Agency: side effects, pancreatitis, pregnancy, no meaningful response, and cost.¹⁴

• Side effects that don’t improve over time, or a serious one such as an inflamed pancreas (pancreatitis). The Canadian labels say not to restart after confirmed pancreatitis.^14,7,3
• A planned pregnancy. The Canadian labels say to stop semaglutide at least 2 months, and tirzepatide at least 1 month, before a planned pregnancy.^7,3 The guideline adds that no data show the best timing.¹
• No meaningful response, judged by your goals and health, not weight alone.^14,1
• Cost. Clinician groups named a lack of affordability.¹⁴ Wegovy came to about $5,066 a year at the price in the 2025 federal review.⁶

Staying on a medicine means staying with its harms. In SURMOUNT-4, 113 of 783 people (about 14 in 100) stopped tirzepatide before week 36, most often because of side effects (53 people, about 7 in 100).³

How do coverage rules tie in to stopping?

Plans that pay often renew only after a 5% weight loss. That rule can end coverage, and with it, treatment for people paying through a plan.^9,6

• Public plans: none paid for Wegovy or Zepbound for weight management as of 12 October 2026. Price talks for Wegovy ended without a deal on 1 December 2025.¹⁰
• What the national agency proposed: a first approval of up to 1 year. To renew, a doctor would document at least a 5% drop in weight or BMI. After that, the loss would only need to be maintained, checked yearly.⁶
• Private plans: one benefits manager’s Wegovy form asks, at renewal, for proof of a 5% or greater loss in body weight.⁹ Your own plan’s rules may differ.

Our post on private insurance and GLP‑1s covers the forms. Why no province covers Wegovy or Zepbound tells the public-plan story.

What do the Canadian labels say about missed doses and restarting?

Each label gives a short window for a missed dose. Only Wegovy’s label covers a longer gap, where restarting at the lower dose steps may be needed.⁷

• Ozempic: take a missed dose within 5 days. After 5 days, skip it and take the next dose on the usual day.⁵
• Zepbound: take a missed dose within 4 days (96 hours). After that, skip it.³
• Wegovy: take one missed dose if the next is at least 2 days away. After more than 2 missed doses in a row, the label says to resume as scheduled or, if needed, restart the dose steps. That may reduce stomach side effects.⁷

Gaps aren’t always chosen. In 2026, some generic semaglutide lots were recalled; our post on the 2026 recalls explains what happened. Health Canada warns about fake and unauthorized GLP‑1 products sold online.¹¹

Questions people ask

How we researched this

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