EN
Home/Canada/Blog/Wegovy for the heart and liver, and Zepbound for sleep apnea: what’s approved in Canada?
CACanada Medicines

Wegovy for the heart and liver, and Zepbound for sleep apnea: what’s approved in Canada?

The newer Canadian approvals beyond weight: what each covers, the trial behind it with its harms, and whether any plan pays.

GLP Guidebook teamPublished 12 Oct 20266 min read14 sourcesWritten from published sources

Written for Canada. Other country versions are coming.

The short answer

Beyond weight, Health Canada approved Wegovy to lower the risk of a non-fatal heart attack in adults with heart disease and a BMI of 27 or more, and, on conditions, for a scarring liver disease called MASH. Sleep apnea is approved for Zepbound, not Wegovy. We found no public plan paying for any of these uses.

Key takeaways

  • Wegovy’s Canadian label covers lowering the risk of a non-fatal heart attack in adults with established heart disease and a BMI of 27 or more.1
  • In the SELECT trial, 6.5 in 100 people on Wegovy had a heart attack, stroke or heart-related death, against 8.0 in 100 on a dummy injection, over about 3 years.2
  • Wegovy’s liver approval (MASH with F2 or F3 scarring) is conditional, based on biopsy results, and depends on a confirmatory trial.1
  • Zepbound has been approved in Canada since June 2026 for moderate to severe sleep apnea in adults with obesity (BMI 30 or more).3
  • Canada’s obesity guideline says no studies of semaglutide in sleep apnea were found.4
On this page
  1. Which newer uses has Health Canada approved?
  2. What did the heart trial show?
  3. What is MASH, and what did the liver trial show?
  4. What did the sleep apnea trials show?
  5. Does any plan pay for these uses?
  6. Questions people ask
  7. How we researched this

Which newer uses has Health Canada approved?

Three, across two medicines: Wegovy for heart-attack risk and for MASH liver disease, and Zepbound for sleep apnea.1,3

Before you go further
  • GLP‑1 medicines are prescription-only in Canada. Every product we mention is on Health Canada’s prescription schedule.5
  • Label facts here come from the Canadian product monographs (the official label each maker files with Health Canada). Where we use another source, we say so.
  • Every risk of these medicines is in Guide 5: Side effects and risks.
  • This post describes rules, labels and trials. It isn’t a plan for your treatment, and no brand or dose guarantees any result.
UseMedicineApproved for
HeartWegovyLowering the risk of a non-fatal heart attack in adults with established heart disease and a BMI of 27 or more1
Liver (MASH)WegovyAdults with MASH and moderate to advanced scarring (F2 to F3), not cirrhosis; conditional approval1
Sleep apneaZepboundModerate to severe obstructive sleep apnea in adults with obesity (BMI 30 or more)3

Canadian product monographs: Wegovy dated 2 Oct 2026, Zepbound dated 11 Jun 2026.

The label is the official list of approved uses. Prescribing for anything else is off-label (outside the approved use).

What did the heart trial show?

Fewer heart attacks, strokes and heart deaths. In SELECT, 6.5 in 100 people on Wegovy had one, against 8.0 in 100 on a dummy injection, over about 3 years.2

How these trials work

  • People are split at random into two groups, so the groups start out alike.
  • One group gets the medicine; the other gets a dummy injection (placebo) that looks the same.
  • Both groups get the same usual care and advice.
  • The gap between the groups is what the medicine added. Trials of different medicines can’t be compared directly.
SELECTWegovy (semaglutide 2.4 mg) weekly vs dummy injection

17,604 adults aged 45 or over with heart disease and a BMI of 27 or more, without diabetes; followed for about 3.3 years on average.2

Had a heart attack, stroke or heart-related death

Wegovy6.5in 100
Dummy injection8.0in 100

Stopped the medicine because of side effects

Wegovy16.6in 100
Dummy injection8.2in 100

So about 1.5 in 100 fewer people had one of these events over about 3 years, while about 8 more in 100 stopped because of side effects. Funded by Novo Nordisk.2

Canada approved part of it. The trial counted heart attacks, strokes and heart deaths together. The Canadian label covers lowering the risk of a non-fatal heart attack only.1,2

Weight fell 9.4% on Wegovy over the first 2 years, against 0.9% on the dummy injection, Canada’s obesity guideline notes.4

What is MASH, and what did the liver trial show?

MASH is fatty liver disease with inflammation that scars the liver. In ESSENCE, inflammation cleared in 62.9 in 100 people on Wegovy, against 34.3 in 100 on a dummy injection.6

MASH stands for metabolic dysfunction-associated steatohepatitis. Fibrosis is scarring, graded in stages: F2 and F3 are moderate and advanced, and F4 is cirrhosis.1

ESSENCEWegovy (semaglutide 2.4 mg) weekly vs dummy injection

800 adults with MASH and moderate or advanced liver scarring (stage F2 or F3), checked by liver biopsy at 72 weeks.6,1

Liver inflammation cleared, scarring no worse

Wegovy62.9in 100
Dummy injection34.3in 100

Scarring improved, inflammation no worse

Wegovy36.8in 100
Dummy injection22.4in 100

So about 29 in 100 more had inflammation clear, and about 14 in 100 more had less scarring, because of the medicine. Stomach side effects were more common on Wegovy. Funded by Novo Nordisk.6

Conditional approval. Health Canada approved this use under its NOC/c policy, based on improvements seen in liver biopsies. Continued approval may depend on a confirmatory trial showing clinical benefit.1 That trial (ESSENCE part 2) is checking whether people stay free of cirrhosis over 240 weeks.4

Free toolQuestions about heart, liver or sleep

A printable list for your doctor about these approvals, your other medicines and follow-up. No sign-up.

Make my list

What did the sleep apnea trials show?

Fewer breathing pauses at night. Without a breathing machine, pauses fell by 25.3 an hour on Zepbound, against 5.3 on a dummy injection.7

In obstructive sleep apnea, the throat closes again and again during sleep. Doctors count these pauses per hour (the AHI); 30 or more is severe.3

SURMOUNT-OSAZepbound (tirzepatide 10 or 15 mg) weekly vs dummy injection

469 adults with obesity and moderate to severe sleep apnea, in two trials: one without a breathing machine (PAP), one using PAP. 52 weeks.7,3

Breathing pauses per hour of sleep (AHI), change: no PAP

Zepbound-25.3per hour
Dummy injection-5.3per hour

Breathing pauses per hour, change: using PAP

Zepbound-29.3per hour
Dummy injection-5.5per hour

Remission or mild sleep apnea without daytime sleepiness: no PAP

Zepbound42.2in 100
Dummy injection15.9in 100

So about 20 fewer pauses an hour without PAP, from a starting average of about 52. Stomach side effects were the most common. Funded by Eli Lilly.7,3

Not Wegovy. Canada’s obesity guideline says it found no studies of semaglutide in sleep apnea.4 Our post on the difference between Zepbound and Mounjaro explains why only Zepbound carries this use.

RisksThe risks, in brief
  • Stomach effects are the most common. On the Wegovy label, 44 in 100 people felt sick (nausea), against 16 in 100 on a dummy injection.1
  • Dehydration from vomiting or diarrhea can harm the kidneys, the Zepbound label warns.3
  • Inflamed pancreas (pancreatitis): severe stomach pain that won’t go away needs medical help straight away.1
  • Gallstones: 1.6 in 100 people on Wegovy, against 0.7 in 100 on a dummy injection.1
  • Not for everyone: not with a personal or family history of medullary thyroid cancer or MEN 2 (a rare inherited condition), and stopped at least 2 months before a planned pregnancy.1
Full detail in Guide 5: Side effects and risks →

Does any plan pay for these uses?

We found none. Canada’s Drug Agency recommended funding Wegovy for people with heart disease only at a lower price, and those price talks failed.8,9

  • Wegovy, heart: the agency recommended funding for adults with a BMI of 27 or more and established heart disease, with conditions.8 Talks ended without agreement on 1 December 2025, and BC lists Wegovy as a non-benefit.9
  • Quebec: INESSS advised against listing Wegovy for heart prevention; the minister deferred the decision in December 2025.10
  • Zepbound, sleep apnea: the agency’s review was taking public input from 29 July to 25 August 2026.11

Private plans set their own rules. Our post on why no province covers Wegovy or Zepbound tells the story.

Get help now: call 911 or go to the nearest emergency department for severe stomach pain that won’t go away; the Canadian labels say to get immediate medical help.1 If you think you injected too much, call a poison centre on 1-844-POISON-X (1-844-764-7669), or 1-800-463-5060 in Quebec.12 For advice that isn’t an emergency, call 811 in most provinces (Info-Santé 811 in Quebec).13

Questions people ask

Is Wegovy approved for heart disease in Canada?

Yes, to lower the risk of a non-fatal heart attack in adults with established heart disease and a BMI of 27 or more.1

Is Wegovy approved for fatty liver in Canada?

For MASH with moderate to advanced scarring (F2 to F3), not cirrhosis, on a conditional basis.1

Is Zepbound approved for sleep apnea in Canada?

Yes, since June 2026, for moderate to severe obstructive sleep apnea in adults with obesity.3

Does Wegovy help sleep apnea?

Canada’s obesity guideline found no studies of semaglutide in sleep apnea.4 It isn’t approved for it in Canada.1

Does Mounjaro have the sleep apnea approval?

No. In Canada, Mounjaro is approved for type 2 diabetes; the sleep apnea use is on the Zepbound label.14,3

Is Zepbound available in Canada?

How we researched this

On 12 Oct 2026 we read the Canadian labels for Wegovy (dated 2 Oct 2026), Zepbound and Mounjaro, the SELECT, ESSENCE and SURMOUNT-OSA papers (abstracts and label summaries), Obesity Canada’s 2025 medicines chapter, Canada’s Drug Agency’s Wegovy recommendation, BC’s documents and INESSS’s notice.

The trials were paid for by the makers, as we note on each card. Trials of different medicines can’t be compared directly. The “in 100” gaps are our arithmetic from the published percentages.

Before you move on

  • Wegovy’s heart approval covers non-fatal heart attack risk in people with heart disease.
  • The MASH approval is conditional and excludes cirrhosis.
  • Sleep apnea is a Zepbound use, not a Wegovy one.
  • We found no public plan paying for these uses.
Side effects and risksShould I consider a GLP-1?Doctor questions tool

More from the Canada blog

CACanadaZepbound vs Mounjaro in Canada CACanadaCanadian obesity guidelines explained CACanadaStopping a GLP-1 in Canada
About GLP Guidebook

The monthly Canada update

An independent guide to GLP‑1 medicines. We don't sell medicines, take drug-company money or earn clinic commissions. Once a month: coverage changes, approvals, safety notices and recalls. How we write

Was this post easy to understand?

Sources

  1. Novo Nordisk Canada. Wegovy (semaglutide injection) product monograph, date of authorization 2 October 2026. Sections 1, 2, 4.4, 4.5, 7, 8, 10, 11, 14 and patient information. pdf.hres.ca
  2. Lincoff AM, Brown-Frandsen K, Colhoun HM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). N Engl J Med 2023;389:2221–32. Funded by Novo Nordisk. DOI · PMID 37952131
  3. Eli Lilly Canada. Zepbound (tirzepatide injection) product monograph, date of authorization 11 June 2026. Sections 1, 4.4, 4.5, 8, 11, 14. pdf.hres.ca
  4. Pedersen SD, Manjoo P, Dash S, Jain A, Pearce N, Poddar M. Canadian Adult Obesity Clinical Practice Guideline: Pharmacotherapy for Obesity Management in Adults, 2025 update. Obesity Canada, version 3, 11 August 2025 (recommendations 1–13; STEP 1 extension, STEP 4, SURMOUNT-4, SELECT, ESSENCE and SURMOUNT-OSA summaries). obesitycanada.ca (PDF)
  5. Health Canada. Drug Product Database: product records and status for semaglutide, tirzepatide and liraglutide products (all on the prescription schedule; generic semaglutide products from Dr. Reddy’s and Apotex marketed in May 2026; Sevmia, Aspen and Sandoz products approved but not marketed). Searched 12 October 2026. health-products.canada.ca
  6. Sanyal AJ, Newsome PN, Kliers I et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis (ESSENCE). N Engl J Med 2025;392:2089–99. Funded by Novo Nordisk. DOI · PMID 40305708
  7. Malhotra A, Grunstein RR, Fietze I et al. Tirzepatide for the treatment of obstructive sleep apnea and obesity (SURMOUNT-OSA). N Engl J Med 2024;391:1193–205. Funded by Eli Lilly. DOI · PMC11598664
  8. Canada’s Drug Agency (CDA-AMC). Semaglutide (Wegovy) reimbursement recommendation SR0841, July 2025 (“Reimburse with conditions” for adults with BMI 27 or more and established cardiovascular disease; renewal needs at least a 5% reduction; about $5,066 a year). canjhealthtechnol.ca
  9. BC PharmaCare. Drug coverage decision: semaglutide (Wegovy), “Non-benefit”, 18 December 2025 (pCPA talks ended without agreement on 1 December 2025). gov.bc.ca (PDF)
  10. INESSS. Extract notice to the Minister: Wegovy (prévention cardiovasculaire, IMC ≥ 27). “Refus d’inscription – Ensemble des aspects”; Minister: “Surseoir à la décision” (11 December 2025). inesss.qc.ca
  11. BC PharmaCare. Your Voice: tirzepatide (Zepbound) for obstructive sleep apnea, public input 29 July to 25 August 2026 for the Canada’s Drug Agency review. gov.bc.ca (PDF)
  12. Health Canada. Canada launches new toll-free 1-844 POISON-X number for poison centres (Quebec keeps the Centre antipoison du Québec, 1-800-463-5060). News release, 20 March 2023. canada.ca
  13. Heart and Stroke Foundation of Canada. Medical services by phone (811 lines by province, including Info-Santé 811 in Quebec). Opened 12 October 2026. heartandstroke.ca
  14. Eli Lilly Canada. Mounjaro (tirzepatide injection) product monograph, date of authorization 23 June 2026. Sections 1 and 11. pdf.hres.ca

Last checked 12 Oct 2026 · Next review due 12 Apr 2027 · Report an error

How this post was made. Written by the GLP Guidebook team from the sources above. It's general information, not medical, legal or tax advice. Talk to a qualified doctor, nurse practitioner or pharmacist before starting, stopping or changing any medicine. How we write