Top Takeaways
- Once daily oral semaglutide (Wegovy) is the first GLP-1 agonist pill FDA approved for obesity.
- Explain its efficacy and side effects appear similar to injectable semaglutide for weight loss.
- Ensure patients understand oral semaglutide’s strict administration requirements.
Patients are asking about Rx semaglutide tablets (Wegovy), the first ORAL GLP-1 agonist FDA approved for obesity and overweight.
It’s the same med in injectable Wegovy for weight loss...or injectable Ozempic or oral Rybelsus for type 2 diabetes.
But oral Wegovy is taken DAILY...versus weekly with the injection.
Using oral semaglutide 25 mg daily for 64 weeks leads to about 11% more weight loss than with placebo, or about 26 lb for a 234 lb patient.
This seems similar to injectable semaglutide 2.4 mg weekly for obesity or overweight...and more than most other po weight loss meds (naltrexone/bupropion ER, etc). But there aren’t any head-to-head trials.
New po semaglutide is also approved to reduce the risk of CV events in patients with CV disease and obesity...like the injection. But it isn’t yet indicated for metabolic dysfunction-associated steatohepatitis (MASH).
And it has very tricky administration...like Rybelsus.
Emphasize that po semaglutide must be swallowed whole with a sip or NO MORE than 4 oz of water...at least 30 minutes before the first food, other beverage, or oral meds of the day. Not doing so reduces efficacy.
Also point out that the tablets should be kept in their original container at room temperature...since they’re sensitive to moisture.
Educate that GI side effects (nausea, etc) of new oral semaglutide are similar to the injectable...and help ensure proper dose titration.
Most patients will start with one 1.5 mg semaglutide tab daily...and increase every month to 4 mg and 9 mg, until the 25 mg/day max is reached.
Expect prior auths for new oral semaglutide...it costs about $1,350/month, the same as the injectable. But patients may be able to get these Rxs for less with manufacturer or direct-to-consumer programs.
Advise on how to handle switches between injections and tabs. For example, patients on injectable semaglutide 2.4 mg who prefer an oral med may switch to semaglutide 25 mg po daily 1 WEEK after the last injection.
On the other hand, patients on oral semaglutide 25 mg daily who need additional weight loss or who can’t tolerate the tabs may switch to semaglutide 1.7 mg injection weekly the DAY after stopping the tabs.
Anticipate that more oral GLP-1s will be approved this year... including once daily orforglipron which can be taken at any time withOUT specific food or water dosing restrictions.
Find more details about oral semaglutide in our GLP-1 and GIP/GLP-1 Receptor Agonist Interactive Comparison Chart. And use our resource, Comparison of Weight Loss Products, to review other meds for obesity.
- Wharton S, Lingvay I, Bogdanski P, et al; OASIS 4 Study Group. Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity. N Engl J Med. 2025 Sep 18;393(11):1077-1087.
- Santulli G. From needles to pills: oral GLP-1 therapy enters the obesity arena. Cardiovasc Diabetol Endocrinol Rep. 2025 Oct 6;11(1):31.
- Saeed ZI, Apovian CM. Semaglutide and Tirzepatide for the Treatment of Obesity and Weight-Related Comorbidities: A Narrative Review. Curr Atheroscler Rep. 2025 Dec 18;28(1):2.
- Medication pricing by Elsevier, accessed January 2026.