Dec. 30, 2025 – Injectable GLP-1 drugs have transformed obesity treatment – and now they’re going oral.
The FDA recently approved a pill form of semaglutide (Wegovy) for weight loss and for reducing the risk of major heart and blood vessel events like hearts attack and strokes. The decision marked the first time a GLP-1 drug was cleared in the U.S. for weight management.
The Wegovy pill is expected to hit the market in January. (Another oral GLP-1 drug, orforglipron, is being reviewed by the FDA on an accelerated timeline and could be available for weight management within months.)
“It’s good to have more options for patients with obesity,” said Melanie Jay, MD, a professor of medicine at NYU Grossman School of Medicine.
Many patients prefer pills to needles, she said. Experts explain how the two forms compare.
Pill vs. Shot: What’s Different?
One’s a daily pill, the other’s a weekly shot.
The Wegovy pill is a tablet you swallow, while the injectable version is given with a syringe, usually in the thigh or abdomen (belly area).
With the pill, you take one tablet a day – in the morning, 30 minutes before eating – so the medication is absorbed into your empty stomach, helping it reach your bloodstream. (Notably, the not-yet-approved orforglipron pill can be taken with or without food, at any time of day.)
With injections, you (or a caretaker) gives the drug once a week; the specific time of day doesn’t matter. Medicine enters your subcutaneous (under-the-skin) fat and quickly moves into your bloodstream.
The pill’s dosage is higher.
The starting daily dose for the Wegovy pill is 1.5 mg, which can be ramped up to the maximum dose of 25 mg over 90 days. The max dose for the injection is 2.4 mg, but both forms deliver a similar amount of semaglutide into your bloodstream, according to W. Timothy Garvey, MD, associate director of the University of Alabama at Birmingham Nutrition Obesity Research Center. (Garvey was an investigator in the Wegovy pill’s clinical trial, funded by drugmaker Novo Nordisk.)
When injected, semaglutide is easily absorbed into the bloodstream, he said. But when you swallow the drug, stomach enzymes dissolve some before your gut’s mucosal lining can absorb and pass it to your bloodstream.
Another oral semaglutide, Rybelsus, was approved in 2019 for type 2 diabetes and contains lower doses, with a maximum dose of 14 mg, 44% less than the most potent Wegovy pill.
The pill is easier to store.
Injectable GLP-1s must be refrigerated. The pill can be kept at room temperature.
The pill has less flexibility than the shot if you miss a dose.
If you forget to take the Wegovy pill in the morning, you simply skip that dose and resume the next day without doubling up, according to the prescribing instructions. For the weekly shot, you can make up a missed dose if your next scheduled dose is more than two days away – otherwise, you skip it and proceed with your next scheduled dose.
The pill may be cheaper.
The starting cost for the Wegovy pill is expected to be about $149 a month for the 1.5 mg dose without insurance. Higher doses may cost more – around $299 per month, depending on the dose.
Injectable Wegovy is generally more costly – about $1,000-plus per month, though the drugmaker, Novo Nordisk, offers a discount price of $199 per month for the first two months, and $349 a month after that.
What Stays the Same?
Both the pill and the shot are effective.
In studies, both forms of semaglutide show similar weight loss results, particularly among patients who are good at taking it as prescribed. “Both injectable and oral semaglutide achieve over 16% weight loss,” said Garvey.
That kind of weight loss can treat and prevent a wide range of obesity-related complications and diseases, and improve quality of life, he said.
Side effects are similar between the two forms.
The most common side effects for both injectable and oral semaglutide include gut issues, such as nausea, vomiting, and constipation, said Hamlet Gasoyan, PhD, an assistant professor of medicine at Cleveland Clinic Lerner College of Medicine.
Which Is Easier to Stick With – the Pill or the Shot?
The key to success with a GLP-1 medication is to keep taking it. Research shows that when people stop using the medication, they can regain up to two-thirds of lost weight within a year.
“We think of these medications like any other chronic medication, like a blood pressure pill or cholesterol pill,” said Jay. “These are things you take to improve health long-term.”
So which will you be more likely to take consistently? That depends on you.
Here’s what to consider:
- Do you hate needles? Fear of needles is common. And some patients “have local skin reactions,” said Garvey. “The pill gives us another option to meet those patients where they are.”
- Do you mind keeping medicine in the fridge? “Obesity is a very stigmatized condition, and people have a lot of judgments about people taking the medications,” said Jay. “One of the benefits of the pill is that you don’t have to have it in your refrigerator and advertise that you’re on the medication.”
- Do you travel often? “It’s easier to use and store the oral pill,” said Garvey. “You can travel with it a lot easier and not worry about refrigeration.”
- Do you have a hard time giving injections? Some people (including patients and caregivers) have visual impairments or physical limitations that make filling a syringe or sticking a needle challenging. “It’s often more difficult for older folks to utilize injectables,” said Jonathan H. Watanabe, PharmD, MS, PhD, a professor of clinical pharmacy at the University of California San Francisco School of Pharmacy.
- Would you rather take your meds once a week or once a day? If you’re already on the weekly injection, you may not want to mess with your routine. “Patients really get used to taking something once per week,” said Jay. “If you forget [a dose], you can remember to take it 10 hours later that day. I think that will lead to better adherence than pills, which you have to take every day on an empty stomach and then wait 30 minutes to eat. That can be difficult for people with busy schedules.”
- What does your insurance cover? Cost and insurance-related barriers are the most common reasons people stop taking GLP-1s, according to research by Gasoyan’s team. Whether the pill improves adherence “will heavily depend on whether insurers cover this new form of semaglutide, and also the pricing for direct-to-consumer sales for this medication,” said Gasoyan.
If you’re considering oral versus injectable semaglutide for weight loss, talk to your doctor about what’s best for you. “It’s a worthwhile discussion for the patient and provider to really think about what is going to help them stay on the medication longer,” said Watanabe.