Novo Nordisk has introduced the first GLP-1 pill specifically for weight loss, offering a daily oral alternative to its popular injectable drugs like Wegovy and Ozempic. This development is seen as a significant step in obesity care, potentially expanding access for patients due to its oral administration, easier storage, and strong clinical results. The new pill, available by prescription, contains semaglutide, the same active ingredient found in the injectable version of Wegovy.

Like other GLP-1 medications, the Wegovy pill works by activating glucagon-like peptide-1 (GLP-1) receptors. These receptors play a crucial role in regulating blood sugar and appetite. By slowing digestion, the drug helps individuals feel full for longer and signals to the brain that they are satisfied, effectively reducing hunger. Clinical trials have demonstrated that the pill is comparably effective to its injectable counterpart; patients taking the pill lost an average of 13.6% of their body weight after 64 weeks, which closely aligns with the 14.9% weight loss observed with semaglutide injections after 68 weeks.

However, patients should anticipate a longer timeframe to observe significant weight loss results with the oral medication compared to injections. Unlike injections, which enter the bloodstream directly, the tablets must first undergo digestion. Consequently, the oral medication requires a much higher dose, with the highest effective dose being 25 milligrams (mg) compared to 2.4 mg for the injections. The recommended dosing schedule is incremental, starting at 1.5 mg for the first month, increasing to 4 mg in the second month, then 9 mg, before eventually reaching the 25 mg dose, which was used in the key study.

Despite hopes for a more affordable option, the current price of the Wegovy pill is largely consistent with the injections. For insured patients, the 25-mg dose can be as low as $25 per month. Without insurance, the cost is around $299 per month, which is $50 less than the injectable version. Experts express some disappointment regarding the similar pricing but view it as a start, hoping that increased usage and the availability of more oral GLP-1 options will lead to further cost reductions.

Patients using the Wegovy pill may experience side effects similar to those reported with the injectable version. These common side effects include nausea, diarrhea, and vomiting, primarily due to the drug's effect of slowing digestion. Other potential side effects encompass headache, fatigue, dizziness, and heartburn.

The oral Wegovy regimen demands a more structured schedule than the weekly injections. It is recommended to take the pill in the morning on an empty stomach and to wait at least 30 minutes before consuming food, beverages, or other oral medications. This specific timing is critical for proper absorption and to minimize gastrointestinal side effects. Beyond medication, maintaining a healthy lifestyle is paramount for maximizing the pill's benefits, including consuming well-balanced, nutritious meals, ensuring adequate hydration, and incorporating strength training to preserve muscle and bone mass during weight loss. It is also important to recognize that obesity is a chronic condition, and continuous use of GLP-1 medication is typically required to sustain weight management.

While the Wegovy pill is currently the only GLP-1 tablet approved specifically for weight loss, it is not the only oral semaglutide on the market. Rybelsus, another semaglutide pill, is already available for the treatment of type 2 diabetes. Furthermore, competition is on the horizon, with Eli Lilly, the manufacturer of Zepbound and Mounjaro, developing its own GLP-1 tablet called orforglipron, which is anticipated to receive FDA approval in the near future.