How long does oral semaglutide take to work?

Before you start a new medication, it’s natural to wonder how long it will be before you see results. And when it comes to oral semaglutide, that’s no exception. So, whether you’re considering the Wegovy pill or Rybelsus, you likely want to know: how long does oral semaglutide take to work?

Below, we answer that question and review the factors that can influence how quickly you can see results on oral semaglutide. 

Oral semaglutide starts working for weight loss soon after you take it, reaching its peak concentration in your bloodstream within one hour. However, it will take longer than that before you notice changes in your body or appetite. 

Typically, people see noticeable weight loss results from oral semaglutide within the first three months. By that point in clinical trials, people with type 2 diabetes taking 14 mg of oral semaglutide (Rybelsus) were:

• Eating nearly 40% fewer calories per day

• Feeling less hungry and more in control of their appetite

• About 5 pounds lighter, mostly due to fat loss

People who took a placebo, on the other hand, lost less than half a pound in the same time frame. 

In clinical trials of the Wegovy pill, people titrating to a dose of 25 mg of oral semaglutide had about 6% weight loss (nearly 14 pounds) after 3 months. This is compared to 1% (about 2 pounds) for those taking placebo. 

In less than a year and a half, people taking:

• 25 mg of oral semaglutide daily lost 13.6% of their body weight

• 50 mg of oral semaglutide daily lost 15.1% of their body weight

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Oral semaglutide starts working for diabetes within one hour after you take it, when it reaches its peak concentration in your bloodstream. 

When starting oral semaglutide, your dose for the first 30 days is not typically effective for blood glucose control. This is because it’s a low dose to help your body get used to the medication. After 30 days, your healthcare provider will likely increase the dose, and you may start to see noticeable changes in your blood sugar.

However, you probably won’t see changes in your A1C levels until the 12-week mark. After all, A1C tests measure your average blood glucose level based on the previous three months. 

After 26 weeks (six months), clinical trials of oral semaglutide (Rybelsus) show that:

• On average, oral semaglutide reduces A1C levels by 1.2%–1.4% from an average of 8%.

• Around 69%–77% of people taking oral semaglutide reach an A1C level below 7% (the benchmark recommended by the American Diabetes Association).

In the first 3–6 months of taking oral semaglutide, you may also notice other changes, according to studies of people with type 2 diabetes. For example, you may notice:

• Less body fat, including less belly fat

• Improved muscle-to-body-fat ratio

• Weight loss of 6–9 pounds

• Lower cholesterol levels

For what it’s worth, the Wegovy pill may also help people with prediabetes lower their blood sugar levels, even though it’s only FDA-approved for weight loss. In the OASIS-4 trial, 71% of people taking oral Wegovy achieved normal blood glucose levels, compared to only 33% of people taking a placebo.

Here’s a timeline of what you can expect during the first year of taking oral semaglutide:

• Three months: You’ll likely start feeling less hungry during this time. You may be eating 40% fewer calories daily, see improved blood sugar levels, and lose up to 5–6 pounds (Rybelsus) or up to 14 pounds (Wegovy pill).

• Six months: You’ll start to notice you’re carrying less body fat, especially around the belly. If you have type 2 diabetes, your blood sugar may have decreased by 1.2%–1.4%, and you may have lost 9 pounds or more (Rybelsus) or 24 pounds (Wegovy pill).

• Nine months: Weight loss continues but tends to slow down, potentially even plateauing for a while. The same goes for A1C levels.

• One year and beyond: Body weight and blood sugar levels start to go down again when you take semaglutide for a year or longer. After 64 weeks of taking the Wegovy pill, people lost 13.6% of their starting body weight in clinical trials.

Whether oral semaglutide is faster than injectable semaglutide largely depends on what dosage you’re taking and what you’re taking it for. 

When comparing some clinical trial data, however, injectable semaglutide may work faster than oral semaglutide for blood sugar control in people with type 2 diabetes. In people with obesity, the Wegovy pill and the injection produce similar weight loss results.

Oral vs. injectable semaglutide for weight loss: 

• Oral semaglutide (Rybelsus): In clinical trials, people with type 2 diabetes taking 14 mg of oral semaglutide daily lost about 6 pounds in 12 weeks.

• Oral semaglutide (Wegovy pill): In clinical trials, people with obesity targeting a dose of 25 mg or oral semaglutide daily lost about 14 pounds in 12 weeks.

• Injectable semaglutide (Ozempic): In clinical trials, people without diabetes taking 1 mg of semaglutide once a week lost about 11 pounds in 12 weeks.

• Injectable semaglutide (Wegovy): In clinical trials, people with obesity taking 2.4 mg of injectable semaglutide once a week lost about 14 pounds in 12 weeks.

So, which one’s faster for weight loss? When it comes to weight loss, higher doses of semaglutide (Wegovy pill and injection) seem to be faster than lower doses of semaglutide (Rybelsus, Ozempic). 

In the span of three months, Wegovy (injectable and oral) drove the most weight loss, followed by Ozempic and Rybelsus. However, this would need to be confirmed in a head-to-head trial to come to a firm conclusion.

The recently-approved Wegovy pill is a higher-strength version of oral semaglutide. According to clinical trials, this semaglutide pill may produce similar long-term weight loss results to Wegovy (13.6% weight loss in 15 months).  

Oral vs. injectable semaglutide for type 2 diabetes:

• Oral semaglutide (Rybelsus): In clinical trials, people taking 7 mg or 14 mg of oral semaglutide daily lowered their A1C levels by 1.2%–1.4% in 26 weeks (six months).

• Injectable semaglutide (Ozempic): In clinical trials, people taking 0.5 mg or 1 mg of injectable semaglutide weekly lowered their A1C levels by 1.4%–1.6% in 30 weeks (seven months).

So, which one’s faster for diabetes? The results of these two clinical trials are not directly comparable because they were in different groups of people. But the data suggest injectable semaglutide may be slightly faster than oral semaglutide when it comes to treating type 2 diabetes.

How fast oral semaglutide works for weight loss and diabetes can depend on several factors, including adherence to treatment, other health conditions, the dosage prescribed, and lifestyle considerations.

• Adherence to treatment: Oral semaglutide should be taken daily in the morning with up to 4 ounces of water, at least 30 minutes before foods, liquids, or other medications. This allows a maximum amount of the medication to be absorbed and remain steady in your bloodstream. It should also be combined with diet and exercise for the best results.

• Other health conditions: Certain health conditions can lead to slower weight loss on oral semaglutide. For example, people with type 2 diabetes tend to lose weight more slowly on oral semaglutide than people with obesity, but without type 2 diabetes. 

• Dosage prescribed: In clinical trials, people tend to lose more weight on higher doses of semaglutide.

• Lifestyle considerations: Being under a lot of stress or sleeping poorly can affect how fast oral semaglutide works, particularly how quickly you see weight loss (if any). Poor sleep revs up your appetite, especially for high-calorie foods. It also increases stress levels and makes it tougher to stick to a diet.

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Oral semaglutide begins working in your system shortly after taking it. But the visible results — like weight loss and lower blood sugar — take more time. 

Based on research (and semaglutide stories from real patients), you can expect to notice changes within the first few months, with more significant results around the six-month mark.

• People lose around 5–6 pounds after three months on oral semaglutide (Rybelsus) and up to 14 pounds in three months and 13.6% of their body weight after 15 months on higher doses (Wegovy pill).

• A1C levels typically drop by 1.2%–1.4% after six months on oral semaglutide, with 69–77% of people reaching target levels below 7%.

• For weight loss, higher doses of semaglutide (Wegovy pill and injection) may work faster than lower doses (Rybelsus, Ozempic).

• Your results may vary depending on your dosage, diet, exercise, sleep, other health conditions, and how consistently you take the medication.

• Combining oral semaglutide with healthy lifestyle changes leads to the best results in both weight loss and blood sugar control.