Oral semaglutide: how it works, side effects, and more

Semaglutide may be best known as the active ingredient in the injectable medications Ozempic and Wegovy. But it’s also available in oral form. 

Rybelsus is already on the market as a prescription medication for people with type 2 diabetes. 

And the Wegovy pill officially received approval from the US Food and Drug Administration (FDA) in late December 2025. This oral semaglutide for weight loss will be available in early 2026 and will come in higher strength dosages. 

If you’re interested in semaglutide for weight loss or diabetes, but the idea of needles gives you the willies, oral semaglutide can be a welcome alternative. Read on as we explore what you need to know about oral semaglutide, including how it works, side effects, cost, and more.

Oral semaglutide is a daily oral medication that’s FDA-approved for different uses as Rybelsus and the Wegovy pill. 

Rybelsus is approved to:

• Improve blood sugar control in people with type 2 diabetes, in conjunction with diet and exercise 

• Reduce the risk of serious cardiovascular problems (e.g. heart attack, stroke, death from heart disease) in adults with type 2 diabetes

The Wegovy pill is approved to:

• Reduce excess body weight and maintain weight reduction long term in

  • Adults with obesity

  • Adults with overweight and at least one weight-related medical condition (e.g. high blood pressure, type 2 diabetes)

• Reduce the risk of serious cardiovascular problems (e.g. heart attack, stroke, death from heart disease) in adults with cardiovascular disease and either obesity or overweight 

Both Rybelsus and the Wegovy pill are indicated alongside diet and exercise, and manufactured by Novo Nordisk. 

Types of oral semaglutide: Rybelsus vs. Wegovy

Oral semaglutide works similarly to injectable semaglutide. Both versions are glucagon-like peptide-1 receptor agonists (GLP-1s), which mimic a gut hormone produced by your body that’s called — you guessed it — GLP-1. 

Like natural GLP-1, semaglutide targets GLP-1 receptors located throughout your gastrointestinal tract, pancreas, and brain to:

• Slow down digestion

• Encourage the release of insulin after eating

• Reduce the amount of glucagon (sugar) that gets released after eating

• Send signals of satiety (fullness) to your brain

Together, these effects help control both your blood sugar levels and your appetite. This is why oral semaglutide can be an effective treatment for type 2 diabetes and weight loss. 

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Yes, you can take oral semaglutide for weight loss. However, since the so-called Wegovy pill is not yet available, it would be an off-label prescription of Rybelsus. 

Rybelsus is the only form of oral semaglutide currently available. It is FDA-approved for managing type 2 diabetes — not for weight loss. Still, some people may take Rybelsus off-label for weight loss.

If and when oral Wegovy is approved, it will be the first version of oral semaglutide (as well as the first oral GLP-1) specifically approved for weight loss. It will also have a higher dosage than Rybelsus.

Research on oral semaglutide for weight loss

Oral semaglutide for weight loss (aka the Wegovy pill) is being developed and has yet to be approved. So far, trial results show it can be quite effective for weight loss in people with obesity or overweight:

• In an OASIS-4 clinical trial, people who took 25 mg of oral semaglutide daily lost an average of 13.6% of their body weight after 64 weeks (about a year and three months). 

• In an OASIS-1 clinical trial, people who took 50 mg of oral semaglutide daily lost an average of 15.1% of their body weight after 68 weeks (about a year and four months). 

• In an early-phase clinical trial that tested whether the drug could reduce calorie intake, people who took 50 mg of oral semaglutide ate about 40% fewer calories on average than those taking a placebo. They also lost nearly 10% of their body weight after five months. 

For comparison, research found that taking 2.4 mg of injectable semaglutide weekly caused an average weight loss of 14.9% of body weight after 68 weeks. 

Prior to the development of the Wegovy pill, the research on oral semaglutide for weight loss was based on Rybelsus, which is taken in lower doses to manage diabetes. 

Since Rybelsus is not approved for weight loss, it hasn’t been as widely studied for that purpose. Even so, these studies found that Rybelsus can produce a modest amount of weight loss in people with type 2 diabetes. 

• One study found that people lost 6.5 pounds in three months and nearly 9 pounds after six months of taking Rybelsus. 

• Another study found that about one in three people lost at least 5% of their body weight after a year and a half of taking Rybelsus. 

It’s worth noting that these studies of Rybelsus were all conducted in people with type 2 diabetes. These people may also be taking medications that can contribute to weight gain and slow weight loss, such as insulin. 

The TL;DR? Until January 2026, the only version of oral semaglutide available is the lower-strength Rybelsus, which has been found to produce modest weight loss. However, available research on oral semaglutide for weight loss — the Wegovy pill — has shown this version of the drug to cause significant weight loss — comparable to that of the Wegovy injection. 

The most common side effects of oral semaglutide include:

• Nausea

• Stomach pain

• Diarrhea

• Decreased appetite

• Vomiting

• Constipation

Typically, these gastrointestinal side effects are most common when starting treatment and when increasing your dose.

Other, less common side effects of oral semaglutide include:

• Bloating

• Upset stomach

• Belching

• Flatulence

• Heartburn

• Gastritis (stomach inflammation)

While rare, oral semaglutide can also cause serious side effects, including:

• Acute pancreatitis

• Diabetic retinopathy complications (diabetes-related vision changes)

• Hypoglycemia (low blood sugar) when used with insulin and similar medications

• Kidney or gallbladder issues

• Severe gastrointestinal reactions

• Severe allergic reactions

• Pulmonary aspiration during general anesthesia or deep sedation

In animal studies, semaglutide caused thyroid tumors, but it’s unclear if this occurs in humans. For this reason, semaglutide has a boxed warning about a possible risk of thyroid tumors and should not be used by people with a personal or family history of thyroid cancer or a genetic disorder called multiple endocrine neoplasia syndrome type 2 (MEN2). 

The Wegovy pill appears to cause similar gastrointestinal issues and carry similar risks as other semaglutide medications. 

In a phase 3 trial (OASIS 4) comparing oral semaglutide 25 mg (the Wegovy pill) to placebo, the most common side effects were:

• Nausea

• Vomiting

• Constipation

• Indigestion (dyspepsia)

• Diarrhea

Most side effects were mild or moderate and went away without stopping treatment. On average, the participants reported that nausea lasted less than two weeks and vomiting lasted a couple of days. 

If the Wegovy pill is approved, its full prescribing information will be published and will include more details about adverse effects.   

Typically, oral semaglutide doses start low and gradually increase over a period of weeks to months as part of a process called titration (aka escalation). This gives your body time to adjust to the medication and its side effects. 

The Wegovy pill comes in the following dosage strengths:

• 1.5 mg 

• 4 mg 

• 9 mg 

• 25 mg 

The standard daily dose for the Wegovy pill will be 25 mg, according to Novo Nordisk.

Rybelsus comes in two dosage formulations that aren’t interchangeable: R1 and R2 tablets. They both contain semaglutide and are taken once daily on an empty stomach. 

But the new R2 formulation contains different inactive ingredients that help the body absorb semaglutide better. So, even though they contain less semaglutide, the R2 tablets are “bioequivalent” to the original (R1) formulation — meaning both deliver the same levels of semaglutide into the bloodstream. 

As for the doses of oral semaglutide for weight loss? The standard daily dose for the Wegovy pill will be 25 mg, according to Novo Nordisk. 

In studies, people started out with lower doses (3 mg, 7 mg, 14 mg) that gradually increased during the escalation phase. That said, official dosage information and instructions will be released when the medication is approved. 

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Here are the costs of oral semaglutide:

• Rybelsus: $997.58 per month without insurance

• Wegovy pill: $149–$299 per month depending on the dose through NovoCare and Novo Nordisk’s partners 

The exact amount you pay, however, may vary depending on location, preferred pharmacy, health insurance, and any coupons or discounts. 

For example, eligible patients with private or commercial insurance may be able to get Rybelsus for just $10/month as part of the manufacturer’s savings offer. You may also be able to lower the cost of oral semaglutide with the help of pharmacy discounts or coupons available through sites like GoodRx. 

There are several differences between oral and injectable semaglutide. But a pretty big one is how you take them: one’s a shot and the other’s just a pill you swallow.

Here’s a rough run-down of oral vs. injectable semaglutide: 

You’ve likely heard about injectable semaglutide — better known as Wegovy and Ozempic — but oral semaglutide is also available in the US. Beyond just featuring the same active ingredient as the headline-making injections, here’s what else you need to know:

• Oral semaglutide is FDA-approved for diabetes (Rybelsus) and, as of late December 2025, for weight loss (Wegovy pill). The Wegovy pill will be available in January 2026, according to the drug manufacturer. 

• Higher doses of oral semaglutide have produced weight loss that’s quite similar to — albeit slightly less than — injectable Wegovy.

• Oral semaglutide is taken once daily in the morning, at least 30 minutes before food, water, or other medications.

• The most common side effects of oral semaglutide include nausea, diarrhea, and stomach pain — all of which typically get better over time.

• Without insurance, Rybelsus starts around $1,000 per month and the Wegovy pill starts at $149 per month through NovoCare and Novo Nordisk’s partners.