Should You Switch to the Wegovy Pill?

The arrival of the Wegovy pill (semaglutide), the first oral GLP-1 drug approved to treat obesity, means freedom of choice: Adults who are looking to lose weight and have at least one weight-related medical condition can now take Wegovy as a once-daily pill instead of a weekly injection.

For people already taking Wegovy injections, the availability of a pill raises an important question: Should you switch? And for those considering starting a GLP-1 for the first time, what goes into the decision about whether to choose a pill or a shot?

Here’s what you need to know.

The Wegovy pill contains semaglutide, the same active ingredient used in the Wegovy shot, which comes in an auto-injector pen.

Semaglutide is a medication that mimics a hormone called glucagon-like peptide 1, which the gut usually releases after eating. The drug helps regulate appetite by signaling fullness to the brain, slowing digestion, and reducing hunger between meals.

When combined with a reduced-calorie diet and increased physical activity, semaglutide drugs in any form can support weight loss, says Yuval Pinto, MD, an obesity and family medicine doctor at Johns Hopkins Medicine in Baltimore.

The main difference between the injection and the pill is how semaglutide gets into the body. With the Wegovy pen, the medication is injected under the skin once a week, allowing most of the dose to enter the bloodstream directly.

With the pill, semaglutide has to move through the digestive system, where much of it breaks down. Because only a small amount makes it into the bloodstream, the Wegovy pill contains a much higher semaglutide dose and has to be taken every day in a very specific way.

Clinical trials show that both versions of Wegovy can lead to comparable weight loss when combined with eating less and exercising more, says Fatima Cody Stanford, MD, MPH, an obesity medicine specialist at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School, both in Boston.

Dr. Stanford said this small difference in total weight loss isn’t enough to be the deciding factor between choosing the injection over the pill.

“The choice should be based on patient preference, adherence [how easy it is for each individual to take the medicine consistently], and clinical context,” says Stanford.

Side effects for the Wegovy pill and the injection are similar, usually involving mild to moderate gut discomforts, with no clear difference in severity, says Stanford.

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal discomfort

These effects are most likely to occur when increasing dosages, and often improve over time as the body adjusts.

But because the body processes the pill differently than the shot, people who found the injections intolerable may have a different experience with the pill. “If you’re interested in trying the oral version after stopping the injectable due to side effects, you should definitely talk to your obesity specialist or primary care doctor,” says Dr. Pinto.

Beyond needle phobia or the physical discomfort of injections, convenience is a key reason people may be interested in switching to the Wegovy pill.

Wegovy injection pens must be kept refrigerated, which can be a logistical challenge. With the injections you will also need more supplies, such as alcohol swabs, and you may want more privacy while giving yourself a shot.

• First thing in the morning on an empty stomach
• With no more than 4 ounces of plain water
• With no food, drink, or other medications for at least 30 minutes afterward
• Swallowed whole, without crushing or splitting

The reason for these rules is that oral absorption of the medication is tricky — that’s why it took so long for a pill to be available, says Dan Azagury, MD, a weight loss physician and bariatric surgeon at Stanford Medicine in Palo Alto, California.

“The very specific instructions need to be followed closely, so that might not be for everyone depending on their daily schedule,” he says.

These rules are necessary, says Pinto, because eating or drinking too soon after taking the pill can significantly reduce how much medication reaches the bloodstream.

“Injections may be preferred for patients who struggle with daily pills or have complex medication regimens,” says Stanford.

People who travel frequently or have irregular schedules may also find daily pills more appealing, she says.

The pill may also make it easier to skip a daily dose now and then to avoid side effects for certain situations — say a plane ride or big date. But would that make the medicine less effective?

That’s not likely, says Pinto. “As long as someone is taking the pills the majority of the time — say 80 to 90 percent of the time — it’s not likely that efficacy will be affected,” he says.

The pill is not automatically cheaper than the injection, particularly at higher doses.

Cost depends on dose, insurance coverage, and whether someone pays out of pocket.

But people won’t pay that much out-of-pocket, with or without insurance coverage.

• The starting 1.5 mg daily pill is priced at $149 per month. Higher doses of the pill will cost $299 a month.
• The first two months of Wegovy injection pens cost $199 per month. Beginning at month three, the cost rises to $349 per month.

Novo Nordisk says that people with insurance coverage may pay as little as $25 per month for the pill or the injection, depending on their plan. Insurance rules may still require prior authorization, especially when switching from injection pens to the pill.

Right now, the U.S. Food and Drug Administration (FDA) has approved the Wegovy pill to treat obesity rather than for maintaining weight loss. Novo Nordisk is not marketing it as a way to maintain weight loss after using injectable Wegovy, says Pinto.

“It is being studied for that, but those results haven’t been published yet,” he says.

What matters most for locking in weight loss is staying on treatment, says Pinto. If you want to take less medication or stop altogether, it’s important to discuss how you will be able to prevent weight regain, whether that’s with another type of weight loss medication, diet or exercise changes, or both, he says.

“Studies of GLP-1 medications and real-world experience show that stopping treatment often leads to weight regain over time,” he says.

For people new to GLP-1 medications, the choice between a pill and an injection often comes down to comfort, routine, and expectations. One is not “better” than the other, says Stanford.

“There’s also no evidence that starting with injections improves outcomes or that switching is necessary,” says Stanford. It’s really all about patient preference, she adds.

• The new Wegovy pill uses the same active ingredient as the injection — semaglutide — and leads to similar weight loss for many people. Choosing between a daily pill and a weekly shot may come down to preference, routine, and what’s easiest to stick with long term.
• The pill may be preferable for people who dislike injections, but it must be taken very precisely on an empty stomach each morning; the injection has fewer timing rules.
• Side effects are generally similar for both the Wegovy pill and injection and cost is comparable. For people paying cash, the pill will be about $50 less a month.
• Neither option is a short-term fix. Stopping Wegovy, whether pill or injection, commonly leads to weight regain, so having a long-term plan with your healthcare provider is key for maintaining results safely.