Oral GLP-1s vs. Injectables: Which Is Right for You?

Users of GLP-1 weight loss drugs now have a choice: injections or pills. There are multiple drug choices within each category, but both methods of administration provide significant weight loss benefits and share similar side-effect profiles, leaving the final decision up to you and your personal lifestyle, budget, and preference for convenience.

For many people, the choice of using a pill rather than a needle might just come down to personal preference. Though enough people have tolerated self-administered injections to make the first wave of GLP-1 drugs into global blockbusters, some experts think that pills will ultimately be more attractive to most consumers.

“Generally, pills are easier to use, and people do not want to use injections forever,” says Caroline Apovian, MD, the codirector of the Center for Weight Management and Wellness and a professor of medicine at Harvard Medical School in Boston. “Instead, they are better able to understand using pills forever.”

Daily GLP-1 Pills

There are now two approved daily GLP-1 weight loss pills:

• semaglutide (Wegovy)
• orforglipron (Foundayo)

Weekly GLP-1 Injections

There are two approved weekly GLP-1 injections for weight loss:

• semaglutide (Wegovy)
• tirzepatide (Zepbound)

There is almost no difference between oral and injectable versions of the same drugs, says Reid. “The difference in weight loss is minimal between the oral and injectable [semaglutide] medications. If you weigh 200 pounds, the difference between oral semaglutide and injectable semaglutide is about 3 pounds.”

There are some differences between drugs, however. Orforglipron, the daily pill that can be taken without any food or timing restrictions, is only about half as effective as tirzepatide, which is only available as an injection.

Here is how GLP-1 options compare, according to clinical trials:

• Daily oral semaglutide (Wegovy): Average weight loss of 13.6 percent of body weight after about 15 months of treatment, compared with 2.2 percent in a placebo group

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• Daily oral orforglipron (Foundayo): Average weight loss of 11.2 percent of body weight after 72 weeks of treatment, compared with 2.1 percent in the placebo group.

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• Weekly injectable semaglutide for weight loss (Wegovy): Average weight loss of 14.9 percent of body weight after about 15 months, compared with 2.4 percent in a placebo group

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• Weekly injectable tirzepatide for weight loss (Zepbound): Average weight loss of 21 percent of body weight after about 16 months, compared with 3.1 percent in a placebo group

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Though this entire family of drugs has benefits for metabolic health, not every particular drug has been approved for the same conditions.

• Semaglutide (Wegovy), in both its oral and injectable forms, has been approved to reduce the risk of cardiovascular illnesses.
• Semaglutide (Wegovy), in both its oral and injectable forms, has also been approved to treat the liver condition MASH.
• Tirzepatide (Zepbound) has been approved to treat obstructive sleep apnea.

• Nausea
• Vomiting
• Appetite loss
• Diarrhea

Only trial and error can reveal whether you will find it easier to tolerate the side effects from pills or injections.

It’s difficult to generalize about the cost of these drugs. Out-of-pocket costs change often, and insurance reimbursements vary widely. Costs are usually lower for smaller doses at the start of medication regimens than for full or maximum doses. Prices may be higher at your local pharmacy. Price ranges include:

• Oral daily semaglutide (Wegovy): $149 per month for starter doses and $299 per month for the maximum dose when purchased directly from the manufacturer or through pharmacies and partners such as WeightWatchers and Costco.

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• Oral daily orforglipron (Foundayo): The newest GLP-1 on the market launched with a price of $149 per month for starter doses and up to $349 per month for the maximum dose when purchased without insurance.

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• Weekly injectable semaglutide (Wegovy): $199 for starter doses and $349 per month for the maximum dose when purchased directly from the manufacturer or through pharmacies and partners such as WeightWatchers and Costco.

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• Weekly injectable tirzepatide (Zepbound): $299 for starter doses and $449 or more per month for full-strength doses when purchased directly from the manufacturer or through pharmacies and partners such as Walmart

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• Newly approved oral GLP-1 medications work in similar ways to injectable GLP-1s for weight management. Your choice of pill or injection may come down to personal preference.
• GLP-1 pills are taken daily, sometimes with food and timing restrictions, while injectable GLP-1s are administered weekly.
• Whether using a pill or injection, GLP-1 weight loss medications have broadly similar results and side effects, though some drugs are more potent than others.