GLP-1 Weight-Loss Pills: What You Need to Know
If you’ve been avoiding GLP-1 medications because of the weekly injectionthere are now pill options.
In January 2025the FDA approved an oral form of Novo Nordisk’s Wegovy (semaglutide) to treat obesity. This monthit approved Foundayo (orforglipron)a daily pill made by Eli Lilly. Both medications work the same way as their injectable counterparts—by mimicking a hormone that slows digestionincreases feelings of fullnesssuppresses appetiteand helps regulate blood sugar.
“The more options people havethe better,” says Avlin ImaedaMDPhDa Yale Medicine gastroenterologist who is board-certified in obesity medicine. “And hopefullythis will also bring the cost down and make it more affordable for more people.”
Why were GLP-1 medications only available as injections until now?
GLP‑1 medications were first developed as injections because digestive enzymes can break down the active compounds before they enter the bloodstream. Administering the drugs by injection avoids that issue altogether.
Recent advances in oral drug delivery have changed that. New formulations use protective technologies that allow the medication to survive the digestive process and be absorbed effectively—though with some important requirements around timing and dosing.
How are the pills different from the injections?
Wegovy: The pill contains the same active ingredient as the injection—semaglutidea peptide-based drug. Because peptides don’t easily survive digestionthe pill is formulated at a much higher dose than the injection to account for the portion of the drug that is lost during digestion before the body can absorb it.
It comes in four dose strengthsranging from 1.5 mg to 25 mg.
It’s worth noting that an oral form of semaglutide is not entirely new. Rybelsusa semaglutide pill approved in 2019has been used to treat type 2 diabetes. Wegovy is the first oral semaglutide formulation specifically approved for weight loss.
Foundayo: The pill form is different from injectable GLP-1 drugs because it doesn’t use the same peptide-based ingredients. Insteadit contains a small-molecule compoundwhich is less likely to be broken down during digestion.
It comes in six dose strengthsranging from 0.8 mg to 17.2 mg.
Does it matter when you take the pill?
This depends on which pill you take.
Foundayo is taken once a day at any timewith or without food. Because it’s designed to hold up well in the digestive systemit doesn’t require special timing.
That flexibility may make it easier for people who already take medications on a strict schedule. Stilldoctors recommend reviewing all medications before starting Foundayobecause it can affect how some other drugs are absorbed. For exampledoctors warn that Foundayo may reduce the effectiveness of oral birth control during the first weeks of treatment or when the dose is increasedand it can also interact with certain drugs such as simvastatina cholesterol‑lowering medication.
Wegovy uses a technology called SNACshort for sodium N-[8-(2-hydroxybenzoyl) amino] caprylatethat protects the medication and allows it to be absorbed in the stomach.
But food triggers the release of stomach acids and digestive enzymes that can break the drug down before absorption occurs. For that reasonthe pill must be taken:
- On a completely empty stomach
- First thing in the morning
- At least 30 minutes before eatingdrinking anything but wateror taking other medications
This schedule can create a practical conflict for patients already taking medications that require an empty stomach—such as levothyroxine (for thyroid conditions) or omeprazole (for acid reflux). Although the Wegovy pill does not directly reduce birth‑control effectivenessvomiting—a common side effect of Wegovy—can prevent the oral birth control from being fully absorbed.
How effective are the pills compared to the injections?
The pill and the injection produce similar resultsthough the injection has a modest edge in clinical trial data.
- Wegovy: In trials of the 25 mg pillparticipants lost an average of 13.6% of body weight over 71 weekscompared to just over 2% in the placebo group. In comparable trials of injectable Wegovyparticipants lost approximately 15% of body weight over a similar period.
- Foundayo: In late‑stage trialsparticipants taking the 17.2 mg dose lost about 12% of their body weight over roughly 72 weekscompared with about 2% in the placebo group. In comparable trials of injectable GLP‑1 drugs from Eli Lillyaverage weight loss has generally fallen in the 15-20% range over a similar time frame.
For most peoplethat difference is small—and for those who would not otherwise use an injectable medicationa pill may be the more practical choice.
Unlike Lilly’s injectable drug tirzepatidewhich targets two appetite-related hormonesFoundayo only targets one. This difference may help explain why the pill produces somewhat less weight loss in clinical trialsDr. Imaeda says.
Are the side effects different with the pills?
Not significantly. Gastrointestinal side effects—such as nauseavomitingand diarrhea—are common with both weight‑loss pills and their injectable counterparts.
In clinical trials of oral GLP‑1 medicationsdigestive symptoms were the most frequently reported side effectsoccurring at rates similar to those seen with injections. These effects were most common when patients first started treatment or increased their dose and were generally mild to moderate.
“I would have thought that the pills would have higher side effectsbut it’s really pretty similar—and it’s no worse than with the shots,” Dr. Imaeda says.
How do the costs compare?
Out‑of‑pocket costs for weight‑loss pills are generally lower than injectionsthough pricing varies by drugdoseand pharmacy.
With health insurance and manufacturer savings programsmonthly costs for both pills and injections may be significantly reduced for some patients—sometimes to tens of dollars per month. Coveragehowevervaries widely by plan and employerand many insurers still place restrictions on coverage for weight‑loss medications.
What other GLP-1 medications are in development?
The field is moving quicklyand newer medications in clinical trials are producing greater weight loss—but with important tradeoffs.
“One thing is thatin trialssome of these new medications are increasing the amount of weight lossbut that means higher rewardhigher riskwith more side effects,” says John MortonMDMPHchief of Yale Medicine Bariatric and Minimally Invasive Surgery and a board-certified obesity medicine specialist.
Dr. Morton points to retatrutidea weekly injection from Eli Lilly currently in clinical development for obesity and type 2 diabetesas an example. “It has had very good weight lossaround 27% of total body massbut the drop-out rate in the trial is 20% due to side effects,” he says. “That’s something to keep an eye on.”
Other companies are developing once-a-month injectable formulations. Dr. Imaeda anticipates continued growth in options: “I do think in the futurethere will be many more for weight loss.”
Should you ask your doctor about switching to a pill?
If you are currently taking an injectable GLP-1 medication and it is working well for youthere may be no reason to switch. But if you have been reluctant to start a GLP-1 medication because of the injectionor if the weekly shot has been difficult to maintainthe pill formulations are worth a conversation with your doctor.
Key questions to bring to that conversation:
- Does the morning timing requirement (for Wegovy) fit my current medication schedule?
- Is the pill covered by my insurance?
- How does my expected weight-loss goal compare to what clinical trials have shown?
Yale Medicine’s obesity medicine specialists can help you decide what’s best based on your individual health history and goals. “The choice between a pill and an injection comes down to individual priorities and how easily the treatment fits into their life,” Dr. Morton says. “That’s a conversation worth having with your doctor.”
