GLP-1 Weight-Loss Pills: What You Need to Know

If you’ve been avoiding GLP-1 medications because of the weekly injection, there are now pill options.

In January 2025, the FDA approved an oral form of Novo Nordisk’s Wegovy (semaglutide) to treat obesity. This month, it 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 digestion, increases feelings of fullness, suppresses appetite, and helps regulate blood sugar.

“The more options people have, the better,” says Avlin Imaeda, MD, PhD, a Yale Medicine gastroenterologist who is board-certified in obesity medicine. “And hopefully, this will also bring the cost down and make it more affordable for more people.”

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.

Wegovy: The pill contains the same active ingredient as the injection—semaglutide, a peptide-based drug. Because peptides don’t easily survive digestion, the 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 strengths, ranging from 1.5 mg to 25 mg.

It’s worth noting that an oral form of semaglutide is not entirely new. Rybelsus, a semaglutide pill approved in 2019, has 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. Instead, it contains a small-molecule compound, which is less likely to be broken down during digestion.

It comes in six dose strengths, ranging from 0.8 mg to 17.2 mg.

This depends on which pill you take.

Foundayo is taken once a day at any time, with or without food. Because it’s designed to hold up well in the digestive system, it doesn’t require special timing.

That flexibility may make it easier for people who already take medications on a strict schedule. Still, doctors recommend reviewing all medications before starting Foundayo, because it can affect how some other drugs are absorbed. For example, doctors warn that Foundayo may reduce the effectiveness of oral birth control during the first weeks of treatment or when the dose is increased, and it can also interact with certain drugs such as simvastatin, a cholesterol‑lowering medication.

Wegovy uses a technology called SNAC, short for sodium N-[8-(2-hydroxybenzoyl) amino] caprylate, that 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 reason, the pill must be taken:

• On a completely empty stomach
• First thing in the morning
• At least 30 minutes before eating, drinking anything but water, or 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 effectiveness, vomiting—a common side effect of Wegovy—can prevent the oral birth control from being fully absorbed.

The pill and the injection produce similar results, though the injection has a modest edge in clinical trial data.

• Wegovy: In trials of the 25 mg pill, participants lost an average of 13.6% of body weight over 71 weeks, compared to just over 2% in the placebo group. In comparable trials of injectable Wegovy, participants lost approximately 15% of body weight over a similar period.
• Foundayo: In late‑stage trials, participants taking the 17.2 mg dose lost about 12% of their body weight over roughly 72 weeks, compared with about 2% in the placebo group. In comparable trials of injectable GLP‑1 drugs from Eli Lilly, average weight loss has generally fallen in the 15-20% range over a similar time frame.

For most people, that difference is small—and for those who would not otherwise use an injectable medication, a pill may be the more practical choice.

Unlike Lilly’s injectable drug tirzepatide, which targets two appetite-related hormones, Foundayo only targets one. This difference may help explain why the pill produces somewhat less weight loss in clinical trials, Dr. Imaeda says.

Not significantly. Gastrointestinal side effects—such as nausea, vomiting, and diarrhea—are common with both weight‑loss pills and their injectable counterparts.

In clinical trials of oral GLP‑1 medications, digestive symptoms were the most frequently reported side effects, occurring 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 effects, but it’s really pretty similar—and it’s no worse than with the shots,” Dr. Imaeda says.

Out‑of‑pocket costs for weight‑loss pills are generally lower than injections, though pricing varies by drug, dose, and pharmacy.

With health insurance and manufacturer savings programs, monthly costs for both pills and injections may be significantly reduced for some patients—sometimes to tens of dollars per month. Coverage, however, varies widely by plan and employer, and many insurers still place restrictions on coverage for weight‑loss medications.

The field is moving quickly, and newer medications in clinical trials are producing greater weight loss—but with important tradeoffs.

“One thing is that, in trials, some of these new medications are increasing the amount of weight loss, but that means higher reward, higher risk, with more side effects,” says John Morton, MD, MPH, chief of Yale Medicine Bariatric and Minimally Invasive Surgery and a board-certified obesity medicine specialist.

Dr. Morton points to retatrutide, a weekly injection from Eli Lilly currently in clinical development for obesity and type 2 diabetes, as an example. “It has had very good weight loss, around 27% of total body mass, but 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 future, there will be many more for weight loss.”

If you are currently taking an injectable GLP-1 medication and it is working well for you, there may be no reason to switch. But if you have been reluctant to start a GLP-1 medication because of the injection, or if the weekly shot has been difficult to maintain, the 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.”