GLP-1 Pills: Rybelsus, Ozempic Tablets, the Wegovy Pill and Orforglipron (Foundayo)

As of October 5, 2026, the FDA has approved four GLP-1 medications you take as a pill, made from two active ingredients. Rybelsus and Ozempic tablets (oral semaglutide) are for type 2 diabetes^[1]. Wegovy tablets, often called the Wegovy pill (oral semaglutide 25 mg), are for weight management and lowering cardiovascular risk^[2]. Foundayo (orforglipron) is for weight management^[3]. So yes, there’s an “Ozempic pill” in the US, but it’s a diabetes medicine, not a weight-loss one. In the EU, Rybelsus and Wegovy tablets are authorized and orforglipron is under review^[7,9,11].

Everything below comes from labels, regulators’ records and published trials. Whether one of these pills suits you, and at what dose, is your prescriber’s decision. How the drug family works is in what are GLP-1 medications, and what to eat on one is in what to eat on GLP-1 medications.

Which GLP-1 pills exist and where they’re approved

A GLP-1 receptor agonist activates the receptor of the gut hormone GLP-1: it helps control blood sugar, slows stomach emptying and reduces appetite. Most are injections; these four are daily pills.

HbA1c is average blood sugar over the past two to three months. Each trial compared a pill with placebo, not with the other pills, so the last column doesn’t show which “works best.”

Rybelsus and Ozempic tablets: oral semaglutide for type 2 diabetes

Rybelsus contains semaglutide, the active ingredient of the Ozempic and Wegovy injections. On January 30, 2026, the FDA approved a supplement to the Rybelsus application that renamed its newer tablet formulation Ozempic tablets^[4]. Both brands share one US label and are indicated as an adjunct to diet and exercise to improve blood sugar control in adults with type 2 diabetes, and to reduce the risk of major cardiovascular events (cardiovascular death, nonfatal heart attack or nonfatal stroke) in adults with type 2 diabetes at high risk for these events^[1]. Neither is approved for weight management.

The cardiovascular indication rests on SOUL, a trial in 9,650 adults with type 2 diabetes and cardiovascular disease, chronic kidney disease or both. A major cardiovascular event occurred in 12% on semaglutide tablets 14 mg and 13.8% on placebo (hazard ratio 0.86; 95% CI: 0.77 to 0.96), over a median follow-up of 49.6 and 49.4 months^[1,19]. The EU label doesn’t list cardiovascular risk reduction as an indication^[7].

Rybelsus vs. Ozempic tablets

The difference is the tablet, not the drug. The US label lists Rybelsus in 3, 7 and 14 mg and Ozempic tablets in 1.5, 4 and 9 mg, and warns that the two are not substitutable on a mg-to-mg basis^[1]. The newer tablet is absorbed better: the label estimates an absolute bioavailability of about 0.4% to 1% for Rybelsus and 1% to 2% for Ozempic tablets, with no clinically significant differences in exposure between Rybelsus 3, 7 and 14 mg and Ozempic tablets 1.5, 4 and 9 mg, respectively^[1]. Any switch between them follows the label and is your prescriber’s call.

In the EU, the brand is still Rybelsus, and its label lists 1.5, 4, 9, 25 and 50 mg tablets. It explains that the original trials used 3, 7 and 14 mg tablets, bioequivalent to 1.5, 4 and 9 mg^[7]. The US label has no 25 or 50 mg diabetes tablet^[1]. Each label’s dose schedule is in the semaglutide guide.

How the label says to take them

Semaglutide is poorly absorbed by mouth, hence the strict instructions in the US label:

• Once a day, on an empty stomach in the morning, with up to 4 ounces (120 mL) of plain water and no other liquids^[1].
• Swallowed whole: not split, crushed, chewed or dissolved^[1].
• Then a wait of at least 30 minutes before eating, drinking or taking other oral medications^[1].

In the label’s studies, semaglutide absorption was higher after a longer fasting period following the dose, and higher with 50 mL than with 240 mL of water^[1]. The EU label adds a recommended fast of at least 8 hours beforehand and warns that absorption is highly variable and may be minimal: 2% to 4% of patients will not have any exposure^[7].

Side effects

In the US label’s pooled placebo-controlled trials in type 2 diabetes (table 2)^[1]:

Most nausea, vomiting and diarrhea happened during dose escalation, and 8% on 14 mg and 4% on 7 mg stopped treatment because of digestive side effects, vs. 1% on placebo^[1]. Food tips are in nausea on GLP-1 medications: what to eat. One interaction: levothyroxine exposure increased 33% when it was taken with semaglutide tablets^[1]. If you take thyroid medication, mention it to your prescriber.

Wegovy tablets: oral semaglutide for weight management

According to the US label, in combination with a reduced-calorie diet and increased physical activity, they are indicated to reduce excess body weight and maintain weight reduction long term in adults with obesity, or in adults with overweight and at least one weight-related condition, and to reduce the risk of major cardiovascular events in adults with established cardiovascular disease and either obesity or overweight^[2]. Unlike the injection, the tablets aren’t approved for teens or for the liver disease MASH^[2].

Doses in the label. The tablets come in 1.5, 4, 9 and 25 mg. The label starts at 1.5 mg once daily and steps up every 30 days (4 mg, then 9 mg) to a maintenance dose of 25 mg from day 91^[2]. The steps aim to reduce digestive side effects, and your prescriber can slow them. They’re taken exactly like Rybelsus: on an empty stomach in the morning with up to 4 ounces of water, then at least 30 minutes before food, drink or other oral medications^[2].

Type 2 diabetes. The label notes that Wegovy tablets have not been studied for weight reduction in adults with type 2 diabetes, and that in people with type 2 diabetes, average semaglutide levels with the 25 mg tablet were lower than with the 2.4 mg injection, with higher variability, so some patients may not reach therapeutic levels^[2].

The OASIS 4 trial

OASIS 4 (trial summary), funded by Novo Nordisk, compared oral semaglutide 25 mg with placebo, plus lifestyle counseling, in 307 adults without diabetes who had obesity, or overweight and a weight-related condition^[13]. Results from the paper, matching the EU label^[8,13]:

95% CI (confidence interval): the range where the true effect probably lies. These are averages; individual responses vary a lot. The US label (Study 7) reports a slightly different analysis: −13.6% vs. −2.4% on placebo, a difference of −11.2 points (95% CI: −13.6 to −8.8)^[2].

On the heart, the labels differ: the US label gives the tablets a cardiovascular indication^[2], while the EU label states that no cardiovascular outcomes studies have been performed with oral semaglutide 25 mg in people with established cardiovascular disease and a BMI of 27 or more^[8].

An earlier trial, OASIS 1 (trial summary), tested 50 mg a day in 667 adults without type 2 diabetes: −15.1% vs. −2.4% on placebo at 68 weeks^[14]. That dose isn’t approved for weight management; Wegovy tablets top out at 25 mg^[2,8].

Wegovy pill side effects

On side effects, the EU label reports nausea in 46.6% vs. 18.6% on placebo, vomiting in 30.9% vs. 5.9% and constipation in 20.1% vs. 9.8%; digestive symptoms led 3.4% to stop treatment^[8]. The US label adds that 5% on the tablets and no one on placebo reported dysesthesia, an abnormal skin sensation such as tingling or burning^[2]. The pill has its own guide, the Wegovy pill, with more on OASIS 4 and how it compares with the shot.

Wegovy tablets in the EU

The tablets joined Wegovy’s EU authorization after a favorable CHMP opinion on May 21, 2026 and a European Commission decision on July 14, 2026^[9]. The EU label covers weight management in adults with a BMI of 30 or more, or 27 to under 30 with at least one weight-related condition, and asks for a recommended fast of at least 8 hours before the tablet^[8]. BMI is body mass index; what it misses is in what BMI measures. In Spain, the tablets are listed as authorized since July 22, 2026, but not marketed^[10].

Orforglipron (Foundayo): a GLP-1 pill you can take with food

Orforglipron isn’t a peptide like semaglutide but a small molecule that activates the GLP-1 receptor^[3,15], which changes how it’s taken. According to the US label, Foundayo is taken by mouth once daily, with or without food, swallowed whole without breaking, crushing or chewing^[3]. In the label’s food-effect study, no clinically relevant food effect was observed: total exposure (AUC) fell by 19% with food compared with the fasted state^[3]. There’s no fasting window and no water limit^[3,12].

• United States. Approved April 1, 2026^[6]. It’s indicated, in combination with a reduced-calorie diet and increased physical activity, to reduce excess body weight and maintain weight reduction long term in adults with obesity, or adults with overweight and at least one weight-related condition^[3]. Type 2 diabetes isn’t a US indication^[3].
• United Kingdom. Authorized by the MHRA on August 10, 2026, for weight management and type 2 diabetes^[12].
• European Union. Not authorized. On the EMA’s September 2026 list, its evaluation for obesity and type 2 diabetes started on January 22, 2026 and restarted on July 20, 2026, after a round of questions^[11].

Doses in the label. The label starts at 0.8 mg once daily, then 2.5 mg after at least 30 days, then 5.5 mg after at least 30 more days; the dose may be raised to 9, 14.5 or 17.2 mg (the maximum), each after at least 30 days, based on response and tolerability^[3]. It also caps the dose at 9 mg a day when taken with a strong CYP3A4 inhibitor, drugs that slow how the liver clears orforglipron^[3]. Which dose fits you is your prescriber’s call.

The trials

All three were funded by Eli Lilly:

The trials used an investigational formulation at 6, 12 and 36 mg^[15,16]. The label presents those data as equivalent Foundayo doses (5.5, 9 and 17.2 mg) and, in its own analysis of ATTAIN-1, reports −11.1% on 17.2 mg vs. −2.1% on placebo^[3]. People with type 2 diabetes lost less weight than those without^[15,16]. The trial results chart puts these trials side by side.

Side effects in the label

The label pools ATTAIN-1 and ATTAIN-2: 3,155 adults treated for up to 72 weeks (table 1)^[3]:

Headache, bloating, fatigue, burping, reflux, gas and hair loss each affected between 4% and 9% on Foundayo^[3]. Other points from the label:

• 8% stopped treatment because of side effects, vs. 3% on placebo, mostly digestive ones. Nausea, vomiting and diarrhea were more frequent during dose escalation and decreased over time^[3].
• Acute pancreatitis was confirmed in 6 people on Foundayo (0.14 per 100 years of exposure) vs. 1 on placebo (0.04). Heart rate rose by an average of 4 to 5 beats per minute, vs. 0.5 on placebo^[3].
• A boxed warning on thyroid C-cell tumors, which GLP-1 drugs cause in rodents; orforglipron isn’t active in rats or mice, and the relevance to humans hasn’t been determined. It’s contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2^[3].
• People using oral hormonal contraceptives are advised to switch to a non-oral method or add a barrier method for 30 days after starting and for 30 days after each dose increase^[3].

Pills vs. shots: what can actually be compared

I haven’t found a published trial comparing a GLP-1 pill head to head with a weekly GLP-1 injection for weight. Here’s what exists:

• Across separate trials. The EU Wegovy label says that efficacy and safety were similar between OASIS 4 (tablet) and STEP 1 (injection), although some patients have not achieved the same exposure with the 25 mg tablet as with the 2.4 mg injection^[8]. The US label predicts that, without type 2 diabetes, semaglutide levels with the 25 mg tablet are comparable to the 2.4 mg weekly injection, with higher variability^[2]. An indirect comparison funded by Novo Nordisk estimated a 1.01-point weight difference favoring the injection (95% CI: −1.61 to 3.63), not a clear difference^[20].
• Pill vs. a daily injection, in diabetes. In a 26-week trial with 711 adults on metformin, with or without an SGLT2 inhibitor (PIONEER 4), semaglutide tablets 14 mg and liraglutide 1.8 mg injected daily lowered HbA1c similarly (difference of −0.1 points; 95% CI: −0.3 to 0), and weight fell 1.2 kg more on the tablet (95% CI: −1.9 to −0.6), about 2.6 lb^[1]. Liraglutide is an older daily GLP-1, not the weekly semaglutide shot.
• Pill vs. pill. In ACHIEVE-3 (trial summary), an open-label trial in 1,698 adults with type 2 diabetes on metformin, funded by Eli Lilly, orforglipron 36 mg lowered HbA1c 0.44 points more than oral semaglutide 14 mg (95% CI: −0.62 to −0.26) at 52 weeks. More people stopped because of side effects on orforglipron (9% to 10% vs. 4% to 5%)^[18]. A second indirect comparison funded by Novo Nordisk estimated more weight loss on oral semaglutide 25 mg than on orforglipron 36 mg (−3.2 points; 95% CI: −5.9 to −0.4)^[21]. Each manufacturer has published the analysis that favors its own drug.

Day to day, the labels differ in other ways: a daily pill or a weekly shot, a fasting routine or none, different interactions^[1,2,3]. Which fits a given person is a conversation with the prescriber. Stopping is covered in what happens when you stop Ozempic, Wegovy or Zepbound, and what to expect on the scale in how much weight people lose on GLP-1 medications.

Availability and cost

Drugs@FDA lists every strength of Rybelsus, Ozempic tablets, Wegovy tablets and Foundayo as a prescription product^[4,5,6]. What you pay depends on your insurance and plan. Prices change often, so I don’t repeat them: the monthly cost calculator shows dated list prices with sources, and generic semaglutide: patents and approvals explains when cheaper versions could arrive. EU, Spanish and UK status is in the sections above^{[7,9,10,11,12]}.

“Natural GLP-1” pills and online sellers

The approved GLP-1 pills are the ones on this page, and all need a prescription^[1,2,3]. A supplement sold as a “natural GLP-1” or “GLP-1 booster” hasn’t been reviewed by the FDA as a drug.

• The FDA warns that many weight-loss products sold as dietary supplements or “all-natural” treatments contain hidden ingredients that can cause serious harm, including hospitalization^[23].
• It has also found counterfeit Ozempic in the US supply and acted against companies selling unapproved GLP-1 drugs labeled “for research purposes” or “not for human consumption”^[22].

What’s in “natural GLP-1” supplements, and in patches sold as GLP-1s, is covered in natural Ozempic supplements and GLP-1 patches.

Frequently asked questions

Is there an Ozempic pill?

In the US, yes. Since January 30, 2026, the newer semaglutide tablet (1.5, 4 and 9 mg) carries the name Ozempic tablets, for type 2 diabetes only, under the Rybelsus label^[1,4]. In the EU, the same tablets are sold as Rybelsus^[7].

What’s the difference between Rybelsus and Ozempic?

Rybelsus and Ozempic tablets are daily semaglutide pills for type 2 diabetes, in different strengths that can’t be swapped milligram for milligram^[1]. The Ozempic injection is the weekly shot of the same drug. The only injectable GLP-1 the tablets were compared with in their label is daily liraglutide^[1].

Is there a Wegovy pill?

Yes. The FDA approved Wegovy tablets on December 22, 2025, for weight management and cardiovascular risk reduction^[2,5]; the EU followed in July 2026^[9].

Is there a Zepbound pill?

No. Zepbound is tirzepatide, and none of the four GLP-1 pills the FDA has approved contains it: they’re semaglutide or orforglipron^[1,2,3]. Lilly’s pill for weight management is Foundayo (orforglipron), approved in the US on April 1, 2026^[6]. It’s a different molecule, a small molecule that activates the GLP-1 receptor, not a tablet form of tirzepatide^[3,15]. More in the orforglipron (Foundayo) guide.

Does Rybelsus work for weight loss?

Its label covers type 2 diabetes only^[1]. The oral semaglutide approved for weight management is Wegovy tablets^[2].

Why does semaglutide have to be taken fasting but orforglipron doesn’t?

Semaglutide is barely absorbed by mouth, and food or a lot of water lowers absorption further^[1]. Orforglipron, a small molecule, can be taken with or without food^[3].

Is orforglipron approved?

Yes in the US, as Foundayo for weight management (April 1, 2026)^[6], and in the UK for weight management and type 2 diabetes (August 10, 2026)^[12]. The EU is still reviewing it^[11].