Semaglutide: Pills Instead of Injections

The 17/2026 issue of Deutsches Ärzteblatt (the official publication of the German Medical Association and the National Association of Statutory Health Insurance Physicians) reports that the oral form of semaglutide (sold under the brand name Wegovy) will go on sale as early as September 1. The article notes that in registration trials, the oral formulation demonstrated efficacy comparable to that of the injectable form. According to experts, the main advantage of the new option is the ability to choose the preferred route of administration.

For those who are afraid of injections

The news has been enthusiastically welcomed by people for whom injections are associated with unpleasant emotions and inconvenience. On social media, they express their eagerness to try this formulation of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) as soon as possible, as well as their hope that it will help achieve sustained weight loss. Indeed, in the OASIS 4 registration trial, oral semaglutide produced weight loss comparable to that achieved with injectable therapy.

In particular, an international research group reported in The New England Journal of Medicine (NEJM) that among 205 participants receiving the drug in its new formulation, mean body weight decreased by 13.6% after 64 weeks, compared with 2.2% in the placebo group. The randomized, double-blind phase 3 trial included 307 adults without diabetes at 22 specialized centers in Canada, Germany, Poland, and the United States. All participants had a body mass index (BMI) of ≥30 or ≥27 in the presence of obesity-related comorbidities; in addition, all participants received lifestyle intervention counseling. The semaglutide dose was gradually increased from 3 mg to 25 mg over 12 weeks, after which treatment was continued through week 64.

Different formulation, same indications

In July, the European Commission approved oral semaglutide for obesity treatment. Its indications do not differ from those of injectable therapy: both formulations are approved for weight management in adults with a baseline BMI of ≥30 kg/m² or ≥27 kg/m² in the presence of at least one weight-related comorbidity. The new formulation is expected to be particularly convenient for people who dislike injections or even have a fear of needles.

Regarding adverse effects, Deutsches Ärzteblatt quotes Dr. Nina M. T. Meyer, the nutrition and endocrinology unit head at the interdisciplinary obesity center at Charité – Universitätsmedizin Berlin. According to Meyer, based on data from registration trials, the adverse effects are comparable to those seen with subcutaneous therapy. They primarily include mild to moderate gastrointestinal symptoms such as nausea, vomiting, constipation, and diarrhea. Like the injectable formulation, the tablet is approved for use as an adjunct to lifestyle modification and may produce optimal results as part of a comprehensive multimodal program.

The tablet must be taken once daily on an empty stomach, at least 30 minutes before eating, drinking, or taking other medications. The question is whether this will ultimately prove more convenient than injections, which are not subject to such restrictions.

There is another factor to consider: the higher dosage of the oral formulation. This is because peptides are rapidly broken down in the stomach and small intestine. As a result, when the same active substance is administered in tablet form, the required dose is approximately 70 times higher than with injection. Oral administration is made possible by the absorption enhancer sodium salcaprozate (SNAC).

For comparison, the maximum dose of oral semaglutide is 25 mg, whereas the dose of injectable therapy can be increased to 2.4 mg. In spring 2026, however, the European Commission approved a higher weekly maintenance dose of 7.2 mg for adults who require additional weight loss after four weeks of treatment with 2.4 mg.

Another administration option and a choice rather than a revolutionary change

Given the comparable efficacy and similar adverse effects, and most likely a roughly comparable price, the introduction of the new formulation does not represent a fundamental change in obesity treatment. Rather, it is an additional option in the therapeutic arsenal.

At the same time, Deutsches Ärzteblatt notes that new treatments are already “on the horizon.” Some are approaching EU approval, such as the small-molecule drug orforglipron. It is also available as a tablet, but unlike oral semaglutide, it can be taken regardless of food or water intake. Retatrutide, a triple agonist administered subcutaneously, is currently undergoing late-stage clinical trials.

Comparison of Weight-Loss Medications

Self-administration without medical supervision is not acceptable

Overall, there is still relatively little data on the long-term efficacy and long-term adverse effects of incretin-based medications - drugs that mimic or enhance the action of natural intestinal hormones (incretins) involved in regulating appetite, blood glucose levels, and metabolism. Therefore, regardless of the active substance or formulation, specialists recommend that such treatment be carried out under medical supervision.

Deutsches Ärzteblatt warns that an approach in which a patient simply finds a doctor to issue a prescription and then proceeds entirely independently, relying solely on the accompanying instructions, cannot be considered either high-quality or medically appropriate.

There are already numerous examples of the improper use of obesity medications resulting in serious harm to health. Such medications should therefore be prescribed by qualified physicians, who should also monitor and support patients throughout all stages of treatment.

References

1.         Wharton S, Lingvay I, Bogdanski P, Duque do Vale R, Jacob S, Karlsson T, Shaji C, Rubino D, Garvey WT, OASIS 4 Study Group: Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity. The New England journal of medicine 2025; 393 (11): 1077–87; DOI: 10.1056/NEJMoa2500969 CrossRef MEDLINE PubMed Central

2.         Lanzke, Alice: Orales Semaglutid: Schlucken statt Spritzen. Deutsches Ärzteblatt Ausgabe 17/2026 19.08.2026