You’ve heard amazing testimonials online and on social media regarding weight loss on Ozempic, Wegovy and Mounjaro. These medications contain the active ingredient semaglutide in the case of Ozempic and Wegovy, or tirzepatide in the case of Mounjaro. These are weekly injections. As soon as some patients hear these are injections (albeit with small needles), their first question is, “is there an oral form?” And the answer is yes, for semaglutide… but it’s not all good news!
Oral vs injectable semaglutide
Rybelsus, made by NovoNordisk, the same maker of Ozempic and Wegovy, is currently the oral version of semaglutide already on the market. It’s a daily tablet that comes in a 7mg and 14mg dose and is indicated for type 2 diabetes. It can certainly be used off-label for weight loss except for one problem – it doesn’t work! Studies show that only 1% of the semaglutide is absorbed into the bloodstream after ingesting orally. That may be enough to treat type 2 diabetes but not enough to provide a 15% weight loss as seen with injectable semaglutide.
NovoNordisk is currently in phase 3 trials to get oral semaglutide at a 50mg dosage approved for weight loss. The results are very promising. This oral daily regimen offers the same ~15% weight loss seen in the Wegovy data submitted to the FDA.
Similarly, Eli Lilly, the makers of Mounjaro and Zepbound are conducting trials for a daily oral GLP-1 receptor agonist called orforglipron. This non-peptide medication is not as fragile or susceptible to degradation by stomach acid. Unfortunately it’s not yet available. So for now, an effective daily oral tablet approved for weight loss is only a future possibility.
Troche or sublingual liquid semaglutide
While we’re waiting for a tablet that can withstand the degradation associated with stomach acid, the other option is a semaglutide troche (think lozenge) or liquid that can be absorbed through the oral mucosa in the mouth. Compounding pharmacies are currently producing these formulations. However, these appear to be best for helping patients maintain their goal weight after weight loss rather than getting them to their goal weight.
So if your provider is offering you oral versions of semaglutide like pills or troches or sublingual liquids, be warned. They may only offer that because they haven’t found a compounding pharmacy that offers the well studied and validated injectable versions of semaglutide or tirzepatide that work well. And you may also be very disappointed when these oral versions don’t meet your expectations that have been built up based on all of the success stories you see online and from friends and family.
For providers, this is a huge mistake to offer patients oral formulations as the primary means of weight loss. Because it won’t allow them to reach their goal weight and you’ll have a very unhappy patient on your hands. So at this current time, data and experience suggest oral formulations should only be used for patients that 1) want to maintain their goal weight or 2) those that are too afraid to self-inject and understand the limitations of the oral versions. In other words, get the patients the results they’re looking for with the best option currently available – injectable semaglutide and tirzepatide.
