Semaglutide oral (obesity)
WEGOVY (oral)
What it isOral GLP-1 receptor agonist formulation for chronic weight management in obesity.
Why this oneIt was the first oral GLP-1 approved for weight management, preserving a familiar molecule without injections.
What limits itAbsorption is fragile: take alone on an empty stomach exactly as directed. GI intolerance and delayed gastric emptying still matter.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Reduce risk of major adverse CV events (established CV disease with obesity or overweight) | Adults | 1.5 mg QD × 30 days | 25 mg QD | 25 mg QD |
| Chronic weight management (obesity, or overweight with ≥1 weight-related comorbidity), with reduced-calorie diet and increased activity | Adults | 1.5 mg QD × 30 days | 25 mg QD | 25 mg QD |
Titration Escalate every 30 days: 1.5 mg (days 1–30) → 4 mg (31–60) → 9 mg (61–90) → 25 mg (91+); delay escalation if not tolerated.
Renal No dosage adjustment needed (eGFR ≥30 to <90 mL/min studied); monitor renal function with volume-depleting GI reactions.
Hepatic No dosage adjustment needed (mild–severe hepatic impairment, Child-Pugh A–C, studied).
If the 25 mg maintenance tablet is not tolerated, consider switching to Wegovy injection 1.7 mg once weekly.
Instructions
- Take once daily on an empty stomach in the morning with up to 4 oz (120 mL) plain water only — no other liquids
- Swallow tablet whole; do not split, crush, chew, or dissolve
- Wait at least 30 minutes before eating, drinking, or taking other oral medications
- Do not take more than one tablet per day; if a dose is missed, skip it and take the next dose the following day
- Use with a reduced-calorie diet and increased physical activity
- If 25 mg once daily is not tolerated, consider switching to Wegovy 1.7 mg injection once weekly
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- Prior serious hypersensitivity reaction to semaglutide (anaphylaxis and angioedema reported)
Cautions
- Acute pancreatitis — discontinue if suspected
- Acute gallbladder disease (cholelithiasis, cholecystitis)
- Hypoglycemia when used with insulin or an insulin secretagogue — consider reducing their dose
- Acute kidney injury due to volume depletion — monitor renal function
- Severe gastrointestinal reactions — not recommended in severe gastroparesis
- Hypersensitivity reactions (anaphylaxis, angioedema) — discontinue if suspected
- Diabetic retinopathy complications in patients with type 2 diabetes
- Heart rate increase — monitor
- Pulmonary aspiration during general anesthesia or deep sedation (delayed gastric emptying)
Adverse reactions
- Nausea, diarrhea, vomiting, constipation, abdominal pain, abdominal distension, eructation, flatulence, dyspepsia, GERD, gastroenteritis
- Headache, fatigue, dizziness, dysesthesia
- Hypoglycemia in patients with type 2 diabetes
- Hair loss
Pregnancy May cause fetal harm; discontinue when pregnancy is recognized (for CV risk reduction or weight reduction). Discontinue at least 2 months before a planned pregnancy (long half-life).
Lactation Breastfeeding not recommended during treatment with Wegovy tablets (potential SNAC accumulation in the infant).
NO BOXED WARNINGS
Classes and tags
Clinical profile
Mechanism of action: Semaglutide oral (obesity) ballicule
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