A new oral option is changing the GLP-1 landscape for weight loss, along with raising questions about efficacy, dosing, and when switching products makes sense.
In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Vickie Danaher, PharmD discusses how semaglutide became the first FDA-approved oral GLP-1 agonist for obesity. She breaks down how it works, how it compares to injectable options, and dosing considerations for patients. Vickie also walks through key counseling points around administration, side effects, cost, and product mix-ups, and offers practical guidance on when switching between injectable and oral semaglutide may or may not be the right choice.
This is an excerpt from our February 2026 Pharmacy Essential Updates continuing education webinar series.
CE Information:
TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.
Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Explain How New ORAL Semaglutide Stacks Up for Weight Loss
- Interactive Chart: GLP-1 and GIP/GLP-1 Receptor Agonist Interactive Comparison Chart
- Resource: Comparison of Weight Loss Products
Don’t miss out! Subscribe today to stay ahead with trusted insights and tools.
🏷️ Use code cc1026b at checkout for 10% off a new or upgraded subscription.
🎓 Are you a student? Great news—students can access a free version of Pharmacist’s Letter.
Email us: [email protected].
The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.
Learn more about our product offerings at trchealthcare.com.
Click here to listen to all podcast episodes.
Listen Now:
Transcript:
This transcript is automatically generated.
00:00:04 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:11 Narrator
On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher reviews how the new oral version of semaglutide is changing how clinicians think about GLP‑1 medications for weight loss.
00:00:22 Narrator
She walks through how it compares to injections, what patients need to know about administration, and when switching dosage forms makes sense, in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:34 Narrator
This podcast offers Continuing Education credit for pharmacists and pharmacy technicians. Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:00:46 Narrator
None of the speakers have anything to disclose.
00:00:49 Narrator
Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday—bringing concise, actionable insights from TRC experts straight to your ears.
00:00:57 Narrator
With that, Let’s get started…
00:01:05 Vickie Danaher
We know that the injectable GLP-1 medications have become pretty popular over the last few years for obesity, type 2 diabetes, and other conditions, but the fact that we now have an oral GLP-1 agonist for weight loss is a big change.
00:01:20 Vickie Danaher
And like our article says, patients are asking about prescription semaglutide tablets,
00:01:25 Vickie Danaher
The first oral GLP-1 agonist, FDA approved for obesity and overweight.
00:01:33 Vickie Danaher
These new tablets, which go by the brand name Wegovy Pill, are essentially the oral version of injectable Wegovy.
00:01:41 Vickie Danaher
So the drug itself, semaglutide, isn’t new.
00:01:45 Vickie Danaher
But this means that we now have multiple different FDA approved semaglutide products that we may get prescriptions for or that our patients may be getting or asking about.
00:01:54 Vickie Danaher
and it can be kind of tricky to keep them all straight.
00:01:57 Vickie Danaher
So for obesity and overweight, we have the new oral semaglutide tablets, which we’re going to focus on today, which are taken daily, as well as the subcutaneous injections, which are given weekly.
00:02:09 Vickie Danaher
And both of these products for weight loss go by the brand name, Wegovy.
00:02:15 Vickie Danaher
And then for type 2 diabetes, we have the daily oral tablets called Rybelsus, as well as the weekly injection, Ozempic.
00:02:23 Vickie Danaher
And we’re used to dispensing these since both of them have been around for a few years now.
00:02:27 Vickie Danaher
But then it was also recently announced that Ozempic oral tablets have been FDA approved for type 2 diabetes.
00:02:34 Vickie Danaher
But these aren’t planned to launch until Q2 of this year.
00:02:39 Vickie Danaher
So having all these options now means there’s going to be a lot more questions about how all these products compare and which option may be best for a patient.
00:02:47 Vickie Danaher
So let’s talk through how this might come up in practice with a patient case.
00:02:52 Vickie Danaher
Our patient today is Jay.
00:02:54 Vickie Danaher
He’s 42 years old, and he’s been taking injectable semaglutide 2.4 milligrams weekly for obesity for the past few months now.
00:03:03 Vickie Danaher
Jay says he’s lost about 15 pounds since starting therapy, and overall he’s tolerated it pretty well.
00:03:10 Vickie Danaher
But he dislikes giving himself weekly injections and wants something easier.
00:03:15 Vickie Danaher
He also wants something easier to transport since he also frequently travels for work.
00:03:20 Vickie Danaher
Jay says he’s heard that there’s now a pill version of his medication, and he asked whether he should switch to that instead.
00:03:28 Vickie Danaher
So how would you respond back to Jay?
00:03:31 Vickie Danaher
What do you think he should know about the semaglutide tablets to help him decide about switching?
00:03:37 Vickie Danaher
We’ll come back to Jay throughout our discussion.
00:03:41 Vickie Danaher
But first, let’s do a quick review of how GLP-1 agonists help with weight loss.
00:03:47 Vickie Danaher
So GLP-1 agonists mimic our body’s natural GLP-1, which is an incretin hormone released from the gut after we eat.
00:03:55 Vickie Danaher
And under normal conditions, when food enters the intestines, GLP-1 is released and triggers several important responses.
00:04:03 Vickie Danaher
For example, GLP-1 increases insulin secretion from the pancreas.
00:04:08 Vickie Danaher
It also suppresses glucagon, the hormone that signals the liver to release stored glucose.
00:04:15 Vickie Danaher
But for weight management, two other effects matter most.
00:04:19 Vickie Danaher
GLP-1 slows gastric emptying, so food leaves the stomach more slowly.
00:04:25 Vickie Danaher
And it also reduces appetite by acting on receptors in the brain involved in hunger and satiety.
00:04:32 Vickie Danaher
So GLP-1 agonist medications activate these same receptors, helping people feel full sooner, staying fuller longer, and ultimately eating less.
00:04:43 Vickie Danaher
They also still help lower post-meal glucose, but their appetite-regulating effects are a big reason why they lead to clinically meaningful weight loss.
00:04:51 Vickie Danaher
But the GLP-1 agonists for obesity have all been injectable up until now.
00:04:58 Vickie Danaher
And that kind of makes sense if you think about the fact that GLP-1 is a peptide, so it’s a short chain of amino acids.
00:05:05 Vickie Danaher
So it would normally be inactivated and broken down in the stomach, just like proteins are broken down in the stomach.
00:05:13 Vickie Danaher
But the new oral semaglutide for weight loss is formulated with an ingredient called salcaprozate sodium, or SNAC, to prevent breakdown in the stomach.
00:05:25 Vickie Danaher
SNAC is a fatty acid derivative that acts as a carrier, and it’s designed to help semaglutide survive stomach acid and pass into the bloodstream.
00:05:34 Vickie Danaher
It also acts as an absorption enhancer, protecting the medication from degradation and boosting absorption.
00:05:41 Vickie Danaher
And SNAC is the same mechanism used in Rybelsus, the oral semaglutide tablets for type 2 diabetes.
00:05:49 Vickie Danaher
So how well does oral semaglutide for obesity work?
00:05:52 Vickie Danaher
Be aware that using oral semaglutide, 25 milligrams daily for 64 weeks, leads to about 11% more weight loss than with placebo.
00:06:03 Vickie Danaher
So this comes out to be about losing 26 pounds for a patient who weighs 234 pounds.
00:06:11 Vickie Danaher
I explain that this seems similar to the weight loss seen with injectable semaglutide 2.4 milligram weekly for obesity or overweight.
00:06:18 Vickie Danaher
And it’s more than most other oral weight loss medications.
00:06:23 Vickie Danaher
But there aren’t any head-to-head trials yet.
00:06:27 Vickie Danaher
So to help put this in perspective, let’s talk for a minute about the efficacy of certain treatments for obesity and overweight.
00:06:33 Vickie Danaher
So oral phentermine alone leads to about 8 pounds more weight loss than placebo.
00:06:39 Vickie Danaher
Naltrexone, bupropion ER, about 9 pounds, and phentermine, topiramate ER, about 19 pounds.
00:06:49 Vickie Danaher
And then either semaglutide products for obesity, so either the oral tablets or the injectable lead to about 26 or 27 pounds more weight loss than placebo.
00:07:00 Vickie Danaher
But injectable tirzepatide or Zepbound achieves more, about 41 pounds more weight loss than placebo over a year in patients without diabetes.
00:07:11 Vickie Danaher
When thinking about meds for weight loss for our patients, we also want to tailor the selection based on things like cost and access, the patient’s other comorbidities, and other medication benefits.
00:07:21 Vickie Danaher
So for instance, the new oral semaglutide for obesity is also approved to reduce the risk of cardiovascular events, such as strokes or heart attacks, in patients with cardiovascular disease and obesity.
00:07:33 Vickie Danaher
And this is similar to the semaglutide injection.
00:07:38 Vickie Danaher
but oral semaglutide isn’t yet indicated for metabolic dysfunction-associated steatohepatitis, or MASH, which is a severe form of fatty liver disease.
00:07:49 Vickie Danaher
And the injection does have this indication.
00:07:54 Vickie Danaher
Also point out that the Wegovy oral semaglutide tablets have pretty tricky administration, like the Rybelsus tablets.
00:08:03 Vickie Danaher
For example, emphasize that oral semaglutide must be taken daily upon awakening on an empty stomach.
00:08:09 Vickie Danaher
It must be swallowed whole with a sip or no more than 4 ounces of water.
00:08:15 Vickie Danaher
And then patients must wait at least 30 minutes before having the first food, other beverage, or oral meds of the day.
00:08:23 Vickie Danaher
Not following these steps can reduce the absorption and efficacy of oral semaglutide.
00:08:27 Vickie Danaher
So these are really important points that should be shared with patients picking up oral semaglutide at our pharmacies or patients like Jay who are thinking about switching from injectable to oral semaglutide.
00:08:41 Vickie Danaher
When patients do get oral semaglutide for obesity, keep in mind that it has similar GI side effects as injectable semaglutide, so things like nausea and upset stomach, and help ensure proper dose titration to help limit these effects.
00:08:56 Vickie Danaher
Most patients getting oral semaglutide for weight loss will start with one 1.5 milligram semaglutide tab daily for 30 days, and then increase every month to 4 milligrams for 30 days, 9 milligrams for 30 days, until the 25 milligram per day maximum is reached.
00:09:16 Vickie Danaher
And of course, the million dollar question with GLP-1 agonist is cost.
00:09:20 Vickie Danaher
And like we often see prior auths with injectable GLP-1 agonists for obesity, we should expect prior auths for the new oral semaglutide too.
00:09:29 Vickie Danaher
Oral semaglutide for obesity costs about $1,350 per month, which is the same as the injectable.
00:09:37 Vickie Danaher
But patients may be able to get these prescriptions for less with manufacturer savings programs or direct-to-consumer programs.
00:09:46 Vickie Danaher
Now with all this in mind, let’s go back to our patient case with Jay.
00:09:50 Vickie Danaher
Again, he’s currently on injectable semaglutide for weight loss, but he says he wants something easier to use and he asks about switching to the tablets.
00:09:59 Vickie Danaher
You can let him know that the oral formulation offers similar weight loss benefits and has similar side effects, but it comes with pretty strict administration rules.
00:10:09 Vickie Danaher
Jay would need to take it every day, first thing in the morning on an empty stomach with no more than 4 ounces of water.
00:10:16 Vickie Danaher
and then he’ll need to wait at least 30 minutes before eating, drinking, or taking any other medications.
00:10:23 Vickie Danaher
So if Jay is motivated to follow these dosing instructions and the daily timing of the medication fits better into his travel routine, switching may help improve adherence.
00:10:33 Vickie Danaher
But if mornings are unpredictable for him, staying on the weekly injection might actually be a little easier.
00:10:40 Vickie Danaher
So the bottom line in this case is the switch may be reasonable, but only if Jay can reliably follow the strict daily dosing requirements with the oral medication.
00:10:51 Vickie Danaher
Now let’s say that Jay does want to go ahead and change dosage forms.
00:10:55 Vickie Danaher
How should we advise on handling switches between the semaglutide injections and tabs?
00:11:01 Vickie Danaher
Explain that patients on injectable semaglutide 2.4 milligram weekly who prefer an oral med like Jay may switch to oral semaglutide 25 milligram tablet daily one week after stopping their last injection.
00:11:19 Vickie Danaher
On the other hand, if patients are taking oral semaglutide 25 milligram daily and either they can’t tolerate the tabs or they need additional weight loss,
00:11:29 Vickie Danaher
they may switch to semaglutide 1.7 milligram injection weekly the day after stopping the tabs.
00:11:38 Vickie Danaher
In addition to switches, we want to watch for patients combining oral and injectable GLP-1 agonists.
00:11:44 Vickie Danaher
Sometimes patients assume that if one GLP is good, then two must be better.
00:11:49 Vickie Danaher
But there’s no evidence that combos work better to improve weight loss or glycemic control, and it likely increases the risk of side effects, especially nausea, vomiting, and GI intolerance.
00:12:02 Vickie Danaher
So if you spot a patient on both, clarify the plan with the prescriber and make sure that only one GLP-1 therapy is being used at a time.
00:12:12 Vickie Danaher
Let’s close out this topic now with a few other key pearls that we can bring back to our pharmacies.
00:12:17 Vickie Danaher
And a big one that we’ll need to continue doing is paying close attention to semaglutide products and strengths.
00:12:23 Vickie Danaher
So for example, be aware that oral Wegovy for obesity comes as 1.5 milligrams, 4 milligrams, 9 milligrams, and 25 milligram tablets.
00:12:33 Vickie Danaher
But oral Rybelsus is available in 3, 7, and 14 milligram tablets.
00:12:40 Vickie Danaher
And then the recently approved oral Ozempic is also planned to be available in similar strengths as oral Wegovy.
00:12:49 Vickie Danaher
Don’t automatically substitute oral Wegovy with injectable Wegovy, oral Wegovy with oral Rybelsus, and so forth.
00:12:57 Vickie Danaher
These products aren’t considered equivalent.
00:13:01 Vickie Danaher
Store oral semaglutide tablets in their original container at room temperature in the pharmacy and tell patients to store them the same way at home, since the tablets are sensitive to moisture.
00:13:12 Vickie Danaher
Now this could also be a consideration for patients like Jay, in our case, who travel.
00:13:16 Vickie Danaher
He shouldn’t be putting those tablets in a pill container or a pill box and will need to take the original bottle with him.
00:13:24 Vickie Danaher
Also know how to handle missed doses.
00:13:27 Vickie Danaher
Because of oral semaglutide’s strict administration requirements, patients who miss a dose should skip the missed dose and just take the next dose the following day.
00:13:39 Vickie Danaher
We’ve also got lots of other valuable resources on our website to support you in your practice.
00:13:43 Vickie Danaher
You can use our GLP-1 and GIP-GLP-1 receptor agonists interactive comparison chart to sort through products, indications, clinical outcomes, and more.
00:13:56 Vickie Danaher
and then see our resource comparison of weight loss products to review other meds for obesity and overweight, along with their pros and cons.
00:14:06 Narrator
Thanks for listening—we hope today’s episode gave you practical insights you can use right away.
00:14:11 Narrator
Now that you’ve listened, pharmacists and pharmacy technicians can receive CE credit. Just log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:14:23 Narrator
We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to our websites, where you’ll find even more concise, evidence-based charts, articles, and tools.
00:14:35 Narrator
If you’re not yet a subscriber, now’s the time—sign up today to stay ahead with trusted, unbiased insights, and continuing education. Listeners save 10% on a new or upgraded subscription just use code cc1026 at checkout.
00:14:52 Narrator
If you found this episode helpful, follow Clinical Capsules and leave a quick rating or review—it helps others discover the show. Better yet, share what you learned with a friend or colleague and let them know they can find the show on any podcast app.
00:15:05 Narrator
Thanks for listening… stay sharp, stay current—and join us next time on Clinical Capsules!
Clinical Capsules
