Wegovy Tablet Formulation

Wegovy (semaglutide 2.4 mg) is not available as an oral tablet—it exists only as a once-weekly subcutaneous injection. 1, 2, 3

Formulation Facts

Injectable semaglutide 2.4 mg (Wegovy) is FDA-approved for chronic weight management in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity. 1, 2
Oral semaglutide (Rybelsus) is FDA-approved only for type 2 diabetes treatment at doses up to 14 mg daily—it is not approved for obesity management. 1
The injectable formulation delivers semaglutide via pre-filled, single-patient-use pens that provide 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg doses. 3

Oral semaglutide is significantly less potent for weight loss than injectable formulations. 1
Injectable semaglutide 2.4 mg achieves 14.9% mean weight loss at 68 weeks (vs. 2.4% with placebo), with 86.4% of patients achieving ≥5% weight loss and 50.5% achieving ≥15% weight loss. 1, 4, 5
Oral semaglutide produces modest weight loss but falls far short of the injectable formulation's efficacy, making it unsuitable for obesity management. 1

First-line injectable options:

Tirzepatide 15 mg weekly (Zepbound/Mounjaro) achieves superior weight loss of 20.9% at 72 weeks, representing the most effective pharmacologic option currently available. 1
Semaglutide 2.4 mg weekly (Wegovy) remains the preferred choice for patients with established cardiovascular disease, offering a 20% reduction in cardiovascular death, nonfatal MI, or stroke (HR 0.80). 1, 2
Liraglutide 3.0 mg daily (Saxenda) achieves 5.2–6.1% weight loss and may be considered when weekly injections are not tolerated. 1

Oral alternatives (less effective):

Phentermine-topiramate ER produces approximately 9% weight loss but should be avoided in patients with cardiovascular disease, uncontrolled hypertension, or glaucoma. 1
Naltrexone-bupropion achieves only 3.01% weight reduction and carries concerning neuropsychiatric risks, making it a distant third-line option. 1

Oral semaglutide (Rybelsus) 14 mg daily provides meaningful HbA1c reductions of approximately 1.4% from baseline and modest weight loss, but is less potent than injectable formulations. 1
Injectable semaglutide 1.0 mg weekly (Ozempic) achieves 7.0% weight loss in diabetic patients, though the 2.4 mg dose (Wegovy) is superior when weight loss is the primary goal. 2
Tirzepatide offers dual benefits of superior glycemic control (HbA1c reductions of 1.87–2.59%) and greater weight loss (20.9% at 72 weeks). 1

Wegovy titration schedule:

Start at 0.25 mg weekly for 4 weeks, then escalate every 4 weeks: 0.5 mg → 1.0 mg → 1.7 mg → 2.4 mg maintenance dose (reached at week 17). 1, 2
Slow titration minimizes gastrointestinal adverse events (nausea 30–40%, vomiting 16%, diarrhea), which are typically transient and mild-to-moderate. 2, 4, 5

Oral semaglutide (Rybelsus) titration:

Start at 3 mg daily for 30 days, increase to 7 mg daily, with optional escalation to 14 mg daily if additional glycemic control is needed. 1
Must be taken 30 minutes before the first food, beverage, or other oral medications of the day with ≤4 oz of plain water to optimize absorption. 1

Absolute contraindications (all semaglutide formulations):

Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN 2). 1, 2

Common adverse events:

Gastrointestinal effects (nausea, vomiting, diarrhea) occur in 30–40% of patients but typically resolve within 4–8 weeks. 2, 4, 5
Pancreatitis and gallbladder disease (cholelithiasis, cholecystitis) are rare but serious risks; discontinue immediately if persistent severe abdominal pain develops. 1, 2

Weight regain after discontinuation:

Patients regain 11.6% of lost weight within 52 weeks after stopping Wegovy, underscoring the need for lifelong treatment. 1, 2

Wegovy (semaglutide 2.4 mg): approximately $1,619 per 30-day supply (average wholesale price). 1
Tirzepatide: approximately $1,272 per 30-day supply, slightly less expensive than Wegovy. 1
Oral semaglutide (Rybelsus): similar cost to injectable formulations ($1,557–$1,619 per 30-day supply) despite lower efficacy. 1
Insurance authorization may be challenging, particularly for obesity management without diabetes. 1

Is the patient seeking weight loss without diabetes?
- Yes, with established CVD → Semaglutide 2.4 mg weekly (Wegovy) for proven cardiovascular benefit. 1, 2
- Yes, maximum weight loss priority → Tirzepatide 15 mg weekly for superior efficacy (20.9% weight loss). 1
- Yes, cannot tolerate injections → Consider phentermine-topiramate ER (9% weight loss) if no cardiovascular contraindications. 1
Is the patient seeking glycemic control with weight loss?
- Strongly prefers to avoid injections → Oral semaglutide (Rybelsus) 14 mg daily for modest weight loss and HbA1c reduction. 1
- Willing to use injections → Injectable semaglutide 2.4 mg weekly or tirzepatide 15 mg weekly for superior outcomes. 1, 2
Does the patient have chronic kidney disease (eGFR <30 mL/min/1.73 m²)?
- No dose adjustment required for semaglutide or tirzepatide across all CKD stages. 1

Do not assume oral semaglutide (Rybelsus) is equivalent to Wegovy—it is FDA-approved only for diabetes and produces significantly less weight loss. 1
Do not prescribe Wegovy for diabetes management—use Ozempic (semaglutide 1.0 mg) or higher doses if weight loss is also a goal. 2
Do not discontinue metformin when starting semaglutide unless a specific contraindication exists. 1
Do not delay GLP-1 RA initiation until multiple oral agents have failed; early use in appropriate candidates yields better outcomes. 1