Semaglutide tablets: Rybelsus, Ozempic tablets and the Wegovy pill

Semaglutide is a peptide, and peptides are digested. Getting it through the stomach took a formulation with an absorption enhancer, first approved as Rybelsus on September 20, 2019 (Drugs@FDA NDA 213051). Two more oral products have followed. All three share the same swallowing rules and none of them shares its dose numbers with the others.

Three products

Rybelsus (3, 7, 14 mg). For adults with type 2 diabetes: glycemic control, and since October 17, 2025 (Drugs@FDA supplement 24) reduction of major adverse cardiovascular events in adults with type 2 diabetes at high risk. Start at 3 mg once daily for 30 days, a dose the label says is for initiation and not effective for glycemic control. Then 7 mg. Then 14 mg if additional glycemic control is needed after at least 30 days at 7 mg.

Ozempic tablets (1.5, 4, 9 mg). The same label describes a second formulation, with 1.5, 4 and 9 mg strengths, that Novo Nordisk now markets as Ozempic tablets. Same indications as Rybelsus. Start at 1.5 mg for 30 days (initiation, not effective for glycemic control), then 4 mg, then 9 mg if additional control is needed after at least 30 days at 4 mg. Novo Nordisk announced FDA approval of the Ozempic tablet branding on February 4, 2026 and US availability from May 4, 2026.

Wegovy tablets (1.5, 4, 9, 25 mg). For adults: weight reduction with obesity or overweight plus a weight-related condition, and cardiovascular risk reduction with established cardiovascular disease. Approved December 22, 2025 per Novo Nordisk. Days 1 to 30 at 1.5 mg, 31 to 60 at 4 mg, 61 to 90 at 9 mg, then 25 mg once daily. If a step is not tolerated, the label says to consider delaying escalation; if 25 mg is not tolerated, it says to consider switching to the 1.7 mg weekly injection.

The rules that apply to all three

One tablet, once a day, in the morning, on an empty stomach, with up to 4 ounces of plain water. The Wegovy label adds: no other liquids. Swallow whole; do not split, crush or chew. Then wait at least 30 minutes before food, any drink, or other oral medicines. A missed tablet is skipped; the next one is taken the following morning; never two in a day.

The window is the price of oral absorption. Food, larger volumes of water and other tablets all reduce what gets through. It is also why the tablet and the injection are not interchangeable milligram for milligram: 25 mg swallowed daily and 2.4 mg injected weekly are calibrated to give comparable exposure through very different routes.

Which numbers go with which product

The label for the diabetes tablets says plainly that the two formulations have different recommended dosages. A patient moved from Rybelsus 7 mg to the newer formulation is not moved to "7 mg"; the prescriber chooses from 1.5, 4 and 9 mg. The titration planner keeps the three products separate for the same reason.

The evidence for the weight-management tablet

OASIS 4 randomised 307 adults with overweight or obesity to 25 mg oral semaglutide or placebo for 64 weeks. Mean weight change was 13.6% versus 2.2%, a difference of 11.4 percentage points (95% CI 9.0 to 13.9). Gastrointestinal adverse events were reported by 74.0% versus 42.2% (PubMed 40934115). Novo Nordisk's announcement quotes 16.6% mean loss "when treatment was adhered to" and one in three participants losing 20% or more; those are on-treatment figures from the same trial. The injection vs tablet comparison sets OASIS 4 against STEP 1.

Adverse reactions

The diabetes tablet label reports, at 7 mg and 14 mg versus placebo: nausea 11% and 20% versus 6%; abdominal pain 10% and 11% versus 4%; diarrhea 9% and 10% versus 4%; decreased appetite 6% and 9% versus 1%; vomiting 6% and 8% versus 3%; constipation 6% and 5% versus 2%. The pattern is the injection's pattern at lower rates, rising with dose.

Cost

NovoCare self-pay prices as of the April 2026 sheet: Wegovy tablets $149 (1.5 mg), $199 (4 mg), $299 (9 and 25 mg) per 30-tablet bottle; Ozempic tablets $149 (1.5 mg, listed for new patients), $199 (4 mg), $299 (9 mg). The cost view dates and compares them. There is no compounded semaglutide tablet with a label; compounded oral products, where they exist, are not FDA approved and were not studied in OASIS 4.