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Oral vs Injectable Semaglutides: man jogging outside

Oral vs. Injectable Semaglutide: What’s Better Suited For You?

Chances are, you’ve heard quite a bit about semaglutide, the drug branded as Ozempic®, Wegovy®, and Rybelsus®. These medications, which are commonly prescribed for managing type 2 diabetes and obesity, have been the talk of the town recently due in part to celebrity testimonials; however, semaglutide has been soaring in popularity over the past seven years

Semaglutide mimics the action of a naturally occurring hormone we produce in the gut called glucagon-like peptide-1 (GLP-1), explains Dr. Suzanne Ben-Kane, M.D., M.B.A., M.P.H., an internal medicine specialist in Sarasota, Florida. “The function of GLP-1 is to send signals from the stomach to the brain so we stop eating when the stomach is full, as well as to regulate our blood sugar levels,” she says. “When the body can no longer sense the GLP-1 hormone, such as the case with someone who is obese, a lack of appetite regulation causes you to overeat.”

Semaglutide was first introduced in 2017 as an injectable medication (Ozempic®) to help lower blood sugar in people with type 2 diabetes. However, doctors soon realized that patients on the drug lost an average of 15 percent of their weight in a year, sparking intense interest in its benefits for weight management. Two years later, in 2019, oral semaglutide (Rybelsus®) was introduced. In 2021, the FDA gave an injectable semaglutide (Wegovy®) approval for the treatment of obesity. 

Both oral and injectable semaglutide are commonly prescribed today. If you’re considering medical weight loss with a semaglutide, it’s important to understand the available options. Here, experts break down how each works, as well as their pros and cons. 

  • ABOUT OUR EXPERTs: Dr. Suzanne Ben-Kane, M.D., M.B.A., M.P.H., is an internal medicine specialist in Sarasota, Florida. Dr. Meghan Garcia-Webb, M.D., is a physician triple-board-certified in internal medicine, lifestyle medicine, and obesity medicine. Mohit Joshipura, M.D., a board-certified internal medicine physician who specializes in weight management, is a member of the Whole Health Rx Medical Advisory Council.

Oral Semaglutide

Oral semaglutide, which is sold under the brand name Rybelsus®, is currently only FDA-approved for diabetes treatment, though it is sometimes prescribed off-label for weight loss. (There is no oral form of semaglutide currently approved for weight management.) 

How does it work in the body?

Both oral and injectable semaglutide mimic the GLP-1 hormone in the small intestine that slows the movement of food through the stomach, explains Dr. Meghan Garcia-Webb, M.D., a physician triple-board-certified in internal medicine, lifestyle medicine, and obesity medicine. A feeling of fullness is created by slowing down the emptying of food from your stomach.

Additionally, “when GLP-1 is released by the intestines, it plays a crucial role in regulating blood sugar levels by stimulating secretion from the pancreas,” she says. “Semaglutide activates these receptors, which increases insulin release in response to elevated blood glucose levels, thereby lowering blood sugar levels and reducing the risk of high blood glucose for those with diabetes.”

How is it administered?

Oral semaglutide is a pill that is taken once daily, ideally with water and 30 minutes prior to the first food or other beverage of the day. 

What are the side effects?

The most common side effects of oral semaglutide are gastrointestinal symptoms such as nausea, vomiting, blurred vision, and constipation, explains Ben-Kane. “A less common side effect is acute pancreatitis, which is an inflammation of the pancreas,” she says. “It causes very severe stomach pain.” Other more serious, but less common, side effects include acute kidney failure, gallbladder disease, diabetic retinopathy, and hypoglycemia. 

Read More: How To Fill Nutritional Gaps If You’re On A GLP-1 Weight Loss Drug

Benefits of oral semaglutide 

Recent research suggests that oral semaglutide is effective for reducing A1C and promoting weight loss in people with type 2 diabetes. Oral semaglutide is also a good option for those who do not want to inject themselves and do not mind a daily medication, according to board-certified internal medicine physician and member of the Whole Health Rx Medical Advisory Council Mohit Joshipura, M.D., who specializes in weight management. 

Drawbacks of oral semaglutide 

Unfortunately, it’s more common to experience gastrointestinal upset—think nausea, vomiting, diarrhea, and constipation—when taking oral semaglutide, research suggests. For most people, these side effects tend to dissipate after the first few weeks of taking the drug; however, they can linger longer for some patients. 

Injectable Semaglutide

Injectable semaglutide is currently available in two FDA-approved options: Ozempic, which is approved for type 2 diabetes, and Wegovy, which is approved for weight management. 

How does it work in the body?

Injectable semaglutide, just like oral semaglutide, mimics the action of the GLP-1 hormone. It works by reducing cravings for food and alcohol and by slowing down the emptying of food from your stomach, which contributes to satiety. It also increases the release of insulin into your body, which helps lower blood sugar.

How is it administered?

Injectable semaglutide is administered via an injection into subcutaneous fat tissue (think hips, buttocks, thighs, or belly) once per week.

What are the side effects?

Because injectable semaglutide is administered with a needle, you may experience bruising at the site of the injectionOtherwise, as with oral semaglutide, the most common side effects of the injectable version are gastrointestinal symptoms such as nausea, vomiting, constipation, burping, and heartburn, according to Ben-Kane. Pancreatitis is another potential adverse effect.

Other serious but uncommon potential side effects include certain cancers, namely cancer of the thyroid gland. 

Benefits of injectable semaglutide 

Perhaps the biggest day-to-day benefit of opting for the injectable form of semaglutide is that you only have to inject yourself once a week as opposed to remembering to take an oral medication once daily, suggests Garcia-Webb. 

Read More: How To Make Supplementing With Fiber More Enjoyable

You may also experience fewer gastrointestinal side effects when taking the injectable semaglutide, a trend Garcia-Webb has noticed in her own practice. This may be due to the fact that the medication doesn’t have to travel through your digestive tract.  

Drawbacks of injectable semaglutide 

The biggest drawback of injectable semaglutide is that you have to inject yourself with a needle once a week, which may be difficult for those who are afraid of needles or sensitive to pain. 

Which is right for you?

If you’re interested in either oral or injectable semaglutide medication, a good place to start is learning whether or not you’re a reasonable candidate for prescription. You can take a short questionnaire about your medical history, stats, and goals at Whole Health Rx to find out, and ultimately be paired with an experienced practitioner if you qualify. 

“It’s very important to find a physician who is familiar with these medications and will be able to monitor you, either virtually or in-person, as semaglutide is titrated up over time and there are often side effects that need to be addressed,” says Garcia-Webb. 

Otherwise, factors such as cost and medication availability might influence which option you go with, says Joshipura.

Should all those factors align, your personal preferences may also drive the decision. If you don’t mind taking a daily pill or can’t stomach the thought of a weekly needle, the oral route may be best, suggests Ben-Kane. Otherwise, you might consider the simplicity of a once-weekly injection and the potential for fewer side effects.

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