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The medicines

GLP-1 pills and injections

For years a GLP-1 meant a needle. There are now two daily tablets for weight management — one is the same molecule as the most-used injection, the other a new kind of molecule altogether. They differ from the injections, and from each other, in ways that matter day to day.

By the Cafeity teamUpdated 2 min read

The short answer

Two GLP-1 tablets are approved for weight management in the US: oral semaglutide 25 mg, which must be taken on an empty stomach with a little water and a 30-minute wait, and orforglipron, which can be taken with or without food.12 In their trials, average weight change was −13.6% at 64 weeks for semaglutide tablets and up to −11.1% at 72 weeks for orforglipron, against −14.9% at 68 weeks for weekly semaglutide injections in STEP 1.123 Side effects are similar in kind. Tablets need no fridge or needles but must be taken every day.

Side by side

From the US prescribing information and the STEP 1 trial. Weight results come from different trials and are not directly comparable.
Semaglutide tabletOrforglipron tabletWeekly injections
How oftenDailyDailyWeekly
Food rulesEmpty stomach, up to 120 ml water, wait 30 minWith or without foodAny time, with or without meals
MoleculePeptide (same as the injection)Small moleculePeptides
StorageRoom temperature, original bottleRoom temperatureFridge, with limited time out
Average weight change in its trial−13.6% at 64 weeks (placebo −2.4%)Up to −11.1% at 72 weeks (placebo −2.1%)Semaglutide −14.9% at 68 weeks; tirzepatide up to −20.9% at 72 weeks

Sources: prescribing information; STEP 1; SURMOUNT-1.1234

Side effects

The semaglutide tablet label says its common reactions were similar in type and frequency to the 2.4 mg injection's; it also reported altered skin sensation in 5% of people against none on placebo.1 Orforglipron's most common reactions were nausea (26–35%), constipation, diarrhoea and vomiting, most frequent during dose escalation.2 Both tablets, like the injections, slow stomach emptying and can affect how other oral medicines are absorbed; orforglipron's label adds specific advice about birth control pills.2

Practical differences

  • Needles: none with a tablet — for some people that alone decides it.
  • Routine: a daily tablet is one more daily habit; the semaglutide tablet's fasting rule shapes every morning.
  • Missed doses: each has its own rule in its patient information — ask your pharmacist.
  • Travel: tablets are simpler to carry; see travelling with a GLP-1.
  • Breastfeeding: not recommended with semaglutide tablets or orforglipron.12

Common questions

Are GLP-1 pills as effective as injections?
In their own trials, semaglutide tablets averaged −13.6% at 64 weeks and orforglipron up to −11.1% at 72 weeks, compared with −14.9% at 68 weeks for weekly semaglutide injections in STEP 1 — different trials, so not a direct comparison.123
Do GLP-1 pills have fewer side effects?
Not obviously: the semaglutide tablet label reports reactions similar to the injection's, and orforglipron's are gastrointestinal too.12

Sources

  1. Semaglutide injection and tablets for weight management — US prescribing information DailyMed, US National Library of Medicine, version published 30 June 2026
  2. Orforglipron tablets for weight management — US prescribing information DailyMed, US National Library of Medicine, version published 13 August 2026
  3. Once-weekly semaglutide in adults with overweight or obesity (STEP 1) Wilding JPH et al. New England Journal of Medicine 2021;384:989–1002
  4. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1) Jastreboff AM et al. New England Journal of Medicine 2022;387:205–216

Written by the Cafeity team from the sources listed here. Figures from prescribing information are quoted as the label states them; trial results are averages from those trials, not predictions for any one person. This page has not yet been reviewed by a clinician — see the editorial policy for how pages are researched and corrected.