Oral Semaglutide Medication Guide
Written by: Justin Zaghi MD
Last updated: 1-8-26
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Table of contents:
About semaglutide
How to get started
1. What is semaglutide?
Semaglutide is the active ingredient in popular weight loss medications Ozempic® and Wegovy®. Semaglutide was FDA-approved in 2017 for type 2 diabetes under the brand name Ozempic® and was later found to be beneficial for weight loss, achieving about 15% weight loss sustainably1. As a result, semaglutide was FDA-approved in 2021 as a weight loss injection called Wegovy®. In late 2025, the FDA approved an oral form of Wegovy®, which is a convenient option for those who prefer to avoid injections.
2. What forms of semaglutide are available?
Semaglutide is available in both injectable and oral tablet formulations. Injectable semaglutide (Wegovy® or Ozempic) is taken once weekly, while oral semaglutide (Wegovy® tablets) is taken once daily. Both forms contain the same active ingredient and work through the same biological pathways, but they differ in how the medication is absorbed and how consistently it reaches the bloodstream.
3. How does semaglutide work?
Semaglutide is a GLP-1 agonist, which is a hormone that naturally is made by your intestines. The medicine works by sending signals to the appetite center in your brain to reduce hunger. By slowing down your stomach, it also helps you to feel fuller. In addition, it has hormonal effects to improve your metabolism, specifically triggering insulin and reducing glucagon from your pancreas.
Oral semaglutide relies on a specialized absorption enhancer called SNAC to help the medication pass through the stomach lining. Because of this, it is very important to take oral semaglutide on an empty stomach, with no more than ½ cup (120 mL) of water, and to wait at least 30 minutes before eating, drinking, or taking other medications after taking the tablet.
4. What are the benefits of semaglutide?
Semaglutide has been shown to lead to sustained weight loss of about 15%2. Weight loss can have significant benefits across many domains of your health, including sleep, mood, energy, and other organs in your body. Studies have shown benefits including:
1. A 20% reduction in cardiovascular events, including heart attack and stroke, and a decreased risk of death3
2. Reductions in heart failure3
3. Improvements in diabetes and blood sugar control1
4. Improvements in cholesterol and blood pressure control1
5. Improvements in kidney health4
6. Improvements in fatty liver disease5
In short, semaglutide can have an incredible benefit on your health!
1. A 20% reduction in cardiovascular events, including heart attack and stroke, and a decreased risk of death3
2. Reductions in heart failure3
3. Improvements in diabetes and blood sugar control1
4. Improvements in cholesterol and blood pressure control1
5. Improvements in kidney health4
6. Improvements in fatty liver disease5
In short, semaglutide can have an incredible benefit on your health!
5. What side effects should I look out for?
The most common side effects are gastrointestinal in nature, including nausea, vomiting, diarrhea, and constipation. When these gastrointestinal side effects happen, they are typically mild in nature and generally subside over time, usually within 2-3 weeks. Nausea is actually considered an “on target” side effect of semaglutide in that the nausea helps you to reduce your caloric intake and lose weight. About 5% of patients on oral semaglutide may experience altered skin sensation, called “dysesthesia” which is usually not serious.
Semaglutide may cause other less common, but more serious, side effects. These include:
Semaglutide may cause other less common, but more serious, side effects. These include:
- Gallstones and pancreatitis (inflammation of the pancreas), especially when the weight loss is rapid
- Low blood sugar
- Allergic reactions
- Kidney problems, especially if you’re very dehydrated
- Changes in vision
- Thyroid tumors or cancer (this has been noted in rodents, but not yet humans)
6. Who should avoid semaglutide?
People with any of the following conditions should not take semaglutide:
- A personal or family history of medullary thyroid carcinoma
- A personal history of multiple endocrine neoplasia syndrome type 2
- An allergic reaction to semaglutide or any of its ingredients
- Pregnant women
7. How do I take oral semaglutide?
Oral semaglutide requires very specific timing to work properly:
- Take first thing in the morning
- With no more than ½ cup (120 mL) of plain water
- Wait at least 30 minutes before eating, drinking (including coffee), or taking other medications
- Take once daily
Because oral semaglutide is absorbed during a short window in the stomach, taking it incorrectly may reduce how well it works. If you miss a dose, skip the missed dose and go back to your regular schedule for the next dose.
8. What dose of oral semaglutide should I take?
Oral semaglutide is started at a low daily dose and increased gradually over several months to improve tolerability. The goal is to reach a 25 mg daily maintenance dose, which is the dose shown to be effective for weight loss in clinical studies.
Your provider will guide dose escalation based on tolerability and response. Below is the standard, FDA-approved dosing schedule for oral semaglutide:
Month 1
1.5 mg
Daily
Month 2
4 mg
Daily
Month 3
9 mg
Daily
Month 4(onward)
25 mg
Daily(full dose)
9. What should I expect while taking semaglutide?
Because semaglutide slows down gastric emptying and signals your brain to be less hungry, you may also feel fuller and naturally want to consume fewer calories. Many patients describe semaglutide as having an effect of reducing “food noise” or constant chatter/thoughts about food. You may also find a decreased desire to consume alcohol.
At the lowest doses of semaglutide,there may be little to no weight loss. That dose is really intended to see how your body reacts to the medicine. As you increase the doses under the guidance of your Shapely team, you should expect to gradually lose weight. A healthy amount of weight loss is about 0.5-1% of your total body weight per week (usually 1-2/lb for a 200 lb person), though weight loss may be greater when starting on treatment.
10. What foods should I avoid while on semaglutide?
While you don’t need to make any strict dietary changes while taking semaglutide, most people will find that they will naturally want to consume fewer calories. In addition, improving the quality of your diet will only help to accelerate and sustain your weight loss.
Occasionally, semaglutide can increase symptoms of heartburn. If you have a history of heartburn, it’s recommended to avoid high-fat foods — like fried or greasy foods, as well as spicy or acidic foods.
Sometimes, patients will experience constipation while on semaglutide. As a result, it’s recommended to have a diet rich in fiber, as well as to consume plentiful water, as both can help minimize constipation.
11. Am I required to exercise while on semaglutide?
Exercise is not strictly required while on semaglutide, but it is strongly recommended! Many people who lose weight on semaglutide may also lose muscle mass. Doing exercise regularly will help ensure that you retain muscle mass and stay healthy.
We’re excited to help you achieve the best shape of you! For any additional questions on semaglutide, please reach out to your Shapely provider using the chat feature in Healthie. Or feel free to give us a call at 424-600-8360.
The best shape of you is a few clicks away.
