Introduction
If you’ve been struggling to lose weight, you may have already made up your mind to take Ozempic or Wegovy. The two semaglutide brands have been flying off the shelves, what with their massive popularity in the past few years. They not only help you shave inches off your waistline but also help regulate your blood sugar levels, too.
That’s all thanks to their active ingredient, semaglutide. You may already know that Ozempic and Wegovy are injectable, but did you know there’s a third semaglutide brand, Rybelsus? This one comes in tablet format.
Which semaglutide formulation is better? Tablets or injectables? In this article, we put them head-to-head to see if one is advantageous to take over the other.
What is semaglutide?
You may be familiar with Ozempic and Wegovy’s weight loss benefits, but their active ingredient, semaglutide, is equally fascinating. What is it exactly and why does it work so well in helping people lose weight?
In our gut is a hormone, glucagon-like peptide-1 (GLP-1). Whenever we finish eating and blood sugar levels are high, GLP-1 prompts insulin release, bringing blood glucose down.
Semaglutide works in the same way, as it is a glucagon-like peptide-1 receptor agonist (GLP-1 Ra). Whenever your blood sugar levels are high, it reacts in the same way as GLP-1.
At the same time, it also delays gastric emptying, where food exits the gut and enters the small intestine. Because digestion is slower, you tend to feel fuller for longer and have fewer food cravings. Because you’re consuming fewer calories, you end up losing weight. At the same time, semaglutide also signals to the brain you’re full, keeping you satiated most of the time.
Off-label use
We’ve mentioned the three semaglutide brands, Ozempic, Wegovy, and Rybelsus. Both Ozempic and Rybelsus have FDA approval to treat type 2 diabetes, while Wegovy has FDA approval for weight management.
Although drugmaker Novo Nordisk markets the three brands differently, they are all essentially semaglutide. In addition, they also offer the same therapeutic benefits of reducing blood sugar levels and promoting weight loss.
Despite only Wegovy being marketed for obesity, many healthcare providers choose to prescribe Ozempic or Rybelsus off-label for weight loss.
Subcutaneous semaglutide
Now that we know about the approved uses of Ozempic, Wegovy, and Rybelsus, let’s take a look at their formats.
Both Ozempic and Wegovy, for instance, are subcutaneous semaglutides, meaning you inject them under the skin. Rybelsus, meanwhile, is oral semaglutide as it comes in tablet format and you must take it orally.
Before examining which format is better than the other, let’s dive into the different features of semaglutide tablets vs. injections.
Formulation and dosages
Each 1ml of Ozempic solution contains 1.34 mg of semaglutide. Meanwhile, one Ozempic pen contains 2 mg semaglutide in 1.5 ml of solution.
Each 0.25 of Wegovy solution, meanwhile, contains 0.5 mg of semaglutide. One Wegovy pen, on the other hand, contains 0.25 mg semaglutide in 0.5 ml of solution.
You should administer Ozempic once a week. It comes in 0.5 mg, 1 mg, and 2 mg doses and is available for purchase with a prescription.
Wegovy, on the other hand, comes in five various dose strengths, from 0.25 mg to 2.4 mg. These different doses come pens of different colors.
Similar to Ozempic, your doctor will start you on small doses, gradually increasing this until you reach a maintenance dose. Wegovy is also a once-weekly injection.
Administration
As we’ve mentioned, you administer both Ozempic and Wegovy subcutaneously or under the skin. You can inject it in three different areas: your 1) abdomen, 2) thigh, or 3) upper arm.
It is best to use a different injection site with every injection. Moreover, you must practice care not to inject it into a muscle or vein.
You can take semaglutide injections with or without meals at any time of the day. For best results, semaglutide manufacturer Novo Nordisk notes that it is best to take semaglutide along with a healthy diet and exercise.
Common and serious side effects
Regardless if you use Ozempic or Wegovy for weight management, you still potentially face developing its side effects. Here are the common and serious side effects of subcutaneous semaglutide Ozempic and Wegovy.
The most common adverse effects of subcutaneous semaglutide include nausea, vomiting, diarrhea, constipation, heartburn, or abdominal pain. Healthcare providers may start you on small doses and work your way up to bigger doses to help manage symptoms.
Serious side effects
The more serious side effects of semaglutide injections include allergic reactions, hypoglycemia, pancreatitis, kidney problems, and thryroid c-cell tumors. Note that these are rare.
Efficacy
A growing number of studies illustrates the benefits of taking semaglutide injections for obesity. Moreover, studies have also found that it potentially has a positive impact on other health conditions.
On obesity
A study looked at the efficacy of semaglutide in treating people who were overweight. 40 percent of participants— people on once-weekly semaglutide—lost at least 15 percent of their body weight over 68 weeks. Those in the placebo group, meanwhile, lost significantly less weight.
On cardiovascular problems
Apart from type 2 diabetes, Ozempic also reduces the risk of developing cardiovascular problems like heart attack, stroke, or death.
Wegovy, meanwhile, has been found to reduce markers of heart disease, from high cholesterol, high blood sugar levels, to hypertension.
Semaglutide tablets
As we’ve mentioned, Rybelsus is semaglutide’s type 2 diabetes medication in tablet format. Although it is not a weight loss drug, weight loss is one of its effects, as with Ozempic and Wegovy.
Some doctors may prescribe Rybelsus to patients who do not feel comfortable or feel squeamish injecting themselves with semaglutide. Alternatively, doctors may also prescribe it to those who prefer taking medication daily than weekly.
Formulation and dosages
Each tablet of Rybelsus contains 3 mg, 7 mg, or 14 mg of semaglutide and inactive ingredients. These include magnesium stearate, microcrystalline cellulose, povidone, and salcaprozate sodium. These inactive ingredients are commonly in medication capsules. Specifically, they act as stabilizers and binders and aid in the effective absorption of the drug.
You typically take Rybelsus at 3mg once per day during the first 30 days of use. After this initial month, your doctor will increase your dose to 7 mg per day. This dose is typically what it takes for your body to regulate its blood sugar levels. After another 30 days on 7 mg, your doctor might increase the dosage to 14 mg per day.
How should you take Rybelsus?
- Take Rybelsus on an empty stomach when you first wake up. You can take it with no more than four ounces or 120 ml of plain water. Do not split, chewed, or crush the tablet. You must swallow it whole.
- Wait at least 30 minutes before eating, drinking, or taking other oral medications by mouth.
- To maximize results, it is best to eat 30 to 60 minutes after taking Rybelsus. Take it the same way every time.
Side effects (common and serious)
Similar to Ozempic and Wegovy, Rybelsus’ most common side effects are nausea, vomiting, abdominal pain, constipation, diarrhea, or appetite loss. Nausea is one of the more typical side effects, which should be reduced with gradual dosing.
Its serious side effects, meanwhile, include allergic reactions, hyperglycemia, kidney problems, vision changes, and signs of pancreatic/kidney disease. Note that these are rare.
Efficacy
A 26-week study found that Rybelsus effectively lowered blood sugar levels in adults with type 2 diabetes. The participants experienced a 1.2 to 1.4% reduction in HbA1c levels whereas those on placebo lost 0.3%.
Semaglutide tablets vs. injection: Which one works better?
Now that you have a deeper understanding of semaglutide and its formats, it’s time to discuss, ‘Which one works better?’
The answer is that both are equally safe and effective for treating either type 2 diabetes or for weight management. Here’s what studies say.
A review concluded once-daily Rybelsus is as, if not more effective for weight loss and reducing A1C than injectable semaglutide. A1 refers to a blood test that shows your blood sugar level over the past two to three months.
Despite the study’s outcome, note that research comparing oral and subcutaneous semaglutide is still relatively new. More studies will need to be done to conclude that one form is more effective than the other. There have also been no clinical studies directly comparing the two forms.
Pros and cons of oral and injectable semaglutide
Both injectable and oral forms of semaglutide are effective in helping promote weight loss. Nevertheless, there are advantages of taking one over another.
Patients will have their own idea of what is inconvenient or cumbersome. Here is a list of their usage requirements:
Oral semaglutide:
- Does not require needles
- Typically taken daily
- Can result in side effects like nausea, vomiting, and abdominal pain
- Must be taken on an empty stomach first thing in the morning
Injectable semaglutide:
- Requires the use of needles
- Typically injected just once weekly
- Can result in side effects such as reactions in the injection site
- Does not matter whether food or liquid has been consumed before or after the injection
Conclusion
Semaglutide is one of the hottest drugs out in the market right now for weight loss use. It comes in two formats: oral (Rybelsus) and subcutaneous semaglutide (Ozempic and Wegovy).
Oral semaglutide is taken once daily on an empty stomach. Meanwhile, subcutaneous semaglutide is injected under the skin once weekly, on the same day of each week, regardless of meals.
Data is limited to confirm that one format or one formulation is more advantageous or beneficial over the other. Oral semaglutide, for instance, comes with inactive ingredients which aid in its stabilization, delivery, and absorption. On the other hand, subcutaneous semaglutide come in a “purer” format as it contains pure semaglutide solution.
There are clear benefits of choosing to administer semaglutide in one way over the other, depending on the patient’s preference. Both formats and formulations, though, are equally safe, effective, and tolerable. As with any drug, these both come with potential risks and side effects. Thankfully, these are usually mild and are manageable, while the more serious ones are rare.
Should you wish to switch semaglutide formats, consult your healthcare provider.
Glossary of terms:
- GLP-1: Glucagon-like peptide-1 is a gut-based hormone involved in the secretion of insulin to lower blood sugar levels typically elevated after meals.
- GLP-1 Ra: Glucagon-like peptide-1 receptor agonist. It mimics the actions of GLP-1.
