The Wegovy pill is the same molecule as the weekly Wegovy injection, semaglutide, in a daily tablet. The FDA approved it on December 22, 2025, for weight reduction in adults with obesity, or overweight plus a weight-related condition [2]. The question most people bring is simple: does the pill work as well as the shot? One 64-week trial of the approved dose answers most of it.
The injectable form, its dosing and its trials are covered in the semaglutide guide. This page is about the tablet, and it sits under the weight goal.
What the FDA approved
The approval letter covers two uses, both alongside a reduced-calorie diet and more physical activity. One is long-term weight reduction in adults with obesity, or with overweight and at least one weight-related condition. The other is lowering the risk of heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and obesity or overweight. [2]
The label states a starting dose of 1.5 mg once a day for 30 days, then 4 mg, then 9 mg, each for 30 days. The maintenance dose from day 91 is 25 mg once daily [1]. The label adds that the tablet should be swallowed whole on an empty stomach with no more than 4 ounces of plain water. Food, other drinks and other oral medicines wait at least 30 minutes [1].
The trial behind the approval
OASIS 4 enrolled adults without diabetes who had a BMI of 30 or higher, or 27 or higher with a weight-related complication [3]. It randomized 307 people, 205 to oral semaglutide 25 mg and 102 to placebo, with lifestyle support in both groups. The dose was stepped up over 12 weeks, then held for 52.
At week 64, mean body weight fell 13.6% on the pill and 2.2% on placebo. The difference was 11.4 percentage points (95% CI, 9.0 to 13.9; P<0.001) [3]. The label’s own analysis of the same trial, using a different way of filling in missing data, reports 13.6% against 2.4% [1].
By the label’s count, 76.3% on the pill lost at least 5% of their weight, against 31.3% on placebo. About one in four, 27.9%, lost 20% or more, against 3.1% on placebo [1]. Those are averages from a trial population that was 79% women with a mean starting weight of 106 kg.
Side effects in the trial
Gastrointestinal events were reported by 74.0% of people on oral semaglutide and 42.2% on placebo [3]. The label puts discontinuation for adverse reactions at 6.9% on the pill and 5.9% on placebo. Gallstones were reported in 2.5% on the tablet and 1% on placebo [1].
One effect is specific enough to name. Dysesthesia, altered skin sensation such as tingling or burning skin, was reported by 5% on the 25 mg tablet and by no one on placebo. The label notes it rose with dose and blood level [1].
Why a pill needs 25 mg when the shot uses 2.4 mg
Semaglutide is a peptide, and the gut normally breaks peptides down before they are absorbed. The label estimates absolute bioavailability at about 1% to 2% for the tablet, against 89% for the injection under the skin [1]. That gap is why the daily oral dose is roughly ten times the weekly injected one.
The tablet works at all because of an absorption enhancer, salcaprozate sodium (SNAC). In human and dog studies, absorption happened in the stomach, close to the dissolving tablet, and did not occur without SNAC. The authors found SNAC buffers the local environment against digestive enzymes and briefly raises uptake through the stomach lining [5]. The fasting and water limits on the label follow from that mechanism.
Pill or injection
No head-to-head trial of the pill against the shot is described on the label. What the label does report is drug levels: in people without type 2 diabetes, average semaglutide concentrations on 25 mg tablets were similar to those on the 2.4 mg weekly injection. [1]
That did not hold for people with type 2 diabetes, whose levels on the tablet were lower. The label says the tablets have not been studied for weight reduction in adults with type 2 diabetes [1].
A higher oral dose was tested first. OASIS 1 gave 50 mg a day, twice the approved dose, to 334 adults for 68 weeks. Weight fell 15.1% against 2.4% on placebo, and gastrointestinal events reached 80% against 46% [4]. The two doses were tested in separate trials and never compared directly.
For how the injectable form compares with tirzepatide, see tirzepatide vs semaglutide. For the wider field of weight-loss peptides and their trial results, see which peptides for weight loss have human trials.
What this means if you are considering it
The approved pill cut weight by about 11 points more than placebo over 64 weeks, at the cost of a daily routine around breakfast. Its trial followed people for only 7 weeks off the drug [1]. The longer record of what happens after stopping comes from the injection trials, set out in what happens when you stop taking semaglutide.