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August 31, 2026
Christine Bürg & Marianne Waldenfels
Wegovy is now available as a pill. But how does it compare with the weekly injection? Prof. Uwe Nixdorff explains the key differences in effectiveness, use, and side effects.
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Prof. Dr. Uwe Nixdorff
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Wegovy will be available in Germany as a tablet starting September 1, marking the arrival of the first oral semaglutide therapy for weight reduction on the German market. Germany is also the first country in the EU where the new Wegovy tablet will be available.
For many, this may initially sound like an appealing alternative to the weekly weight-loss injectionAfter all, a tablet seems easier and more convenient for daily life than a regular injection. However, taking it is not quite as simple as it might appear. And despite sharing the same active ingredient, the tablet and the injection differ in important ways.
So can the Wegovy tablet hold its own against the injection — and who is it actually the better choice for? Cardiologist and preventive medicine specialist Prof. Dr. Uwe Nixdorff sees great potential in the new dosage form, but does not expect it to fully replace the injection.
Whether the new GLP-1 tablet will prove more popular than the established injections in the long term remains to be seen, according to Prof. Uwe Nixdorff. What is clear, however, is that many people may initially find a tablet more appealing than an injection.
Nixdorff points, among other things, to a survey by endocrinologist Prof. Jens Aberle from the University Medical Center Hamburg-Eppendorf. "If you ask people whether they would prefer to inject a medication or take it as a tablet, around 90 percent say they'd prefer tablets," says Nixdorff.
Ease of use aside, there is also a psychological dimension. "For many people, a tablet sounds less like a serious illness. This could make a real difference for those who have previously found the idea of injecting themselves a barrier to treatment."
At the same time, Nixdorff observes in his own practice that most patients adapt to the weekly injection without difficulty. "In my experience, patients have no problems with the injection."
That said, the new therapy is not quite as straightforward as a conventional tablet. While the Wegovy injection is given just once a week, the tablet must be taken every day — in the morning after at least eight hours of fasting, with water. Patients must then wait at least 30 minutes before eating, drinking, or taking any other medications.
Current approval data show that Wegovy in tablet form can also produce significant weight loss. In the Phase III trial relevant for approval, adults with obesity or overweight who took 25 milligrams of oral semaglutide daily lost an average of 13.6 percent of their body weight after 64 weeks, compared with 2.2 percent in the placebo group. Around three quarters of participants lost at least five percent of their starting weight.
This puts the weight loss in a broadly similar range to that of the Wegovy injection. In one of the major studies on the weekly injection with 2.4 milligrams of semaglutide, participants lost an average of around 15 percent of their body weight after 68 weeks. However, the results cannot be compared directly, as they come from different studies.
The large difference in dosage is striking: while Wegovy as an injection is administered at up to 2.4 milligrams once a week, the standard maintenance dose of the tablet is 25 milligrams per day. This does not mean the tablet is more potent, however. The reason is simply that only a small fraction of orally ingested semaglutide is absorbed by the body.
Prof. Uwe Nixdorff had already highlighted this ahead of the market launch: "The pharmacokinetics are such that the tablet does not work quite as strongly as subcutaneous administration. That is why the dosage is also significantly higher."
The approval criteria for the Wegovy tablet mirror those for the existing injection therapy. It is indicated for adults with obesity (BMI of 30 kg/m² or above) or for people with a BMI of 27 kg/m² or above who already have a weight-related comorbidity such as type 2 diabetes, high blood pressure, or sleep apnea.
There is, however, one difference when it comes to age. "It is only approved for adults, whereas the injections can already be used from the age of twelve."
As with the Wegovy injection, patients in Germany will generally have to pay for the weight-loss tablets out of pocket. Medications for weight reduction are excluded from reimbursement by statutory health insurers.
At market launch, packs of 30 tablets in doses of 1.5, 4, and 9 milligrams are initially available. The pharmacy retail price for the 9-milligram dose is listed at €233.32. The standard maintenance dose of 25 milligrams had not yet been listed immediately before the market launch, meaning a final monthly cost for long-term therapy cannot yet be stated.
Like the established Wegovy injection, the tablet can also cause primarily gastrointestinal complaints. The most common side effects include nausea, vomiting, diarrhea, constipation, and abdominal pain. According to the assessment of the EMA, the safety profile of the daily tablet is broadly comparable to that of the weekly Wegovy injection. These complaints tend to occur most frequently at the beginning of treatment.
Whether the tablet is better tolerated than the injection cannot yet be reliably assessed, says Nixdorff. "We'll have to wait and see. The effect is somewhat lower, so it's possible it may also be somewhat better tolerated."
According to Nixdorff, oral GLP-1 therapy is likely to be just one step in a rapidly evolving field. Several companies are already working on new active substances that simultaneously target multiple metabolic receptors.
"There will be triple agonists — compounds that simultaneously activate GLP-1, GIP, and glucagon receptors."
One such active substance is retatrutide, which is currently being investigated in Phase III studies. Results so far suggest that even greater weight losses may be achievable with it than with the GLP-1 medications currently available.
Prof. Nixdorff: "With the triple agonists, we're getting up to 30 percent. That really makes a difference."
From a cardiologist's perspective, this is likely to give rise to competition between different drug classes. Depending on efficacy, tolerability, and price, different therapies may become established for different patient groups.
Despite all these advances, Nixdorff cautions against viewing GLP-1 medications as an easy fix. "The therapy is meaningless, and I would reject it if carried out without accompanying counseling." He adds: "If you taper the medication and don't change your lifestyle, you get a yo-yo effect — and in my view it's stronger than with other therapies."
The reason: during weight loss, not only fat tissue is lost, but also muscle mass. If this is not subsequently maintained or rebuilt through strength training and sufficient protein intake, it is primarily body fat percentage that rises again after discontinuation.
"People absolutely must change their diet and exercise habits. Ideally, strength training should be part of that too."
That is precisely why the cardiologist does not see these medications as a replacement for a healthy lifestyle, but rather as a tool to help people with obesity make the transition to a sustainably healthier life. Many of those affected have already tried numerous diets and have struggled with excess weight for years.
"There are people who simply cannot manage to lose weight — who have been struggling with excess weight for years or even decades. If they are ten or twenty kilograms lighter, they not only feel better. Metabolism, cardiac function, and insulin resistance also improve significantly."
From September 1, the Wegovy tablet expands the treatment options for obesity in Germany and is likely to be of particular interest to people who prefer not to inject themselves regularly. It is not automatically more convenient, however: while the injection is given just once a week, the tablet must be taken daily on an empty stomach under specific conditions.
Which option is more suitable — the tablet or the injection — will therefore depend on individual needs, efficacy, and tolerability. For Prof. Uwe Nixdorff, the dosage form is ultimately less important than long-term treatment success. And in his view, that depends not on medication alone, but on whether lasting changes to diet, exercise, and muscle-building are genuinely incorporated into everyday life.
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