Introduction
With rising cases of diabetes and obesity, it’s a relief to know there are medicines helping patients live better lives. We’re sure you’ve heard of two medicines helping them effectively control blood sugar levels and lose weight: semaglutide brands Ozempic and Wegovy.
The two injectable drugs have achieved household recognition with more people singing their praises about them. But there’s actually a third variant that comes in tablet form: Rybelsus.
With the same active ingredient, semaglutide, are they equivalents of each other? Can you substitute one for the other? In this article, we tackle these and more about the similarities and differences between semaglutide tablets and injections.
What is semaglutide?
Before we compare semaglutide tablets and injections, let’s first define with semaglutide is and how it works.
Semaglutide belongs to a class of drugs, glucagon-like peptide-1 receptor agonists, or GLP-1 Ras. In our gut is the hormone GLP-1, which triggers the pancreas to release insulin, a hormone regulating blood sugar levels.
Semaglutide copies GLP-1 and does the same. It also has an effect that slows down digestion (delays gastric emptying), making you feel fuller for longer. As a result, people’s appetites are weaker and they lose weight.
You can only purchase semaglutide products with a prescription. Ozempic and Rybelsus have FDA approval for treating type 2 diabetes while Wegovy treats weight loss. Despite these key differences, many healthcare providers prescribe Ozempic and Rybelsus off-label for weight loss.
Semaglutide injections: An overview
As we’ve mentioned, two semaglutide brands come in injectable format: Ozempic and Wegovy. Although only Wegovy actually has approval as a weight loss drug, Ozempic has been equally popular for weight management.
Dosages
Ozempic is in an injectable pen format and you should administer it once a week. It comes in 0.5 mg, 1 mg, and 2 mg doses and is only available for purchase with a prescription.
Wegovy, on the other hand, also comes in a pre-filled injectable pen format, but in five various dose strengths. The different doses come in different colored pens.
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 of semaglutide
You administer both Ozempic and Wegovy by injecting them subcutaneously (under the skin). You can inject them in three different areas: the 1) abdomen, 2) thigh, or 3) upper arm. It is important to not inject them into a muscle or vein. It is best to use a different injection site with every injection. However, if you want to use the same injection site, pick a different spot in that area.
You can take semaglutide injections with or without meals at any time of the day. For optimal results, semaglutide manufacturer Novo Nordisk recommends taking the drug with diet and exercise.
Common and serious side effects
Regardless if you use Ozempic or Wegovy for weight management, you still face potential 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 of semaglutide
Semaglutide’s more serious side effects include allergic reactions, hypoglycemia (low blood sugar), pancreatitis, kidney problems, and thyroid c-cell tumors. Note that these are rare.
Efficacy
Studies show 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 semaglutide’s efficacy 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 heart problems
Apart from type 2 diabetes, Ozempic also helps reduce the risk of developing cardiovascular problems like heart attack, or stroke.
Wegovy, meanwhile, helps reduce markers of heart disease, from high cholesterol, high blood sugar levels, to hypertension.
Semaglutide tablets: An overview
As we’ve mentioned, Rybelsus is semaglutide’s type 2 diabetes medication that comes in tablet format. Although not a weight loss drug, weight loss is one of its effects, as with semaglutide brands Ozempic and Wegovy.
Some doctors may prescribe Rybelsus to patients who do not feel comfortable or feel squeamish injecting themselves with semaglutide. Alternatively, they may prescribe it for those who prefer to take a medication daily rather than once weekly.
Dosages
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, the dosage might increase to 14 mg per day.
Administration
You must take Rybelsus on an empty stomach when you first wake up. Take it with no more than four ounces or 120 ml of plain water. Do not split, chew, or crush the tablet. You should swallow it whole.
Next, 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. It’s essential that you 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 include allergic reactions, hyperglycemia, kidney problems, vision changes, as well as 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 suffering from type 2 diabetes. Participants experienced 1.2 to 1.4% reduction in their HbA1c levels whereas those on placebo only lost 0.3%.
Semaglutide injections vs. tablets
A review concluded that once-daily Rybelsus is as, if not more effective for reducing weight A1C levels than injectable semaglutide. This applies to people with diabetes.
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.
Supply issues
Towards late 2023, there was a major shortage in Wegovy and Ozempic amid the clamor for the drugs. It is likely that the shortage problem will persist for several more years.
Novo Nordisk admitted a “short-term stock-out” of Wegovy in the US through December due to demand surpassing supply capacities.
Switching and substitution
As consumers grapple with this shortage, they may opt for a different semaglutide product to continue their treatment. If an Ozempic user suddenly found the drug unavailable, can she use Wegovy or Rybelsus in the meantime?
Although it’s not commonly recommended, it’s not entirely impossible. Some patients have switched between Rybelsus and Ozempic, if they prefer to take tablets versus injections.
Those taking 14 mg a day of Rybelsus, for example, may switched to 0.5 mg Ozempic weekly. Those on 0.5 mg dose of Ozempic weekly may switch to 7 mg or 14 mg of Rybelsus daily. But if you’re taking 1 mg injections of Ozempic weekly, note that there’s no actual equivalent for Rybelsus.
But Ozempic and Rybelsus are both anti-diabetic medicines. What about switching between Wegovy and Rybelsus?
In this case, this is not possible. Currently, there is no equivalent for a Rybelsus dose that can be translated into a Wegovy dose.
Conclusion
Ozempic and Wegovy are two of the hottest weight loss drugs right now. Although only Wegovy is FDA-approved for weight loss, Ozempic is often prescribed for its off-label effect of reducing body weight.
The two medicines come in a pre-filled injectable format and share a common active ingredient: semaglutide. Semaglutide also has another anti-diabetic drug: Rybelsus, which comes in tablet form.
To ensure results are maximized, the three medicines must be administered properly each time, whether subcutaneously or orally.
Regardless if semaglutide is taken according to approved use or not for weight loss, patients can still experience side effects. Nausea and vomiting are some of the most common adverse effects, while more serious ones are rare.
A review found that oral semaglutide could be just as effective, if not more effective, than injectable semaglutide. However, more research is needed to conclude whether one form is more effective than the other. On their own, Rybelsus, Ozempic, and Wegovy have been evidenced by studies to be effective in lowering blood sugar levels.
Some may prefer to take medicine orally than subcutaneously due to a fear of needles or a discomfort with injections. Others may want to switch from injectable to oral semaglutide, or the other way around.
Amid a supply crisis, patients may be forced to explore using other semaglutide variants should their medicine be unavailable. While Ozempic and Rybelsus users can be interchanged, Wegovy and Rybelsus cannot.
Should you wish to lose weight with semaglutide, seek your healthcare provider’s recommendation on the best medication for you. Make sure you discuss in its entirety any past or current health issues to avoid the risk of complications.
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