Which ones are pills
- Rybelsus® and Ozempic® tablets (semaglutide), once daily, for type 2 diabetes in adults; since 10/2025 the label also lists lowering the risk of major cardiovascular events in adults with type 2 diabetes at high risk [1].
- Wegovy® tablets (semaglutide), once daily, for weight reduction and cardiovascular risk reduction in adults [2].
- Foundayo™ (orforglipron), once daily, for weight reduction and maintenance in adults [3].
- The injectable versions of semaglutide (Ozempic®, Wegovy®) and tirzepatide (Mounjaro®, Zepbound®) are given once weekly under the skin.
Side by side
| Point | Semaglutide tablets | Foundayo™ tablet | Weekly semaglutide or tirzepatide pen |
|---|---|---|---|
| How often | Once a day [1][2] | Once a day [3] | Once a week [4][5] |
| Food and water | Empty stomach, up to 4 oz plain water, then 30 minutes before food, drink or other oral medicines [1][2] | With or without food [3] | Any time of day, with or without meals [2][4] |
| Share of the dose reaching the blood | About 0.4% to 1% (Rybelsus®) or 1% to 2% (Ozempic® and Wegovy® tablets) [1][2] | 77% after a 0.8 mg dose [3] | 89% for semaglutide, 80% for tirzepatide [4][5] |
| Peak after a dose | About 1 hour [1][2] | 4 to 8 hours [3] | 1 to 3 days for semaglutide; 8 to 72 hours for tirzepatide [4][5] |
| Dose steps | Every 30 days [1][2] | At least 30 days per step [3] | At least 4 weeks per step [4][5] |
| Storage | Room temperature, original bottle, away from moisture [1][2] | Room temperature [3] | Refrigerated, with limited time out of the fridge [2][5] |
The semaglutide tablet routine
The semaglutide tablet labels set out a strict morning routine. One tablet goes down first thing, before any food, with a small amount of plain water: 4 ounces (about 120 mL) at most, and nothing else to drink. It is swallowed whole, never split, crushed or chewed, and only one is taken per day. Food, drinks and any other oral medicine follow no sooner than half an hour later [1][2].
The European product information asks for at least 8 hours of fasting before the tablet [7]. The Canadian monograph frames the same rule from the other end: take the tablet at least 30 minutes before the first food, drink or other oral medicine of the day, since a shorter wait or more water is likely to reduce the amount absorbed [9].
How a peptide gets through the stomach
Semaglutide is a peptide, and peptides are usually broken down in the gut. The tablets contain an absorption enhancer called SNAC, and the labels say absorption happens mainly in the stomach [1]. A laboratory and clinical study published by the manufacturer’s scientists found that this absorption takes place close to the surface of the dissolving tablet, that it needs SNAC, and that SNAC appears to protect the peptide locally and only briefly [10].
That is why the tablet routine is so exact. In the label’s water study, absorption was higher with 50 mL than with 240 mL, and in a 10-day study it rose as the wait after the dose was lengthened from 15 to 120 minutes [1]. A population model of the trial data put bioavailability at 0.8% under the recommended conditions, with large day-to-day variation that daily dosing and the long half-life smooth out at steady state [11].
Foundayo™ works differently
Foundayo™ does not share that routine. Its label says to take it once daily with or without food, swallowed whole, no more than one tablet a day [3]. In a food study with an investigational tablet, total exposure was 19% lower and the peak 26% lower with food, which the label does not regard as clinically relevant.
The difference comes from the molecule. Orforglipron is not described as a peptide, and its label gives a bioavailability of 77% after a 0.8 mg dose, a peak 4 to 8 hours after the tablet and a half-life of about 29 to 49 hours [3].
Absorption and blood levels
Injected semaglutide has a bioavailability of 89%, and injected tirzepatide 80%, according to their labels [4][5]. That is why the tablet doses are numerically much larger than the injection doses: a milligram figure on a tablet cannot be compared directly with a milligram figure on a pen. The Rybelsus® label adds that even its two tablet products are not substitutable milligram for milligram [1].
The Wegovy® label says that in people with overweight or obesity without type 2 diabetes, the 25 mg daily tablet is predicted to give semaglutide levels comparable to the 2.4 mg weekly injection, but with more variation from person to person: 90% of people had average levels between 27 and 186 nmol/L on the tablet, against 51 to 110 nmol/L on the injection [2]. A modelling analysis by the manufacturer reported that 82.2% of tablet users in the OASIS 4 trial fell within the exposure range seen with the injection in STEP 1 [12].
Type 2 diabetes changes the picture for Wegovy® tablets
Section 8.6 of the Wegovy® label sets out a difference that matters for some readers. In people with type 2 diabetes, average semaglutide levels on the 25 mg tablet were lower than on the weekly injection, about 44 against 68 nmol/L, and spread more widely [2]. The label links this to lower absorption and says some people with type 2 diabetes on the tablets may have levels below the effective range.
The tablets were not studied for weight reduction in people with type 2 diabetes. For those with an inadequate response, the label asks prescribers to consider alternatives, including the injection [2].
Missed doses
- Semaglutide tablets: skip the missed tablet and take the next one the following day [1][2].
- Foundayo™: take the missed dose as soon as possible, but do not double up. If 7 or more doses in a row are missed, the label says the dose steps are restarted at a lower dose [3].
- Ozempic® injection: take it within 5 days; Mounjaro® and Zepbound®: within 4 days. Otherwise skip it and keep the usual day [4][5][6].
- Wegovy® injection: take it if the next dose is more than 2 days away; skip it if less. Missing 2 or more weekly doses in a row means restarting at a lower dose [2].
Switching between a tablet and a pen
The labels treat switching as its own step rather than a simple swap. For type 2 diabetes, people on the 0.5 mg Ozempic® injection can move to Rybelsus® or Ozempic® tablets one week after the last injection [1]. For Wegovy®, the 2.4 mg injection can be replaced by the 25 mg tablet a week after the last injection, and going the other way the injection starts the day after the last tablet [2].
European product information adds a caution: because oral semaglutide is absorbed more variably, the effect of switching cannot easily be predicted [7]. It also lists 25 mg and 50 mg Rybelsus® tablets that the US label does not have, and steps the Wegovy® tablet up every four weeks rather than every 30 days [7][8]. Which form and step apply to you is your prescriber’s decision.
Storage and travel
The tablets are stored at room temperature, 20°C to 25°C, with short excursions allowed between 15°C and 30°C. The semaglutide tablets must stay in their original bottle to protect them from moisture [1][2][3].
The injectable pens are refrigerated before use. The labels then allow limited time out of the fridge: for example, a Wegovy® single-dose pen can be kept between 8°C and 30°C for up to 28 days, and a single-dose Mounjaro® pen unrefrigerated up to 30°C for a total of 21 days [2][5].
Interactions, pregnancy and breastfeeding
- All of these medicines slow stomach emptying and may affect the absorption of other oral medicines. The Wegovy® label reports that semaglutide tablets raised total thyroxine exposure by 33% when taken with levothyroxine [2]. Our article on GLP-1s and oral medicines covers each label in detail.
- Foundayo™ is broken down by the liver enzyme CYP3A4, so its label limits the dose with strong CYP3A4 inhibitors, says to avoid strong inducers and caps simvastatin at 20 mg a day [3].
- Breastfeeding is not recommended with Rybelsus®, Ozempic® tablets or Wegovy® tablets, because, as the Rybelsus® label explains, SNAC and its breakdown products pass into breast milk [1][2]. The Foundayo™ label also says it is not recommended while nursing [3].
- For oral birth control, the Foundayo™ label points pill users to a contraceptive that is not swallowed, or an added condom, for 30 days at the start and 30 days after every step up; the tirzepatide labels use four weeks. The semaglutide labels ask women to stop at least 2 months before a planned pregnancy [1][3][5].
How long each one stays
The semaglutide tablets keep the same one-week half-life as the injections, and semaglutide remains in the body for about five weeks after the last tablet, according to the Rybelsus® label [1]. The Wegovy® label gives about 5 to 7 weeks after the last 25 mg tablet or 2.4 mg injection [2].
Foundayo™ clears much faster, with a half-life of about 29 to 49 hours, and reaches steady state after about a week of daily tablets [3]. The tirzepatide pens sit in between, with a half-life of about five days [5].
Ozempic®, Wegovy® and Rybelsus® are registered trademarks of Novo Nordisk A/S. Mounjaro® and Zepbound® are registered trademarks, and Foundayo™ is a trademark, of Eli Lilly and Company. PepLabo is not affiliated with or endorsed by Novo Nordisk or Eli Lilly and Company.
When to get help
| Sign | Who to contact | How fast | Source |
|---|---|---|---|
| Trouble breathing or swallowing, or a swollen face, lips, tongue or throat | Emergency services (911 or your local number) | Emergency | Rybelsus® and Ozempic® tablets Medication Guide [1] |
| More tablets taken than prescribed | Poison Help line or emergency department | Emergency | Medication Guide [1] |
| Severe stomach pain that will not go away, with or without vomiting, sometimes reaching the back | Stop the tablets and call your prescriber | Today | Medication Guide; section 5.2 [1] |
| Questions about switching forms, or about a tablet that does not seem to work with type 2 diabetes | Your prescriber | At your next appointment | Wegovy® label, sections 2.5 and 8.6 [2] |
