Wegovy Pill vs Injection (and vs Foundayo): Weight Loss, Dosing and Price

The Wegovy pill and the Wegovy pen hold the same drug, semaglutide, and they share one FDA label. Both are approved in adults for weight loss and for lowering the risk of heart attack and stroke in people with heart disease. Only the injection is also approved for teens 12 and older and for a form of fatty liver disease called MASH¹. The differences are in how you take them, what the trials showed and what you pay. Foundayo, the other GLP-1 pill, is a separate drug, and it's covered at the end.

How much weight do people lose on the pill vs the shot?

There's no head-to-head trial of the Wegovy pill against the shot, so the fairest comparison is each one against placebo in its own trial.

Sources: OASIS 4³, STEP 1⁴, STEP UP⁵, ATTAIN-1⁶. The STEP UP trial also had a 2.4 mg group, which averaged 15.6%, so the 7.2 mg dose added about 3 points⁵. Foundayo's label reports ATTAIN-1 at its own tablet strengths. The trial paper calls the same top dose 36 mg, because it used an earlier formulation²⁶.

On average, the pill and the 2.4 mg shot land close together. The label backs this up: at 25 mg, the pill's blood levels are predicted to be comparable to the 2.4 mg shot's, but they vary more from person to person¹. The 7.2 mg shot is the strongest semaglutide option, and there's no pill equivalent.

How do you take each one?

This is the real difference for most people.

The pill is one tablet every morning on an empty stomach, with no more than 4 ounces of plain water. You swallow it whole and wait at least 30 minutes before eating, drinking anything else or taking other pills. If you miss a day, you skip it and take the next one the following day¹.

The shot is one injection a week, on the same day each week, at any time of day, with or without food. If you miss a dose and the next one is more than 2 days away, you take it as soon as you can. Miss two or more in a row and your prescriber may restart you at a lower dose¹.

If a 30-minute fasting window every morning sounds hard to keep, the weekly shot is simpler. If needles are the problem, the pill solves that. For the injection itself, see how to inject semaglutide.

What are the doses?

Both step up slowly to limit nausea. The pill steps up every 30 days, the shot every four weeks¹.

The pill's maintenance dose is 25 mg and the injection's is 2.4 mg. The 7.2 mg injection is an option after at least four weeks on 2.4 mg¹.

Foundayo steps up at least 30 days apart, and above 5.5 mg the label leaves the next step to response and tolerability².

Which has more side effects?

Both forms of semaglutide cause mostly stomach side effects: nausea, diarrhea, vomiting and constipation, most often while the dose is climbing. In OASIS 4, 74.0% of people on the pill reported a stomach side effect, versus 42.2% on placebo³. In STEP 1, more people on the 2.4 mg shot stopped treatment because of stomach side effects than on placebo (4.5% vs 0.8%)⁴. The 7.2 mg dose raises the rate again, and about 1 in 5 people on it reported dysesthesia, an unusual skin sensation⁵. The trials used different methods, so these numbers can't be lined up against each other directly. For the full list, see semaglutide side effects.

What does each cost?

These are the self-pay prices read in October 2026 on TrumpRx and on each maker's own pharmacy page.

Sources: TrumpRx⁷⁸, NovoCare⁹, LillyDirect¹⁰. The $199 injection offer runs through December 31, 2026. Foundayo's 2.5 mg and 5.5 mg prices are temporarily reduced through the same date, and its top two doses are $299 only if you refill within 45 days¹⁰.

Over the first 12 fills, the pill comes to $3,338 and the pen to $3,888 (two $199 fills, then ten at $349). That makes the pill about $50 a month cheaper at maintenance. Compounded semaglutide is usually cheaper than either. As of October 2026, its median published price across the programs we track was $178 a month, though it isn't FDA-approved. TrumpRx GLP-1 prices has the full price breakdown, and cheapest semaglutide compares current programs.

Can you switch from the injection to the pill?

Yes, at the top doses, and the label spells out how. If you're on the 2.4 mg shot, you wait one week after your last injection and then start the 25 mg pill once daily. Going the other way, you take your first 2.4 mg injection the day after your last 25 mg tablet. If the 25 mg pill doesn't agree with you, the label suggests switching to the 1.7 mg shot¹. Don't switch on your own: your prescriber has to write the new prescription.

The Wegovy pill isn't the same as Rybelsus or the Ozempic tablet. Those are diabetes pills with different strengths, and the labels say they aren't swapped milligram for milligram. Rybelsus vs the Wegovy pill covers that.

Wegovy pill vs Foundayo: which pill?

Foundayo (orforglipron) is a GLP-1 drug, but it isn't semaglutide or a peptide. It's a small molecule, which is why it doesn't need the empty-stomach routine. You can take it with or without food². The trade-off is weight loss: its top dose averaged 11.2% at 72 weeks in ATTAIN-1, compared with 13.6% at 64 weeks for the Wegovy pill in OASIS 4. These are separate trials, not a head-to-head test. Prices are close, with both at $299 a month at maintenance.

If morning fasting is the deal-breaker, Foundayo is the easier pill to live with. If you want the most weight loss without a needle, the Wegovy pill has the stronger trial result. More on Foundayo is in the orforglipron oral GLP-1 pill. Not medical advice; see our medical disclaimer.