New daily diet pills containing semaglutide and orforglipron are emerging as oral alternatives to popular weight-loss injections, offering new options for individuals seeking to manage their weight. These oral medications, designed to mimic the effects of GLP-1 gut hormones, aim to reduce appetite and increase feelings of fullness.
One such pill, an oral version of Wegovy containing semaglutide, has been approved by the UK's Medicines and Healthcare products Regulatory Agency (MHRA) and is available privately for approximately £100 per month. In the United States, this drug received approval earlier this year and generated three million prescriptions within its first five months. The Wegovy pill is taken once daily on an empty stomach and its dosage can be gradually increased up to 25mg. It works by signaling the brain to reduce appetite and slowing gastric emptying, with a carrier molecule, salcaprozate sodium (SNAC), protecting the drug from stomach acid for absorption into the bloodstream.
Clinical trial data suggests that patients taking the highest dose of the Wegovy pill can expect to lose an average of 16.6% of their body weight over 64 weeks. For example, an individual weighing 106kg could lose approximately 17.7kg. While this is slightly less than the average weight loss reported for Wegovy injections (19%), a significant portion of obese volunteers in the pill trial lost 20% or more of their body weight. Beyond weight loss, the Wegovy pill has demonstrated other health benefits, including significant improvements in HbA1c levels, lower blood pressure, and a reduction in waist circumference by an average of 12.2cm. Cholesterol and triglyceride levels also saw modest reductions.
However, the Wegovy pill is associated with gastrointestinal side effects, affecting 74% of trial participants compared to 42% in a placebo group. These side effects, such as nausea and vomiting, led to a 7% dropout rate in trials, comparable to the 6% dropout rate in the placebo group. The pill must be taken at least 30 minutes before eating and daily, which differs from the once-weekly Wegovy injections. The cost of the Wegovy pill ranges from £98.97 for lower doses to £188.97 for the highest dose per month. Availability on the UK's National Health Service (NHS) is not expected before 2027, pending appraisal by the National Institute for Health and Care Excellence (NICE).
Another weight-loss pill, Foundayo, which contains orforglipron and is made by the manufacturer of Mounjaro, is expected to be available in the UK later this year. Unlike the Wegovy pill, Foundayo is a small molecule drug that is chemically stable and does not require a protective coating against stomach acid. It can be taken at any time of day without food restrictions. The starting dose is 0.8mg, with the potential to increase up to 17.2mg.
Foundayo has shown an average weight loss of 12.4% of body weight over 18 months. It has also been observed to help individuals who had plateaued on weight-loss injections maintain 75% to 80% of their lost weight when switched to Foundayo. Health benefits include an average reduction in waist circumference of 11.1cm and a drop in systolic blood pressure by 6.7mmHg. Harmful blood fats, triglycerides, fell by 21.6%, and non-HDL cholesterol dropped by 8.5%.
Side effects reported for Foundayo include nausea, constipation, diarrhea, and vomiting, with a dropout rate between 5% and 10% depending on the dose. Other reported effects include headache, tiredness, and hair loss. The drug is currently available in the US for around $147 (£111) per month. It is expected to be cheaper to produce than injectable GLP-1s due to its simpler powder form. Foundayo is expected to become available privately in the UK later this year, pending review by the MHRA and appraisal by NICE for potential NHS availability.
While an estimated 2.6 million people in the UK currently use weight-loss injections, the advent of these new oral medications could significantly increase the demand for such treatments in pill form.