Pick a pill
How much of the dose gets through
The bar is a plain reading of what each label reports about food, water and timing, not a measured percentage for those exact conditions. For oral semaglutide the label gives directions rather than numbers: absorption was higher with 50 mL of water than with 240 mL, and higher after a longer fast once the tablet was swallowed. For orforglipron the label gives the numbers and calls them unimportant. Nothing here predicts your own absorption, and neither pill should be taken any way other than the way its label says.
How much of one dose reaches the bloodstream
absolute bioavailability, from each label
This is the single number that explains everything else on this page. A semaglutide tablet delivers about 1% to 2% of what is swallowed, so the pill is dosed at 25 mg a day to land where a 2.4 mg weekly injection lands. Orforglipron is not a peptide, so nothing in the gut is trying to digest it, and it behaves like an ordinary tablet. The last bar is blank because no compounded oral or under-the-tongue semaglutide product has an established bioavailability at all.
Which pill is which
Tap any one to open it. A rose dot means it is not an FDA-approved medication.
What SNAC actually is
SNAC is salcaprozate sodium, a small fatty-acid-like molecule mixed into every semaglutide tablet. It is not a second medication and it does nothing to appetite. Its only job is to buy the semaglutide next to it a few minutes of safety and a way through the stomach wall, and the research behind it is unusually clear about how that works.
01
It changes the pH right where the tablet sits
As the tablet erodes it releases a lot of SNAC into a small pocket of stomach lining. That raises the local pH, and the acid-loving enzyme pepsin, which would otherwise cut the peptide apart, stops working in that pocket. The rest of the stomach is unaffected.
02
The absorption happens in the stomach, not the intestine
This is the part that surprised people. Almost every oral drug is absorbed further down, in the small intestine. Oral semaglutide is absorbed through the stomach wall itself, at the exact spot where the tablet is dissolving, which is why the tablet must be alone in there.
03
It goes through the cells, not between them
SNAC helps semaglutide cross straight through the cells of the stomach lining. It does not loosen the junctions between cells, so it is not opening a general hole that anything else can follow through. The effect is specific to the compound it is paired with.
04
And it still only gets 1% to 2% in
Even with all of that, most of the swallowed dose never reaches the blood. The window is narrow and it closes fast. This is why the tablet is 25 mg where the injection is 2.4 mg, and why anything sitting in your stomach at the same time matters so much.
SNAC belongs to Novo Nordisk's formulation. Nothing about this mechanism transfers to a peptide that has simply been put into a capsule, a liquid, or a drop under the tongue. That is the practical difference between the approved pill and everything sold as an oral version of it.
Why the morning rules are so fussy
Take the tablet first thing, on an empty stomach, with no more than four ounces of water, nothing else to drink, swallow it whole, then wait at least thirty minutes before eating, drinking anything, or taking any other medication. Those are the label's instructions, and each one is protecting the same narrow window: a tablet dissolving against the stomach wall with nothing washing it away.
The label reports the studies behind them. Absorption was higher with 50 mL of water than with 240 mL, and higher after a longer fast once the tablet went down. A big glass of water carries the tablet away from the lining it needs to sit against, and breakfast at fifteen minutes ends the window early.
Even followed exactly, the oral route is less predictable than the injection. In the label's own comparison, 90% of people on the 25 mg tablet had average blood levels between 27 and 186 nmol/L, against 51 to 110 nmol/L for the 2.4 mg weekly injection. The average is similar. The spread is roughly three times wider.
That is worth knowing rather than worrying about. It is one reason the label says that if the 25 mg tablet is not tolerated, switching to the 1.7 mg injection is an option, and it is why the pill is not automatically the gentler choice.
Orforglipron is not a tirzepatide pill
This one gets muddled constantly, and the confusion is understandable: it is Eli Lilly's, it is a pill, and Lilly also makes Zepbound. It is a different molecule entirely. There is no oral tirzepatide, and nothing in development is Zepbound in a tablet.
What it is not
It is not tirzepatide, it is not a peptide, and it does not touch the GIP receptor. Tirzepatide's whole identity is that it activates two receptors. Orforglipron activates one, the GLP-1 receptor, the same single target as semaglutide.
What it is
A small molecule, 902 g/mol against semaglutide's 4,114, built to fit the GLP-1 receptor without being a copy of the hormone. Because there is no peptide chain to digest, it needs no SNAC, no empty stomach and no water rule. It is taken once a day, any time, with or without food, and 77% of the dose reaches the blood.
So the answer to the usual question is yes, it is a GLP-1, in the sense that matters: it activates the GLP-1 receptor and it produces the same kind of effect through the same door. It is just built out of completely different material, and it is a Lilly product with a Lilly-sized marketing push, which is most of why it is being read as the Zepbound pill.
Being a small molecule has one practical consequence worth knowing. Orforglipron is broken down by CYP3A4, the liver's busiest drug-processing enzyme, so its label carries dose adjustments and cautions around common medications that block or speed up that enzyme. The peptides are dismantled by ordinary protein breakdown instead and have far fewer interactions of that kind. Tell your prescriber and your pharmacist everything you take.
Why compounded oral versions are a different thing
Sublingual drops, dissolving tablets and oral liquids described as semaglutide are still widely sold. This section is not about whether the sellers mean well. It is about what is known and what is not, and the honest summary is that the important parts are not known.
01
The absorption problem is not solved by wishing
Semaglutide's own maker needed SNAC, a stomach-targeted tablet and a strict fasting routine to get 1% to 2% of a dose into the blood. A compounded drop or a plain capsule has none of that. There is no published bioavailability figure for these products, which means nobody, including the seller, can say what dose is being delivered.
02
Some of them are not the same active ingredient
The FDA has stated that semaglutide salt forms, sold as semaglutide sodium or semaglutide acetate, are different active ingredients from the one in the approved drugs, and that it lacks information on whether they have the same chemical and pharmacologic properties.
03
The legal window closed in 2025
Large-scale compounding of these drugs was allowed because of a shortage. The FDA declared the tirzepatide shortage resolved in December 2024 and the semaglutide shortage resolved in February 2025, with compounders required to stop through the spring of 2025. The products did not all disappear when the permission did.
04
The reports are real
As of 31 May 2026 the FDA had received 990 adverse event reports involving compounded semaglutide and more than 730 involving compounded tirzepatide, including dosing errors serious enough to require hospitalisation. Compounded drugs are not reviewed by the FDA for safety, effectiveness or quality before they are sold.
This is not a judgment about anyone using one
Plenty of people came to compounded medication because the approved version was unaffordable or unavailable, and that is a real problem that has not been solved. The point of this page is only that an oral compounded product is not a cheaper version of the approved pill. It is an unknown quantity, and now that an approved pill exists, it is worth asking a prescriber what it would cost you.
What each one is approved for
| Pill | What is in it | Approved for | Doses | Weight result in its trial |
|---|---|---|---|---|
| Wegovy tablets | Semaglutide + SNAC | Weight reduction, and cardiovascular risk reduction, in adults. Approved 22 December 2025. | 1.5 → 4 → 9 → 25 mg, 30 days at each step | −13.6% at 64 weeks against −2.4% on placebo |
| Foundayo | Orforglipron, a small molecule | Weight reduction in adults with obesity, or overweight with a related condition. Approved 1 April 2026. | 0.8 → 2.5 → 5.5 → 9 → 14.5 → 17.2 mg, 30 days minimum at each step | −11.1% at 72 weeks against −2.1% on placebo |
| Rybelsus | Semaglutide + SNAC | Type 2 diabetes, and cardiovascular risk in type 2 diabetes. Not approved for weight. | 3 → 7 → 14 mg | not a weight indication |
| Ozempic tablets | Semaglutide + SNAC, newer tablet | Type 2 diabetes, and cardiovascular risk in type 2 diabetes. Not approved for weight. | 1.5 → 4 → 9 mg | not a weight indication |
| Compounded oral semaglutide | Not established | Nothing. Not FDA approved and not reviewed for safety, effectiveness or quality. | no established dose | no trial |
Both trial figures are the intention-to-treat results, which count everyone who was randomised including those who stopped early. The company announcements quote higher figures for people who stayed on the medication throughout: 16.6% for the Wegovy pill and 12.4% for orforglipron. Both numbers are honest and they answer different questions. Rybelsus 3, 7 and 14 mg and Ozempic tablets 1.5, 4 and 9 mg reach the same blood levels as each other in that order, which is a good reminder that a milligram number on a box means nothing across different formulations.
Four things worth keeping straight
A pill is not a gentler medication
Nausea, constipation, diarrhoea and vomiting are the most common reactions to both pills, at rates in the same range as the injections. Gastrointestinal reactions were reported by 60% to 69% of people on orforglipron against 37% on placebo.
The same warnings apply
All of these carry the thyroid C-cell tumour boxed warning and are contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2, orforglipron included, even though it did not produce those tumours in rodents.
Daily is a different commitment
A weekly injection is 52 decisions a year. A pill with a fasting window is 365, each one in the first half hour of the morning. Which of those is easier is a genuinely personal answer, and it is worth thinking about before switching.
There is still no tirzepatide pill
Nothing on this page is oral tirzepatide, because no such product exists. If something is being sold to you under that description, that alone tells you what you are dealing with.
Not medical advice
This is a mechanism explainer, not a recommendation and not a safety summary. Every one of these medications has contraindications, warnings and interactions that are not covered here. Talk with your own prescriber and pharmacist, and call 911 in an emergency.
Sources
8 references
- Wegovy (semaglutide) Prescribing Information. Novo Nordisk. Current label at DailyMed. Source for the tablet being co-formulated with SNAC, absorption occurring predominantly in the stomach, an absolute bioavailability of approximately 1% to 2% against 89% for the injection, a peak at 1 hour, the 1.5 to 4 to 9 to 25 mg escalation over 30-day steps, the empty stomach and four ounces of water and 30 minute instructions, the water volume and post-dose fasting studies, the predicted comparability of the 25 mg tablet with the 2.4 mg weekly injection with 90% of patients between 27 and 186 versus 51 and 110 nmol/L, the option to switch to the 1.7 mg injection if the tablet is not tolerated, and the Study 7 result of −13.6% against −2.4% at 64 weeks.
- Rybelsus and Ozempic (oral semaglutide) tablets Prescribing Information. Novo Nordisk. Current label at DailyMed. Source for the type 2 diabetes indications, the 3, 7 and 14 mg and 1.5, 4 and 9 mg strengths, the statement that the two are not substitutable on a milligram-to-milligram basis, and the study finding no clinically significant difference in steady-state exposure between the corresponding doses of the two formulations.
- Foundayo (orforglipron) Prescribing Information. Eli Lilly. Current label at DailyMed. Source for orforglipron being a GLP-1 receptor agonist with no GIP activity, the molecular weight of 902.0 g/mol, dosing once daily with or without food, 77% absolute bioavailability, a peak at 4 to 8 hours, an elimination half-life of 29 to 49 hours, metabolism by CYP3A4 with 87% of a dose recovered in faeces, the CYP3A4 dose adjustments, the 0.8 to 17.2 mg ladder, the Trial 1 result of −11.1% against −2.1% at 72 weeks, the gastrointestinal reaction rates of 60% to 69% against 37%, and the boxed warning wording noting orforglipron is not pharmacologically active in rats or mice.
- Buckley ST, Bækdal TA, Vegge A, et al. Transcellular stomach absorption of a derivatized glucagon-like peptide-1 receptor agonist. Science Translational Medicine. 2018;10(467):eaar7047. doi:10.1126/scitranslmed.aar7047. The study behind the SNAC mechanism: buffering of local pH to protect against enzymatic degradation, absorption through the stomach at the site where the tablet erodes, and a transcellular route with no evidence of an effect on tight junctions.
- U.S. Food and Drug Administration. FDA's concerns with unapproved GLP-1 drugs used for weight loss. fda.gov. Source for compounded drugs not being FDA approved or reviewed, for semaglutide salt forms being different active ingredients, for the dosing errors and hospitalisations, and for the 990 and 730-plus adverse event report counts as of 31 May 2026.
- U.S. Food and Drug Administration. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. fda.gov. Source for the tirzepatide shortage being resolved in December 2024, the semaglutide shortage in February 2025, and the dates by which compounders had to stop.
- Novo Nordisk. FDA approves the Wegovy pill, the first and only oral GLP-1 for weight loss in adults. Company announcement, 22 December 2025. The approval date and the 16.6% figure for participants who stayed on treatment.
- Eli Lilly. FDA approves Foundayo (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions. Company announcement, 1 April 2026. The approval date and the 12.4% figure for participants who stayed on treatment.