By Karen Kier, Pharmacist
On behalf of the ONU HealthWise team

On November 6, 1981, the Cars released their fourth studio album titled *Shake It Up.* Ric Ocasek was the lead vocalist and guitarist for the new wave band, and he wrote the majority of their hits, including the album's title single. "Shake It Up" reached number four on the Billboard Hot 100 charts in the United States, with one notable line being, “Shake it up, make a scene.”

One could argue that the GLP-1 (glucagon-like peptide-1) weight loss drugs made a significant impact in 2025. Approximately 12% of the U.S. adult population is currently taking a GLP-1 drug for weight loss, according to two different surveys. GLP-1 drugs were initially FDA-approved for treating type 2 diabetes, with the first being exenatide (Byetta®), which received approval in April 2005. To date, seven different GLP-1 medications have been approved and marketed in the U.S. for diabetes, while only three GLP-1 drugs have been approved specifically for weight loss.

PAGE 2 ▶︎ Out of the three drugs approved for weight loss, two have GLP-1 as their sole mechanism of action: liraglutide (Saxenda®) and semaglutide (Wegovy®). Liraglutide is a daily injection for weight loss, whereas semaglutide is given as a weekly injection. Tirzepatide (Zepbound®) operates through a dual mechanism of action, incorporating GLP-1 along with the GIP (glucose-dependent insulinotropic polypeptide) action.

While the generic names are the same for both diabetes and weight loss drugs, they are marketed under different brand names. For instance, semaglutide is known as Wegovy® for weight loss and Ozempic® for diabetes. Similarly, tirzepatide is marketed as Zepbound® for weight loss and Mounjaro® for diabetes, while liraglutide is sold as Saxenda® for weight loss and Victoza® for diabetes.

Up until recently, all three GLP-1 drugs for weight loss were only available in injectable form. However, the FDA approved the oral version of Wegovy® on December 22, 2025. The oral tablet, also known generically as semaglutide, follows the previous approval of Rybelsus® (also semaglutide), which is an oral tablet for managing diabetes.

Rybelsus® tablets come in 3 milligrams (mg), 7 mg, and 14 mg doses, while the new Wegovy® tablet for weight loss is available in 1.5 mg, 4 mg, 9 mg, and 25 mg strengths. The various strengths of the Wegovy® tablet follow a "stairstep" dosing pattern similar to that of the GLP-1 injectable drugs. The FDA-approved dosing regimen for oral Wegovy® consists of four weeks at 1.5 mg daily, followed by four weeks at 4 mg daily, four weeks at 9 mg daily, and finally reaching a maximum strength of 25 mg daily. The maintenance dose for weight loss is 25 mg daily.

The FDA-approved indication for oral Wegovy® is chronic weight management in conjunction with a reduced-calorie diet and increased physical activity. It was also approved for reducing the risk of heart disease.

The *New England Journal of Medicine* (NEJM) published a clinical study confirming these findings on September 17, 2025. The study, known as OASIS 4, demonstrated a mean weight loss of 16.6% over 64 weeks. 

However, not all GLP-1 medications are the same. A comparator study published in the NEJM examined the effectiveness of semaglutide injection versus tirzepatide injection for weight loss. The SURMOUNT-5 trial revealed an average weight loss of 20.2% with tirzepatide compared to 13.7% with semaglutide. This difference may be attributed to tirzepatide’s dual mechanism of action. Other studies of weight loss with semaglutide have indicated a higher average loss than 13.7%.

PAGE 2 ▶︎ It's important to note that these medications can have side effects. A study published in the *Annals of Internal Medicine* evaluated emergency room (ER) visits among patients taking semaglutide for weight loss and found that four out of every 1,000 users required evaluation for side effects. The majority of these cases were gastrointestinal issues, including nausea, vomiting, and diarrhea. Surprisingly, around 16% of those visiting the ER experienced low blood sugar, which is uncommon since GLP-1 medications typically lower blood sugar only in diabetic patients.

The oral Wegovy® tablets are expected to be available in pharmacies by January. The cost of GLP-1 weight loss drugs can be high, and this expense may deter some individuals from using them. Moreover, not all insurance plans cover these medications for weight loss, adding to the financial burden for consumers. Novo Nordisk, the manufacturer of oral semaglutide products, offers some introductory discounts on their website, but these discounts are only temporary, and the drugs are intended for long-term use.

The arrival of oral Wegovy® could certainly shake things up in 2026!

For more information, you can contact ONU HealthWise Pharmacy at 419-722-3784.

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