# Semaglutide

A long-acting copy of the gut hormone GLP-1, taken weekly as an injection or daily as a tablet for weight loss and type 2 diabetes. It also cuts heart attacks and strokes in people with heart disease and excess weight.

Also called: Ozempic, Wegovy, Rybelsus, Wegovy pill
Source page: https://peplogue.com/peptides/semaglutide/
Updated: 2026-10-22. Not medical advice.

## How it works

- Where it acts: GLP-1 receptors in the pancreas, the stomach and the appetite centres of the brain.
- What it changes: More insulin when blood sugar is high, less glucagon, a slower-emptying stomach and fewer hunger signals.
- What people notice: A smaller appetite and earlier fullness within weeks. Nausea or constipation are common while the dose is being raised.

## What the evidence shows

- **Weight loss in obesity**: Proven. STEP 1: about 15% average loss at 68 weeks on 2.4 mg a week. STEP UP: 18.7% at 72 weeks on 7.2 mg, or 20.7% in people who stayed on it. OASIS 4: 16.6% on the 25 mg daily pill in people who stayed on it.
- **Type 2 diabetes**: Proven. Approved as Ozempic injections and Rybelsus tablets.
- **Fewer heart attacks and strokes**: Proven. SELECT (17,604 people with heart disease and excess weight but no diabetes): major cardiac events fell 20%.
- **Fatty liver with scarring (MASH)**: Proven. US accelerated approval in August 2025. Conditional EU authorization as Kayshild in March 2026. In ESSENCE, liver inflammation cleared in about 6 in 10 people, against about 1 in 3 on placebo.
- **Knee arthritis pain with obesity**: Supported. STEP 9 (407 people, 68 weeks): knee pain fell clearly more than on placebo.
- **Slowing Alzheimer's disease**: Failed. Two large trials of the tablet (EVOKE and EVOKE+) found no slowing of decline.

## Side effects and risks

- serious: Boxed warning for thyroid C-cell tumors, seen in rodents.
- serious: Pancreatitis and gallbladder disease, including gallstones.
- serious: A rare kind of sudden vision loss (NAION), listed by European regulators as a very rare side effect.
- common: Nausea, vomiting, diarrhea and constipation, mostly while the dose is rising.
- common: Muscle is lost along with fat. Weight returns after stopping: in one trial people regained about two-thirds within a year.
- common: Low blood sugar when combined with insulin or sulfonylureas.
- common: Food stays in the stomach longer. Tell the anesthesia team before any procedure.

Who should avoid it: Pregnancy or trying to conceive (stop at least two months before), medullary thyroid cancer or MEN 2 in you or your family, and past pancreatitis unless a specialist agrees.

## How it is taken

Weekly injection under the skin, starting at 0.25 mg and rising every four weeks to a maintenance dose of 2.4 mg, or 7.2 mg where that dose is approved. The weight-loss tablet is taken daily on an empty stomach with a sip of water, 30 minutes before food, stepping up from 1.5 mg to 25 mg. A prescriber sets the schedule.

## Legal status

- United States: undefined. Ozempic, Rybelsus, Wegovy injection (up to 7.2 mg) and the Wegovy pill. Maker self-pay prices in October 2026: $149 to $299 a month for the pill and $349 for the injection ($399 for 7.2 mg), with a new patient's first two months at $199. Large-scale compounding lost its legal basis when the shortages ended in 2025. Compounded versions are still sold, and FDA has sent warning letters over them.
- European Union: undefined. Ozempic, Rybelsus and Wegovy, plus Kayshild for fatty liver disease. The 7.2 mg dose was approved in February 2026 and the Wegovy pill in July 2026.
- Spain: undefined. Ozempic, Rybelsus and Wegovy are marketed (CIMA). Ozempic and Rybelsus are SNS-funded for type 2 diabetes; Wegovy for obesity is not (Dec 2025).
- Germany: undefined. Ozempic, Rybelsus, Wegovy (pen; pill since 1 Sep 2026) on sale, Rx only. GKV pays for diabetes, not weight loss (§ 34 SGB V).
- France: undefined. Ozempic (diabetes, 30% per BDPM) and Wegovy (obesity, 65% if BMI 35+ with illness or 40+, since 15 Jun 2026) are sold. Wegovy pill: no launch found.
- Italy: undefined. Ozempic and Rybelsus: classe A, SSN pays for type 2 diabetes (Nota 100). Wegovy: classe C, you pay. Wegovy pill EU-approved Jul 2026, not yet on sale in Italy.
- Netherlands: undefined. Ozempic and Rybelsus (diabetes) are insured under conditions. Wegovy needs a prescription but is not insured (XGVS). Zorginstituut is reviewing obesity cover.
- United Kingdom: undefined. NHS Wegovy comes only through specialist weight-management services. Private prescriptions go through registered pharmacies, which must verify your weight independently. The pill was approved in June 2026.
- Canada: undefined. Ozempic, Rybelsus and Wegovy. Generic semaglutide since April 2026, and a generic for weight management since June 2026.
- Australia: undefined. Ozempic is subsidized for type 2 diabetes only. Wegovy was a private prescription when last checked; a narrow subsidy has been recommended. Pharmacy-compounded versions have been banned since 1 October 2024.

## Questions people ask

**Are Ozempic and Wegovy the same drug?**

Yes. Both are semaglutide from Novo Nordisk. Ozempic and the Rybelsus tablet are approved for type 2 diabetes, while Wegovy, as a weekly injection or a daily pill, is the weight-loss brand.

**How much weight do people lose on semaglutide?**

In the STEP 1 trial, average loss was about 15% at 68 weeks. A higher dose reached 18.7% at 72 weeks in STEP UP, and the daily pill reached 16.6% in people who stayed on it in OASIS 4.

**What are the side effects of semaglutide?**

Nausea, vomiting, diarrhea and constipation are common, mostly while the dose is rising. Serious risks include pancreatitis, gallbladder disease, a boxed warning for thyroid C-cell tumors seen in rodents, and a very rare kind of sudden vision loss (NAION).

**What happens when you stop taking semaglutide?**

Weight usually returns. In one trial people regained about two-thirds of the lost weight within a year of stopping.

**How much does Wegovy cost without insurance in the US?**

The maker's self-pay prices in October 2026 were $149 to $299 a month for the pill and $349 a month for the injection, or $399 for the highest dose, with a new patient's first two months at $199. Large-scale compounding lost its legal basis when the shortages ended in 2025, and FDA has sent warning letters over compounded versions that are still sold.

## Sources

- Novo Nordisk: FDA approves the Wegovy pill (22 Dec 2025): https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=916472
- Drugs.com: Wegovy approval history: https://www.drugs.com/history/wegovy.html
- EMA: Wegovy product page: https://www.ema.europa.eu/en/medicines/human/EPAR/wegovy
- EMA: Kayshild product page: https://www.ema.europa.eu/en/medicines/human/EPAR/kayshild
- NovoCare: Wegovy self-pay prices: https://www.novocare.com/obesity/products/wegovy/let-us-help/explaining-list-price.html
- Health Canada: first generic semaglutide (28 Apr 2026): https://www.canada.ca/en/health-canada/news/2026/04/canada-becomes-the-first-g7-country-to-approve-a-generic-version-of-semaglutide.html
- Health Canada: first generic semaglutide for weight loss (29 Jun 2026): https://www.canada.ca/en/health-canada/news/2026/06/canada-approves-first-generic-semaglutide-for-weight-loss.html
- Novo Nordisk: half-year report 2026: https://www.sec.gov/Archives/edgar/data/0000353278/000035327826000023/caq22026.htm
- Gallup: GLP-1 use reaches new high (7 Jul 2026): https://news.gallup.com/poll/712157/glp-usage-reaches-new-high.aspx