The three oral GLP-1 medications relevant in 2026
Until recently, the only GLP-1 medications licensed for weight loss in the UK were available only as weekly injections. Wegovy and Mounjaro both rely on a self-administered pen.
However, oral weight-loss medications have been in development in recent years and are now expected to be available in the UK in 2026.
Oral semaglutide already exists in the UK as Rybelsus, although the licensed use is type 2 diabetes rather than obesity. Two new oral options are in regulatory review, each working in a different way.
Here are the three medications this article covers, what they contain, and where they sit in the UK pipeline.
What’s driving UK interest in oral GLP-1s
The first is needle aversion. Some people who would benefit from a GLP-1 medication don’t want to inject. A daily tablet removes that barrier.
The second is discretion. A pill doesn’t always need refrigeration, doesn’t require sharps disposal, and travels more easily.
The third is maintenance. People who’ve lost significant weight on Wegovy or Mounjaro injections want a way to maintain the loss without continuing weekly injections forever, and an oral option may be more sustainable in the long term.
The fourth is cost. Mounjaro on a private prescription costs around £150 to £300 a month, and many people want a cheaper alternative.
Pricing for the new oral medications is still to be confirmed in the UK, but the U.S. self-pay price for the Wegovy pill launched at around $149 a month, and Foundayo at $149 to $349, depending on the dose1,2.
At-a-glance comparison of oral GLP-1 medications
| Medication |
Drug and dose |
UK status (May 2026) |
Average weight loss |
Dosing rules |
U.S. self-pay price |
| Rybelsus |
Oral semaglutide 3 mg / 7 mg / 14 mg |
Available; licensed for type 2 diabetes |
2 to 4 kg at 26 to 52 weeks in type 2 diabetes trials3,4 |
Empty stomach, max 120 ml water, then 30-minute fast |
N/A (NHS prescription for type 2 diabetes) |
| Wegovy pill |
Oral semaglutide 25 mg |
Under MHRA review; UK decision expected late 2026 |
13.6% body weight reduction at 64 weeks5 |
Empty stomach, max 120 ml water, then 30-minute fast |
~$149 a month |
| Foundayo |
Orforglipron 0.8 mg to 17.2 mg (six dose steps) |
FDA approved April 2026; MHRA review expected later 2026 |
11.2% body weight reduction at 72 weeks6 |
Any time of day, with or without food or water |
~$149 to $349 a month, dose dependent |
The dose listed for Rybelsus is the maximum currently licensed in the UK. The 25 mg oral semaglutide formulation in the Wegovy pill is a different product from Rybelsus, even though both contain semaglutide.
Rybelsus (oral semaglutide 7 mg / 14 mg): what UK patients can access now
Rybelsus is a daily tablet containing semaglutide, the same drug as Wegovy and Ozempic. It’s made by Novo Nordisk and has been available in the UK since 2020.
The UK licence covers only type 2 diabetes. The medication isn’t approved by the MHRA for weight loss.
Some private prescribers offer it off-label for weight management, but the NHS won’t prescribe it for that purpose.
For a full explanation of off-label access and prescriber options, see our guide to Rybelsus private prescription in the UK.
Doses start at 3 mg for the first month, increase to 7 mg, and reach a maximum licensed dose of 14 mg.
In the PIONEER trials for type 2 diabetes, the 14 mg dose produced average weight loss of 2.3 to 4.4 kg over 26 to 52 weeks compared to placebo, depending on the trial3,4.
The observed weight loss is clinically significant and likely contributes to improved blood sugar control in patients living with type 2 diabetes, but is below the average weight loss seen with injectable Wegovy or Mounjaro at full dose.
How to take Rybelsus correctly
The absorption of oral semaglutide requires following a strict dosing protocol.
Take the tablet on an empty stomach with no more than 120 ml of plain water, then wait at least 30 minutes before eating, drinking anything else, or taking other medications7.
Food, other liquids, or shorter waits all reduce the amount of the drug that enters the bloodstream.
Many people find that the first thing in the morning works best because it falls within the fasting window before breakfast.
Where to get Rybelsus in the UK in 2026
For type 2 diabetes, your GP can prescribe Rybelsus on the NHS if it’s clinically appropriate.
For weight loss, you’d need a private prescriber willing to issue it off-label. Costs typically range from £150 to £200 a month, depending on dose and provider.
Second Nature doesn’t provide Rybelsus off-label for weight loss.
For a deeper comparison of how Rybelsus performs against the injection-based options, see Wegovy vs Rybelsus and Mounjaro vs Rybelsus.
Wegovy pill (oral semaglutide 25 mg): what UK consumers can expect
The Wegovy pill is a higher-dose tablet formulation of semaglutide, specifically designed for weight management. It was approved by the U.S. FDA in December 20251.
The supporting trial, OASIS 4, ran for 71 weeks across 22 sites in four countries.
Adults with overweight or obesity but without type 2 diabetes took either 25 mg oral semaglutide or a placebo once a day.
At week 64, the active treatment group lost an average of 13.6% of their body weight compared to 2.2% on placebo, an average difference of 11.4 percentage points5.
That result puts the Wegovy pill close to the injectable Wegovy 2.4 mg pen in terms of average weight loss, while delivering the medication as a tablet.
Around 30% of adherent participants achieved at least a 20% reduction in body weight.
When the Wegovy pill is expected in the UK
Novo Nordisk applied for MHRA approval in late 2025. As of May 2026, the application is still under review, with a regulatory decision expected in late 2026.
If approval is granted on that timeline, private launch is likely in late 2026 or early 2027.
NICE will then need to issue technology appraisal guidance for NHS use, which typically takes a further 6 to 12 months after MHRA approval.
Pricing for the UK hasn’t been set. The U.S. self-pay price launched at around $149 a month, with insured patients paying about $25 with savings programmes1.
UK private prices will likely sit in a similar range, although NHS access will depend on NICE.
How to take the Wegovy pill
The Wegovy pill follows the same strict dosing rules as Rybelsus.
Take it on an empty stomach with no more than 120 ml of water, then wait 30 minutes before eating, drinking, or taking other medications5.
The strict dosing protocol is a possible concern for those considering the Wegovy pill.
The 30-minute fast every morning will work better for some people than others.
For a more in-depth look at the trial results and side-effect profile, see our explainer on the first GLP-1 weight-loss pill and the dedicated Wegovy pill guide.
Foundayo (orforglipron): the pill with no food or water rules
Foundayo is the brand name Eli Lilly uses for orforglipron, the first non-peptide oral GLP-1 receptor agonist.
It was FDA-approved on 1 April 2026 for adults with obesity or with overweight and a related health condition2.
Foundayo is structurally different from semaglutide. Semaglutide is a peptide and breaks down easily in the digestive tract, which is why oral versions need empty-stomach dosing and a small water volume.
Foundayo is a small molecule, which means it’s stable in the gut and can be taken at any time of day, with or without food, with or without water2.
Foundayo has no fasting window, no 120 ml water rule, and no daily routine adjustment.
What the ATTAIN-1 trial showed
ATTAIN-1 was a Phase 3 trial (a large human trial with thousands of participants) enrolling 3,127 adults with obesity but without type 2 diabetes.
Participants took 6 mg, 12 mg, or 36 mg of orforglipron capsules once a day, or placebo, for 72 weeks6.
At the 36 mg dose, average weight loss was 11.2% compared to 2.1% on placebo.
Among participants on 36 mg, 54.6% achieved at least 10% body weight reduction, and 36.0% achieved at least 15%6.
The approved Foundayo product is a tablet with six dose steps up to 17.2 mg.
The 17.2 mg tablet delivers the same dose as the 36 mg capsule used in the trial, and produces 11.1% average weight loss at the approved dose, essentially matching the trial result2.
For context, the Wegovy pill achieves an average weight loss of 13.6% at peak dose, and injectable Mounjaro 22% to 25% at top dose, compared with Foundayo’s 11.2%.
When Foundayo is expected in the UK
Eli Lilly is preparing the regulatory application for the MHRA and the European Medicines Agency.
Industry estimates point to UK approval in late 2026 or 2027, with launch following NICE appraisal.
For a full breakdown, including how Foundayo differs from injectable tirzepatide, see our Foundayo guide and the FDA approval coverage.
Foundayo as a maintenance option after injections
The ATTAIN-MAINTAIN trial tested Foundayo as a maintenance treatment after weight loss on injectable Mounjaro or Wegovy.
After people reached their weight-loss plateau on injections, they were switched to Foundayo or a placebo for one year.
People who switched from Mounjaro to Foundayo maintained 74.7% of their weight loss, compared to 49.2% on placebo.
People who switched from injectable Wegovy to Foundayo maintained 79.3% of their weight loss, compared to 37.6% on placebo8.
This is the first study to investigate the use of oral weight-loss medications to maintain weight loss achieved with weight-loss injections.
No such study has been completed with the Wegovy pill at this stage.
What about Orlistat?
Orlistat is the one oral weight-loss medication currently licensed on the NHS for obesity in the UK.
It’s available on prescription as Xenical (120 mg) and over-the-counter as Alli (60 mg).
Orlistat works differently from the GLP-1 pills covered in this article.
It’s a lipase inhibitor, which means it blocks around a third of the fat in a meal from being absorbed in the gut, rather than reducing appetite or food noise.
Average weight loss is around 3% of body weight over a year on top of diet and exercise, compared to 11.2% to 13.6% reported for the GLP-1 pills.
Side effects are different, too. The most common are oily stools, urgency, and faecal incontinence, particularly if you eat a meal higher in fat while taking it.
Orlistat is a reasonable option for people who can’t access GLP-1 medications. For a full review on Orlistat, see our guide to Orlistat on the NHS.
What about a Mounjaro pill (oral tirzepatide)?
There isn’t a Mounjaro pill, and there isn’t one in development.
Tirzepatide, the drug in Mounjaro, is a peptide with a molecular weight too high to be absorbed through the gut wall, even with the kind of absorption enhancer used to make oral semaglutide work.
Eli Lilly’s oral obesity strategy is Foundayo (orforglipron), a small molecule rather than a peptide, so it doesn’t face the same absorption barrier.
For people on Mounjaro injections who want a pill alternative, the choice is currently between Foundayo and the Wegovy pill.
For an in-depth review on this topic, see our Mounjaro pill guide.
Side effects compared
All three oral GLP-1s share a similar side-effect profile because they all act on the same hormone receptor (they all mimic the hormone GLP-1).
The most common side effects are gastrointestinal, dose-related, and most pronounced during dose escalation.
| Side effect |
Rybelsus 14 mg7 |
Wegovy pill 25 mg5 |
Foundayo 17.2 mg2 |
| Nausea |
~20% of people |
46.6% |
~30 to 40% |
| Vomiting |
~6 to 10% |
30.9% |
~10 to 15% |
| Diarrhoea |
~7 to 10% |
Common |
Common |
| Constipation |
~5% |
Common |
Common |
| Hair loss |
Not commonly reported |
Not commonly reported |
4 to 5% |
| Discontinuation due to side effects |
~5 to 7% |
7% (vs 6% on placebo) |
5 to 10% across dose groups |
The Wegovy pill nausea figure (46.6%) is high, but the discontinuation rate (7% on the medication vs 6% on placebo) is unusually close for a GLP-1 trial, which suggests most nausea was manageable.
Hair loss is listed on the Foundayo label and is more common in women (7%) than in men (under 1%). It isn’t unique to Foundayo.
Hair loss is reported across the GLP-1 class (around 3% on injectable Wegovy, 5 to 6% on injectable Mounjaro) and is usually a temporary response to rapid weight loss rather than a direct effect of the drug. Hair loss usually eases once weight stabilises.
All three medications carry a boxed warning about thyroid C-cell tumours, based on findings in animal studies.
None are recommended if you have a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.
How to choose between Rybelsus, the Wegovy pill, and Foundayo
The decision depends on what’s actually available where you are, what you’re using the medication for, and how rigid your morning routine is.
If you need access right now and you live with type 2 diabetes, Rybelsus is the only option of the three available on prescription in the UK. Your GP can prescribe it if it’s clinically appropriate.
If you’re looking for weight loss specifically and can wait, the Wegovy pill is likely to reach the UK first among the new oral options, based on the current MHRA review timeline.
For people whose morning routine doesn’t allow for a 30-minute fast before breakfast, Foundayo will likely be the more practical option once it’s available in the UK.
Injectable Mounjaro still produces more weight loss than either oral option, with 22% to 25% at the top dose compared with 13.6% for the Wegovy pill and 11.2% for Foundayo.
If maximum weight loss is the goal and needles aren’t an issue, injectable Mounjaro remains the strongest option.
See our coverage of the best weight loss injections in the UK.
If you’re already on Mounjaro or Wegovy injections
The Wegovy pill and Foundayo aren’t yet UK options, so for now, there’s nothing to switch to. Both are likely to be available in late 2026 or 2027.
When they do arrive, switching from injection to pill won’t be straightforward for everyone.
Oral semaglutide at 25 mg appears to match the results of injectable Wegovy at 2.4 mg in the OASIS 4 trial, but real-world switching data are limited.
Foundayo has the ATTAIN-MAINTAIN results showing it can preserve most of the weight loss achieved with injectables, which is useful for people considering maintenance.
If you’re paying privately for Mounjaro and want to lower costs, it’s worth waiting for UK pricing on the oral options rather than switching to off-label Rybelsus, which doesn’t deliver the same weight loss results at its current licensed doses.
Maintaining muscle mass on oral GLP-1 medications
All three oral GLP-1s produce meaningful weight loss, and a share of that weight loss can come from muscle and other lean tissue rather than fat.
The three things that help maintain muscle mass during weight loss are: losing weight slowly at a rate of around 1lb per week, eating around 1.2 to 1.6 grams of protein per kg of body weight per day (a serving the size of the palm of your hand at each meal), and adding resistance training a couple of times a week.
Frequently asked questions
Is there a weight loss pill available on the NHS in the UK?
Orlistat is the only oral medication currently licensed on the NHS for weight loss. It works differently from GLP-1 medications and produces less weight loss (around 3% over a year).
As of May 2026, no GLP-1 weight-loss pill is licensed or available on the NHS.
Rybelsus is available on the NHS, but only for type 2 diabetes.
The Wegovy pill and Foundayo are not yet approved by the MHRA.
Can I buy oral semaglutide for weight loss in the UK?
Some private clinics prescribe Rybelsus off-label for weight loss, although the medication isn’t licensed for that use in the UK.
Costs are typically £150 to £200 a month. The Wegovy pill, which is the higher-dose version specifically licensed for weight loss in the U.S., isn’t yet available in the UK.
Is the Wegovy pill the same as Rybelsus?
Both contain semaglutide, the same drug. The Wegovy pill is a 25 mg tablet formulated for weight loss.
Rybelsus is available in 3 mg, 7 mg, and 14 mg tablets licensed for type 2 diabetes.
The doses, licensed uses, and weight loss results differ. For a full comparison, see our guide on Wegovy in tablet form.
When will Foundayo be available in the UK?
Eli Lilly is preparing the MHRA application. UK availability is expected in late 2026 or 2027, although there’s no confirmed date yet.
NICE will then need to issue a technology appraisal before NHS prescribing can begin.
What’s the difference between Foundayo and the Wegovy pill?
Foundayo is a small molecule with no food or water restrictions, taken at any time of day.
The Wegovy pill is a peptide tablet that needs to be taken on an empty stomach, with 120 ml of water, and a 30-minute fast.
The average weight loss is 11.2% with Foundayo and 13.6% with Wegovy.
Will the oral pills work as well as injections?
For weight loss, the Wegovy pill 25 mg matches injectable Wegovy 2.4 mg in trial results.
Foundayo’s 11.2% peak result is below injectable Mounjaro’s 22% to 25% range.
Choosing between the types of medication depends on your goals, your tolerance for daily routines, and your preference for tablets over needles.
Does Rybelsus help with food noise?
Yes, oral semaglutide has a similar effect on lowering cravings and hunger as injectable semaglutide.
People taking Rybelsus often report reduced food noise (the constant, intrusive thoughts about food that GLP-1 medications quieten), although the effect is usually less pronounced than with higher injectable doses.
Can I take Rybelsus with my morning coffee?
No. Coffee counts as food or drink and will reduce how well the medication is absorbed.
Take Rybelsus first thing with plain water only, then wait 30 minutes before coffee, breakfast, or other tablets.
What happens if I miss a dose of Rybelsus or the Wegovy pill?
If you miss a dose of Rybelsus or the Wegovy pill, skip the missed dose and take the next one the following morning at the usual time.
Don’t double up to make up for a missed dose. With the strict empty-stomach window, taking the tablet later in the day rarely works well.
What are the main side effects of oral GLP-1 medications?
The most common side effects are gastrointestinal: nausea, vomiting, diarrhoea, constipation, and abdominal pain.
These are usually worse in the first few weeks at each dose step and improve over time.
Gradually increasing the dose can help if side effects are difficult to tolerate.
How quickly does Rybelsus work for weight loss?
Lower appetite often appears within the first few weeks, but meaningful weight loss usually takes 3 to 6 months on a stable dose.
For specifics on the time course, see our guide on how quickly Rybelsus produces weight loss.
Will there be a Mounjaro pill?
No. Tirzepatide is too large a molecule to be absorbed through the gut wall, so there’s no oral version in development.
Eli Lilly’s oral obesity strategy is Foundayo (orforglipron), which is a different drug.
Can the oral options help me maintain weight loss after injections?
Foundayo has the strongest evidence so far.
In the ATTAIN-MAINTAIN trial, switching from injectable Mounjaro to oral Foundayo preserved 74.7% of weight loss over a year, and switching from injectable Wegovy preserved 79.3%. Placebo groups maintained 49.2% and 37.6%, respectively.
The Wegovy pill doesn’t yet have an equivalent maintenance trial.
How Second Nature supports people on weight-loss medication
The Second Nature programme combines GLP-1 medication, where appropriate, with structured habit-change support from a registered nutritionist or dietitian.
The balanced plate model, made up of half vegetables, a quarter protein, a quarter complex carbohydrates, and a serving of fat, sits at the centre of how we help people eat well while losing weight on medication.
Our peer-reviewed JMIR study showed people on the semaglutide-supported programme lost an average of 19.1% of their body weight at 12 months, with 77.7% achieving at least 10% weight loss9. We’ve worked with the NHS on weight-management programmes since 2017.
Second Nature's Mounjaro and Wegovy programmes
Second Nature provides Mounjaro or Wegovy as part of our Mounjaro and Wegovy weight-loss programmes.
Why choose Second Nature over other medication providers, assuming you're eligible?
Because peace of mind matters.
We've had the privilege of working with the NHS for over eight years, helping people across the UK take meaningful steps toward a healthier, happier life.
Our programmes are designed to meet people where they are, whether that means support with weight loss through compassionate one-to-one health coaching, or access to the latest weight-loss medications (like Mounjaro and Wegovy) delivered alongside expert care from a multidisciplinary team of doctors, psychologists, dietitians, and personal trainers.
At the heart of everything we do is a simple belief: real, lasting change comes from building better habits, not relying on quick fixes. We're here to support that change every step of the way.
With over a decade of experience, thousands of lives changed, and a long-standing record of delivering programmes used by the NHS, we believe we're the UK's most trusted weight-loss programme.
We hope to offer you something invaluable: peace of mind, and the support you need to take that first step.
Take home message
Three oral GLP-1 medications are relevant to UK consumers in 2026. Rybelsus is available now for type 2 diabetes, with limited off-label use for weight loss.
The Wegovy pill is under review by the MHRA, with launch likely in late 2026. Foundayo, the first oral GLP-1 with no food or water dosing rules, is FDA-approved and under MHRA review.
Orlistat remains the only oral weight-loss medication currently NHS-licensed for obesity, but it works differently and produces around 3% weight loss, compared to the 11% to 14% reported for the GLP-1 pills.
None of the oral GLP-1 options matches injectable Mounjaro at peak dose for weight loss, but they remove the needle and offer a different daily routine.
References
- Novo Nordisk. (2025). Wegovy pill approved in the US as first oral GLP-1 for chronic weight management in adults. Press release, 22 December 2025.
- Eli Lilly and Company. (2026). FDA approves Lilly’s Foundayo (orforglipron). Press release, 1 April 2026.
- Aroda, V.R., et al. (2019). PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes. Diabetes Care, 42(9), 1724-1732.
- Pratley, R., et al. (2019). Oral semaglutide versus subcutaneous liraglutide and placebo in type 2 diabetes (PIONEER 4): a randomised, double-blind, phase 3a trial. The Lancet, 394(10192), 39-50.
- Wharton, S., et al. (2025). Oral semaglutide at a dose of 25 mg in adults with overweight or obesity (OASIS 4). New England Journal of Medicine, 393(11). PMID: 40934115.
- Wharton, S., et al. (2025). Orforglipron, an oral small-molecule GLP-1 receptor agonist, for obesity treatment (ATTAIN-1). New England Journal of Medicine, 393(18). PMID: 40960239.
- Electronic Medicines Compendium. Rybelsus Summary of Product Characteristics. Novo Nordisk Ltd.
- Aronne, L.J., et al. (2026). Orforglipron for maintenance of body weight reduction: the double-blind, randomized phase 3b ATTAIN-MAINTAIN trial. Nature Medicine. DOI: 10.1038/s41591-026-04386-7.
- Richards, R., Whitman, M., Wren, G., Campion, P. (2025). A Remotely Delivered GLP-1RA-Supported Specialist Weight Management Program in Adults Living With Obesity: Retrospective Service Evaluation. JMIR Formative Research, 9(1), e72577.
