It’s no secret that injectable GLP-1s provide significant weight loss results. This year, two pill options of GLP-1s were approved for weight loss: Wegovy pill (semaglutide) and Foundayo (orforglipron) are two new weight loss medications that offer the convenience of a daily oral pill instead of a weekly injection.
In addition, these weight loss pills don’t require refrigeration and have a lower price tag. While they differ in their structure, weight loss results and dosing requirements, understanding these differences can help patients and healthcare providers determine which medication may be a better fit based on lifestyle habits and weight loss needs.
[READ: GLP-1 Muscle Loss: How to Prevent Muscle Wasting on Wegovy and Other GLP-1s]
Comparing the Wegovy Pill vs. Foundayo
| Wegovy pill | Foundayo pill | |
| Active ingredient | Semaglutide | Orforglipron |
| Target hormone | GLP-1 | GLP-1 |
| Structure | Peptide-based GLP-1 + SNAC absorption enhancer | Non-peptide small-molecule GLP-1 RA |
| Average loss percentage | 14% | 11% |
| How to take it | Strict: Every morning on an empty stomach, 30 minutes before food, beverages or other medications, with a sip of water | Flexible: Any time of day, with or without food |
| Structure | Peptide-based, large molecule that requires an absorption enhancer | Small molecule |
| Average cost without insurance | $149 to $299 per month | $149 to $299 per month |
| FDA-approved uses |
— Weight loss — Cardiovascular risk reduction |
— Weight loss |
| Manufacturer | Novo Nordisk | Eli Lilly and Company |
How Well They Work for Weight Loss
Independent clinical trials show that the Wegovy pill results in greater weight loss than Foundayo.
In practice, however, Dr. Omodamola (Damijey) Aje, a board-certified endocrinologist at Berkshire Medical Center, a University of Massachusetts Medical School affiliate and co-director of the Bone Density Program, says that in terms of effectiveness, she hasn’t noticed a significant difference in weight loss success between the two medications. Response tends to be determined by individual factors, dosage adjustment and patient adherence.
Here’s how oral Wegovy and Foundayo compare:
— Wegovy pill weight loss results. The Oasis-4 trial studied the effect of oral semaglutide (Wegovy) 25 milligrams versus a placebo, in addition to a reduced-calorie diet and exercise, in people who were overweight or had obesity. After 64 weeks, participants who took oral semaglutide lost about 14% of their body weight. Participants who took a placebo lost an average of 2.2% of their body weight.
— Foundayo pill weight loss results. The effectiveness of once daily oral orforglipron (Foundayo) in adults with obesity without diabetes was studied in the Attain-1 trial. Participants who took orforglipron achieved an average weight loss of 11.2% of their body weight compared with 2.1% among those who took a placebo.
While there has not been a direct study comparing the Wegovy pill to Foundayo for weight loss, the Achieve-3 study compared oral semaglutide to orforglipron for Type 2 diabetes. Foundayo resulted in greater weight loss and reductions in average blood sugar levels compared with semaglutide; however, the semaglutide doses were maintenance doses, not maximum weight loss doses.
Weight loss maintenance
While clinical trials show greater weight loss with the Wegovy pill, weight loss isn’t the only factor to consider. Foundayo may be a good option for maintaining weight loss after reaching your goal, as weight gain commonly occurs after stopping GLP-1 medications.
The Attain-Maintain study looked at whether orforglipron can help maintain weight loss after using injectable tirzepatide or semaglutide. Results showed that orforglipron is very effective at maintaining weight loss. Participants previously on semaglutide only gained about 2 pounds with orforglipron, while those previously taking tirzepatide gained about 11 pounds back on orforglipron.
[READ: Not Losing Weight on Wegovy? Why GLP-1s Work for Some and Not Others]
How to Take Oral GLP-1 Drugs for Weight Loss
Both the Wegovy pill and Foundayo are taken once daily. The biggest difference between them is how they are taken.
Taking the Wegovy pill
Like the injectable version, Wegovy is a peptide, which is a large molecule. It comes with strict dosing requirements. When starting the Wegovy pill, you will need to stick to a consistent daily routine for it to be effective.
Key requirements for the Wegovy pill include:
— Take it first thing in the morning, on an empty stomach with a sip of water.
— Avoid eating, drinking or taking other medications for 30 minutes.
— If you miss your morning dose, skip that day.
Taking the Foundayo pill
The Foundayo pill is a small molecule that is more easily absorbed by the body. This allows the dosing to be more flexible, without restrictions. It can be taken with or without food, at any time of the day. It should be taken around the same time daily to keep medication levels consistent.
Foundayo offers more dosing flexibility, which can support better medication-taking behavior, adds Dr. Rozalina McCoy, an endocrinologist at the University of Maryland Medical Center Midtown Campus and an associate professor at the University of Maryland School of Medicine.
If a medication is easier for patients to take, it’s more likely to be effective and work. This is especially important in the real world, where busy schedules can affect how compliant patients are with their medications, she adds.
Dosing titration schedules
— Wegovy pill: Starts at 1.5 mg daily, titrating every 30 days through 4 mg and 9 mg up to the 25 mg max maintenance dose.
— Foundayo: Starts at 0.8 mg daily, titrating through 2.5 mg, 5.5 mg, 9 mg, 14.5 mg, up to the 17.2 mg max maintenance dose
[READ: Semaglutide vs. Tirzepatide vs. Orforglipron for Weight Loss]
How the Wegovy and Foundayo Pills Work
The Wegovy pill and Foundayo are both glucagon-like peptide-1 receptor agonists, or GLP-1 agonists. They mimic natural gut hormones to promote weight loss. They regulate blood sugar, control appetite and slow digestion.
Where they differ is in their structure. The Wegovy pill uses semaglutide, the same active ingredient as injectable Ozempic and Wegovy. It is a large molecule, peptide-based drug, made up of short chains of amino acids that are broken down by stomach acid. The Wegovy pill contains an ingredient called SNAC (salcaprozate sodium) so that it can survive in the stomach long enough to be absorbed.
Without the addition of SNAC, the Wegovy pill would not have an effect. Even with the addition of SNAC, only about 1% to 2% is absorbed, which is why the Wegovy pill requires higher strengths than the injectable version.
Since the Wegovy pill is absorbed through the stomach, it needs to be taken on an empty stomach. Food and beverages can decrease how much Wegovy is absorbed.
Foundayo, on the other hand, is a small molecule that uses orforglipron as the active ingredient. It can easily bypass stomach acid without the addition of protective coatings. Because of this, it can be taken at any time of day, with or without food. In general, small-molecule drugs are also easier and less expensive to manufacture than large-molecule drugs.
Cardiovascular benefits
In addition to its weight loss benefits, the Wegovy pill can also reduce the risk of cardiovascular events in people with cardiovascular disease.
The 25 mg Wegovy pill holds FDA approval to reduce major adverse cardiovascular events (heart attack, stroke) in adults with heart disease and obesity.
This is important to keep in mind, especially if the patient has a high risk of cardiovascular disease, McCoy adds.
Foundayo is currently approved for weight management only.
[READ: GLP-1 Drugs for Heart Health: Benefits, Side Effects & Who Should Take Them]
Side Effects: How They Compare
Because both the Wegovy pill and Foundayo belong to the GLP-1 receptor agonist class, their primary side effects are gastrointestinal and are largely similar. These digestive symptoms are common during initial treatment and as you increase dose.
| Side Effect / Event | Wegovy Pill (25 mg) OASIS-4 Trial | Foundayo (17.2 mg) ATTAIN-1 Trial |
| Nausea | 47% | 35% |
| Vomiting | 31% | 24% |
| Diarrhea | 18% | 25% |
| Constipation | 24% | 24% |
| Headache and Fatigue | 8%–10% | 8%–9% |
Is Foundayo or the Wegovy Pill Right for Me?
Foundayo and the Wegovy pill are both effective oral weight loss medications. Choosing one over the other will depend on your weight loss goals, ability to follow instructions and whether you have other health conditions.
Foundayo and the Wegovy pill are both GLP-1 receptor agonists, but Wegovy is a large-molecule peptide, while Foundayo is a small molecule. Because of its large molecular structure, the Wegovy pill requires strict timing requirements, which may not work for everyone.
While a head-to-head trial does not exist, independent trials have shown that the Wegovy pill provides greater weight loss results. Foundayo allows for more flexibility with dosage timing and may appeal to those with busy or unpredictable schedules. It is also a good option to preserve weight loss when transitioning off an injectable GLP-1.
Aje adds that the major factors that determine success with her patients are the ability to take the medication as prescribed and to incorporate lifestyle changes, such as dietary modifications and exercise.
According to McCoy, ultimately, the best drug is the one that my patient can access, afford and tolerate.
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Wegovy Pill vs. Foundayo Pill: How the 2 New GLP-1 Drugs Compare originally appeared on usnews.com
