Mechanism
A single agonist.
It activates one receptor, GLP-1. Its sequence is 94% the same as human GLP-1, with small changes that let it last about a week.21
US FDA approved
Semaglutide
One receptor. Weekly injection or daily tablet.
Semaglutide is a long-acting version of GLP-1, a gut hormone that helps manage blood sugar and appetite. It activates one receptor, and it is the active ingredient in Ozempic, Wegovy and Rybelsus. Tirzepatide and retatrutide add a second and a third receptor to this GLP-1 pathway.
- Targets
- GLP-1
- Dosing schedule
- Once weekly, injected under the skin, or once daily as a tablet, depending on the brand
- Half-life
- About 1 week
- Brand names
- Ozempic, Wegovy, Wegovy pill, Rybelsus
Approved uses
- Type 2 diabetes in adults, alongside diet and exercise (Ozempic, Rybelsus)
- Lowering the risk of heart attack, stroke and cardiovascular death in adults with type 2 diabetes and established heart disease (Ozempic) or at high risk (Rybelsus)
- Lowering the risk of worsening kidney disease, kidney failure and cardiovascular death in adults with type 2 diabetes and chronic kidney disease (Ozempic)
- Chronic weight management in adults with obesity, or overweight with a weight-related condition, and in children aged 12 and older with obesity (Wegovy; the Wegovy pill is for adults only)
- Lowering the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and obesity or overweight (Wegovy)
- Noncirrhotic MASH (fatty-liver inflammation) with moderate-to-advanced liver fibrosis in adults, under accelerated approval (Wegovy injection)
US approvals as of the May 2026 Ozempic, June 2026 Wegovy and January 2026 Rybelsus labels. Approved uses differ by country; in the Philippines, check the FDA product register.
Developed by Novo Nordisk.
A support, not a shortcut.
This is not a magic weight-loss elixir. It works alongside a healthier diet and regular exercise, and only with a doctor's prescription and guidance.
Approved brands
Semaglutide, by brand name.
The same active ingredient is sold as four branded products, each with its own approved uses and form. All are prescription-only medicines.
Ozempic
Once-weekly injection penApproved for (US)21
- Type 2 diabetes in adults, alongside diet and exercise
- Lowering the risk of heart attack, stroke and cardiovascular death in adults with type 2 diabetes and established heart disease
- Lowering the risk of worsening kidney disease, kidney failure and cardiovascular death in adults with type 2 diabetes and chronic kidney disease
- First approved
- December 2017 (US FDA)
- Philippines
- Reported as registered with the Philippine FDA for type 2 diabetes, as a prescription-only medicine. Check verification.fda.gov.ph for the current registration.39
Not approved for weight management in the US; Wegovy is the semaglutide brand for that. In the US, a once-daily tablet is also sold as "Ozempic tablets" (see Rybelsus).
Wegovy
Once-weekly injection penApproved for (US)22
- Chronic weight management in adults and children aged 12 and older with obesity, and adults with overweight plus a weight-related condition
- Lowering the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and obesity or overweight
- Noncirrhotic MASH (fatty-liver inflammation) with moderate-to-advanced fibrosis in adults, under accelerated approval
- First approved
- June 2021 (US FDA)
- Philippines
- Approved by the Philippine FDA as a prescription-only injection and launched in the Philippines in April 2026. Check verification.fda.gov.ph for the current registration.40
Used together with a reduced-calorie diet and more physical activity. A higher-dose version, Wegovy HD, was approved in the US in March 2026.
Wegovy pill
Once-daily tabletApproved for (US)22
- Chronic weight management in adults with obesity, or overweight plus a weight-related condition
- Lowering the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and obesity or overweight
- First approved
- December 2025 (US FDA)
- Philippines
- Not confirmed on the Philippine FDA register as of November 2026 — check verification.fda.gov.ph.
The first GLP-1 tablet approved for weight management. Adults only. Also authorised in the EU in 2026.
Rybelsus
Once-daily tabletApproved for (US)23
- Type 2 diabetes in adults, alongside diet and exercise
- Lowering the risk of heart attack, stroke and cardiovascular death in adults with type 2 diabetes at high risk
- First approved
- September 2019 (US FDA)
- Philippines
- Not confirmed on the Philippine FDA register as of November 2026 — check verification.fda.gov.ph.
The first GLP-1 tablet. In the US, a reformulated version is sold as "Ozempic tablets" under the same label; the two are not interchangeable milligram for milligram. Rybelsus is still marketed outside the US.
Brand names are listed for identification only; Gtides does not sell or recommend any product. Only a licensed physician can prescribe these medicines. In the Philippines, check a product's registration on the FDA verification portal and have it dispensed by an FDA-licensed pharmacy.
Highlights
Get to know Semaglutide.
By the numbers
What the trials measured.
How it works
One receptor. One molecule.
GLP-1 is an incretin: a hormone released by the gut after a meal. Semaglutide copies it at a single receptor. It boosts insulin and lowers glucagon only when blood sugar is high, slightly slows stomach emptying, and acts on brain areas that regulate appetite, so people eat less. Tirzepatide adds GIP activity on top of this, and retatrutide adds glucagon as well.
GLP-1 receptor
Responds to Glucagon-like peptide-1
- Boosts insulin release when blood sugar is high
- Lowers glucagon after meals
- Slows stomach emptying
- Signals fullness to the brain
Not targeted
GIP receptor
Responds to Glucose-dependent insulinotropic polypeptide
Semaglutide does not act on this receptor. Tirzepatide and Retatrutide add it.
Not targeted
Glucagon receptor
Responds to Glucagon
Semaglutide does not act on this receptor. Retatrutide adds it.
The molecule
Engineered to last.
- Length
- 31 amino acids24
- Molecular formula
- C₁₈₇H₂₉₁N₄₅O₅₉21
- Molecular weight
- ≈ 4,114 g/mol21
- Backbone
- Human GLP-1, with 94% sequence homology21
- Stability
- One Aib residue (position 2; position 8 in GLP-1) resists breakdown by the DPP-4 enzyme
- Half-life extension
- C18 fatty diacid attached to lysine 20 (Lys26 in GLP-1) through a spacer, enabling albumin binding24
- Bioavailability (injection)
- About 89% after injection under the skin21
- Bioavailability (tablet)
- About 0.4–2%, helped by the absorption enhancer SNAC23
Amino-acid sequence
- HPosition 1
- AibPosition 2
- EPosition 3
- GPosition 4
- TPosition 5
- FPosition 6
- TPosition 7
- SPosition 8
- DPosition 9
- VPosition 10
- SPosition 11
- SPosition 12
- YPosition 13
- LPosition 14
- EPosition 15
- GPosition 16
- QPosition 17
- APosition 18
- APosition 19
- KPosition 20
- EPosition 21
- FPosition 22
- IPosition 23
- APosition 24
- WPosition 25
- LPosition 26
- VPosition 27
- RPosition 28
- GPosition 29
- RPosition 30
- GPosition 31
Aib (non-standard, resists DPP-4) Lysine with C18 fatty-acid side chain
Aib = α-aminoisobutyric acid, a non-standard amino acid, at GLP-1 position 8. Lysine 20 (Lys26) carries the fatty-acid side chain. The arginine at residue 28 (Arg34) replaces a lysine, so only one side chain attaches.
Research
The key trials.
STEP 1
Phase 3- Who
- 1,961 adults with obesity, or overweight with a related condition, without diabetes
- How long
- 68 weeks
- Compared
- 2.4 mg weekly injection vs placebo, both with lifestyle support
Average body-weight change of −14.9% vs −2.4% with placebo. 50.5% of people on semaglutide lost at least 15% of their weight, vs 4.9% on placebo.25
- Placebo2.4
- 2.4 mg14.9
STEP UP
Phase 3b- Who
- 1,407 adults with obesity, without diabetes
- How long
- 72 weeks
- Compared
- 7.2 mg or 2.4 mg weekly injection vs placebo
Average weight loss of 18.7% with 7.2 mg and 15.6% with 2.4 mg, vs 3.9% with placebo. Altered skin sensations (dysesthesia) affected 22.9% on 7.2 mg.27
- Placebo3.9
- 2.4 mg15.6
- 7.2 mg18.7
OASIS 4
Phase 3- Who
- 307 adults with obesity or overweight, without diabetes
- How long
- 64 weeks
- Compared
- 25 mg once-daily tablet vs placebo
Average body-weight change of −13.6% vs −2.2% with placebo (−16.6% vs −2.7% among people who kept taking it). This trial supported the Wegovy pill approval.28
- Placebo2.2
- 25 mg tablet13.6
SELECT
Phase 3- Who
- 17,604 adults aged 45 or older with heart disease and overweight or obesity, without diabetes
- How long
- About 40 months on average
- Compared
- 2.4 mg weekly injection vs placebo
Heart attack, stroke or cardiovascular death in 6.5% vs 8.0% with placebo, a 20% lower risk. Deaths from any cause: 4.3% vs 5.2%.29
SUSTAIN-6
Phase 3- Who
- 3,297 adults with type 2 diabetes at high cardiovascular risk
- How long
- 104 weeks
- Compared
- 0.5 or 1 mg weekly injection vs placebo, on top of usual care
Heart attack, stroke or cardiovascular death in 6.6% vs 8.9% with placebo. Diabetic eye complications were more common: 3.0% vs 1.8%.30
SOUL
Phase 3- Who
- 9,650 adults aged 50 or older with type 2 diabetes and heart disease, chronic kidney disease or both
- How long
- About 4 years (median 49.5 months)
- Compared
- Once-daily tablet (up to 14 mg) vs placebo
Heart attack, stroke or cardiovascular death in 12.0% vs 13.8% with placebo, a 14% lower risk. The kidney outcome did not differ significantly.31
FLOW
Phase 3- Who
- 3,533 adults with type 2 diabetes and chronic kidney disease
- How long
- Median 3.4 years
- Compared
- 1 mg weekly injection vs placebo
Stopped early because of clear benefit: 24% lower risk of kidney failure, major kidney decline or death from kidney or heart causes. Kidney function declined more slowly each year.17
ESSENCE
Phase 3- Who
- Adults with MASH (fatty-liver inflammation) and moderate-to-advanced fibrosis; first 800 of 1,197 analysed
- How long
- 72 weeks (part 1; outcomes part ongoing)
- Compared
- 2.4 mg weekly injection vs placebo, with liver biopsies
Steatohepatitis resolved without fibrosis worsening in 62.9% vs 34.3%; fibrosis improved without inflammation worsening in 36.8% vs 22.4%.32
EVOKE and EVOKE+
Phase 3- Who
- 3,808 adults aged 55–85 with mild cognitive impairment or mild dementia due to Alzheimer's disease
- How long
- 104 weeks
- Compared
- Once-daily tablet (up to 14 mg) vs placebo
A negative result: neither trial slowed Alzheimer's progression, measured by a dementia-severity score (CDR-SB), compared with placebo.33
Safety
What to know about side effects.
Most common
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Stomach pain
- Headache
- Tiredness
- Indigestion
- Dizziness
In Wegovy's weight-management trials, 44% of people had nausea, versus 16% on placebo. In STEP 1, digestive side effects were usually mild to moderate and temporary.
Warnings on the label22
Thyroid C-cell tumors
Boxed warning: caused thyroid C-cell tumors in rodents; whether this applies to humans is unknown. Not for people with a personal or family history of medullary thyroid carcinoma or MEN 2.
Pancreatitis
Severe, persistent stomach pain, sometimes spreading to the back, needs prompt medical attention.
Gallbladder problems
Including gallstones and gallbladder inflammation.
Diabetic eye disease
In SUSTAIN-6, eye complications occurred in 3.0% vs 1.8% on placebo; the increase was larger in people who already had retinopathy. Rapid improvement in blood sugar can temporarily worsen it.
Sudden vision loss (NAION)
In 2025 the EMA judged NAION, a loss of blood flow to the optic nerve, a very rare side effect (up to 1 in 10,000 users). In November 2026 the US FDA required all GLP-1 medicine labels to add a possible increased risk; cause and effect is not proven. Sudden vision loss needs urgent care.3441
Low blood sugar
Risk rises when combined with insulin or a sulfonylurea.
Kidney problems
Dehydration from vomiting or diarrhea can worsen kidney function.
Severe digestive reactions
Not recommended for people with severe gastroparesis (very slow stomach emptying).
Heart rate
Resting heart rate rose by about 1–4 beats per minute on average.
Pregnancy and breastfeeding
The labels advise stopping at least 2 months before a planned pregnancy, because it stays in the body for weeks. Breastfeeding is not recommended with the tablets.
Anaesthesia and sedation
Slower stomach emptying raises the risk of inhaling stomach contents. Tell your care team before any procedure.
This is a summary, not a complete list. Only a qualified healthcare professional can say whether a medicine is appropriate for someone.
Timeline
From lab to clinic.
2015
Novo Nordisk scientists publish the discovery of semaglutide.
2016
SUSTAIN-6 heart-safety results published in NEJM.
Dec 2017
FDA approves Ozempic for type 2 diabetes.
Sep 2019
FDA approves Rybelsus, the first GLP-1 tablet.
Jan 2020
Ozempic label adds lowering cardiovascular-event risk in type 2 diabetes.
Jun 2021
FDA approves Wegovy for chronic weight management.
Dec 2022
Wegovy approved for adolescents aged 12 and older with obesity.
Mar 2024
Wegovy approved to lower heart-event risk in adults with heart disease and overweight (SELECT).
Jun 2024
WHO warns of falsified Ozempic batches found in Brazil, the UK and the US.
Jan 2025
Ozempic approved to lower kidney and heart risk in type 2 diabetes with kidney disease (FLOW).
Aug 2025
Wegovy gets accelerated approval for MASH with liver fibrosis.
Oct 2025
Rybelsus approved to lower cardiovascular-event risk (SOUL).
Nov 2025
EVOKE trials show no benefit in early Alzheimer's disease.
Dec 2025
FDA approves the Wegovy pill, the first GLP-1 tablet for weight management.
Mar 2026
FDA approves Wegovy HD (7.2 mg). The Philippine College of Physicians warns against compounded and unregistered semaglutide.
Apr 2026
Wegovy launches in the Philippines as a prescription-only medicine.
Nov 2026
FDA requires all GLP-1 medicine labels to mention a possible risk of sudden vision loss (NAION).
Keep exploring
The other focus peptides.
- Investigational · Phase 3 complete
Retatrutide
Three receptors. One weekly peptide.
LY3437943 · no approved brand yet