Oral Semaglutide for Weight Management in Australia: What a Once-Daily Tablet Means for Patients
A once-daily tablet form of semaglutide has now been approved in Australia for weight management. Here is what the evidence shows, how it is taken, who it may suit, and how it compares with the weekly injection.
Dr Chun Guan Chong
MBBS · FRACGP · Grad Dip Surg Sci
A New Option, Not a New Medicine
Semaglutide has been used in Australia for several years as a once-weekly injection, both for type 2 diabetes and for weight management. What is new is a once-daily tablet containing the same active ingredient at a dose designed for weight management. It has now been approved by the Therapeutic Goods Administration (TGA), with supply in Australian pharmacies expected later this year.
The most common question I already hear is a simple one: "Can I just take a tablet instead of an injection?" For some people the answer will be yes. For others, the injection will remain the better fit. This article explains why.
Who It Is Approved For
The approved uses are the same as for weekly semaglutide injections used for weight management. It is intended for adults, alongside a reduced-energy diet and increased physical activity, who have:
- A body mass index (BMI) of 30 or more, or
- A BMI of 27 to under 30 with at least one weight-related condition, such as high blood pressure, high cholesterol, obstructive sleep apnoea or pre-diabetes
It is also approved to reduce the risk of major cardiovascular events (heart attack, stroke and cardiovascular death) in adults with established cardiovascular disease and a BMI of 27 or more who do not have diabetes.
The tablet is approved for adults only. It has not been studied in people under 18.
As with any GLP-1 medicine, being eligible on paper is only the starting point. Suitability depends on your full medical history.
How It Works
Semaglutide copies the action of GLP-1, a hormone your gut releases after eating. It reduces appetite, increases fullness and slows stomach emptying.
Large protein-based medicines like semaglutide are normally broken down in the digestive tract before they can be absorbed, which is why they have historically been injected. The tablet gets around this by combining semaglutide with an absorption enhancer called SNAC. The tablet dissolves in the stomach, and SNAC briefly helps semaglutide pass through the stomach lining into the bloodstream.
That mechanism is also why the tablet must be taken in a very particular way (see below).
What the Evidence Shows
The main trial supporting approval for weight management is OASIS 4, published in the New England Journal of Medicine in 2025. It followed 307 adults with obesity, or overweight with a weight-related condition, for 64 weeks, comparing the 25 mg daily tablet against a placebo. Everyone also received diet and physical activity support.
| Measure | Semaglutide 25 mg tablet | Placebo |
|---|---|---|
| Average weight loss, all participants | 13.6% | 2.2% |
| Average weight loss, if taken as directed throughout | 16.6% | 2.7% |
| Lost at least 5% of body weight | 76.3% | 30.5% |
| Lost at least 15% of body weight | 47.0% | 5.4% |
| Average starting weight | ~106 kg | ~105 kg |
Two numbers are reported because trials analyse results in two ways. The first counts everyone who started, including people who stopped the medicine or did not take it consistently. The second estimates the effect in people who kept taking it as directed. The real-world figure for any individual usually sits somewhere in that range, and depends heavily on taking the tablet correctly every day.
For context, the 25 mg daily tablet produced semaglutide levels in the blood comparable to the weekly 2.4 mg injection, and the injection's main trial (STEP 1) reported 14.9% average weight loss over 68 weeks. The tablet should be thought of as a different way of taking a similar treatment, rather than a stronger or weaker one.
Among people with pre-diabetes at the start of OASIS 4, 71% on the tablet had normal blood glucose by the end of the trial, compared with 33% on placebo.
Side Effects
The side effect profile is similar to the injection, and mostly affects the gut. In OASIS 4:
| Side effect | Semaglutide tablet | Placebo |
|---|---|---|
| Any gastrointestinal side effect | 74.0% | 42.2% |
| Nausea | 46.6% | 18.6% |
| Vomiting | 30.9% | 5.9% |
| Constipation | 20.1% | 9.8% |
| Diarrhoea | 17.6% | 8.8% |
Most of these were mild to moderate and settled with time. 6.9% of people stopped the tablet because of side effects, compared with 5.9% on placebo.
About 5% of people on the tablet also noticed altered skin sensation, such as sensitive or tingling skin. This was mild to moderate and usually settled while treatment continued.
Gradual dose increases are the main way to reduce side effects, which is why the starting dose is deliberately low. Vomiting and diarrhoea can cause dehydration, so it is important to keep up your fluids.
The usual precautions for GLP-1 medicines still apply:
- Not suitable for people with a personal or family history of medullary thyroid cancer or MEN2, or during pregnancy or breastfeeding. If you are planning a pregnancy, semaglutide should be stopped at least two months beforehand.
- Severe abdominal pain should always be assessed urgently, as pancreatitis and gallbladder problems are recognised risks with this class of medicine.
- Sudden loss of vision, even partial, needs urgent eye assessment. A rare eye condition called NAION has been reported with semaglutide.
- Before any surgery or procedure under anaesthesia or sedation, tell the treating team you take semaglutide, because it slows stomach emptying.
- Changes in mood, including low mood or thoughts of self-harm, should be reported to your doctor promptly.
How It Is Taken
Doses are increased step by step, with at least one month at each level:
- 1.5 mg daily
- 4 mg daily
- 9 mg daily
- 25 mg daily (maintenance dose)
Only one tablet is taken each day. Taking two tablets to reach a higher dose is not recommended.
Only about 1–2% of each tablet is absorbed, and food, drink and other tablets in the stomach reduce that further. That is why how you take it matters as much as whether you take it. According to the approved Product Information:
- Take it on an empty stomach, after fasting for at least 8 hours. For most people this means first thing in the morning.
- Swallow it whole with up to half a glass of plain water (120 mL). Do not split, crush or chew it.
- Wait at least 30 minutes before eating, drinking anything else, or taking any other tablets.
- If you miss a dose, skip it and take the next tablet the following day.
Your doctor and pharmacist will go through these instructions with you.
This is the single biggest practical difference from the injection. A weekly injection takes seconds, once a week. The tablet asks for a consistent morning routine, every day.
Tablet or Injection: Who Might Suit Which?
| The tablet may suit you if... | The weekly injection may suit you better if... |
|---|---|
| You are reluctant to start an injection, or have a strong needle aversion | Your mornings are unpredictable, or you often eat or drink as soon as you wake |
| You have a reliable morning routine | You take several other medicines first thing in the morning that would need re-timing |
| You prefer a daily habit to a weekly one | You would rather think about treatment once a week |
| You travel often, since tablets are stored below 30°C and need no fridge | You need a higher dose than the tablet offers |
Other medicines matter. Semaglutide can change how some medicines are absorbed. Thyroxine (levothyroxine) levels rose by about a third in studies, so thyroid blood tests may need checking, and people on warfarin need closer INR monitoring when starting. Taking other tablets at the same time as oral semaglutide also reduces how much semaglutide is absorbed. Bring a full list of your medicines to your appointment.
For adults who started treatment with a BMI of 30 or more, the weekly injection can also be increased to a higher 7.2 mg maintenance dose, given as three 2.4 mg injections. That gives more room to adjust treatment where needed.
It is possible to switch between the two forms. The tablet can be started one week after the last weekly injection, and the injection can be started the day after the last tablet. This should always be planned with your doctor rather than done on your own.
Cost and Availability
At the time of writing:
- The tablet is approved but not yet stocked in Australian pharmacies. Supply is expected later this year.
- It is not listed on the PBS, so it will be a private prescription and you will pay the full pharmacy price.
- Pricing has not yet been confirmed. I will discuss expected costs with you before prescribing anything, as I do for every weight management medicine.
Please be cautious about anyone offering a semaglutide tablet before it is available in Australian pharmacies, or offering it without a proper medical assessment. As the recent counterfeit retatrutide cases in Victoria showed, products bought outside the regulated supply chain can be dangerous. I prescribe only TGA-approved medicines dispensed by Australian pharmacies.
The Bottom Line
A tablet form of semaglutide is a genuinely useful addition, particularly for people who have avoided treatment because of injections. It is not a shortcut, and it is not a different medicine. It works best as part of a comprehensive plan that includes nutrition, physical activity, sleep and management of any related conditions.
If you would like to discuss whether a GLP-1 medicine, in either form, is appropriate for you, I am happy to talk it through. Weight management consultations are available at Knox General Practice and Family Medicine and Medi Weight Loss in Bayswater. No referral is needed.
Call (03) 9100 3130 or book online via HotDoc.
Important: This article is general information and is not a substitute for individual medical advice. Medicines mentioned here are prescription-only and are not suitable for everyone. Please speak with your own doctor about your circumstances, and read the Consumer Medicine Information before starting any new medicine.
Sources: Wharton S, et al. N Engl J Med. 2025;393(11):1077–1087 (OASIS 4). Australian Product Information for semaglutide (weight management), revised 3 November 2026.
Ready to take the next step?
Book a consultation with Dr Chun Guan Chong at Knox General Practice or Medi Weight Loss, Bayswater.