Pills, Shots, Capsules, Oh My!
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Patients have been asking us about a few newer weight loss options lately. Some are GLP-1 medications. One is not a GLP-1. One is not technically a medication at all, but rather a device.
So, naturally, the internet has handled this with its usual calm and organized approach. Kidding…It is chaos.
The four names we keep getting asked about are:
Epitomee Capsule
Wegovy HD
Oral Wegovy
Foundayo
This is not a “which one should you ask for?” blog. It is more of a “what are these, what do they cost, how much weight loss are we talking about, and who might they make sense for?” blog.
Basically, a golf club review, but for the newest weight loss medications.
First, the big thing to know
More options are good, but more options are also confusing.
The best weight loss medication is not always the newest one. It is the one that fits your body, health history, side effects, insurance, budget, schedule, and goals.
We help patients when appropriate sort through evidence based weight loss medications and anti-obesity treatment options without making it feel like you need a medical degree and three cups of coffee.
This especially matters for women in perimenopause and menopause. Weight loss can change during this stage of life because appetite, sleep, insulin resistance, muscle mass, stress, hormones, and energy can all shift at the same time.
Very rude.
Quick Comparison Guide
*Quoted cost is based on current cash pay prices
** All four of these options is currently only approved for adults 18 and older. Wegovy injection (up to 2.4mg) is approved for ages 12 & up.
Epitomee
What it is: Prescription capsule device. Not a GLP-1.
Dosing: Twice daily before meals
Average weight loss: 6.6%
Cost notes: Around $189/month
Cody’s thoughts: Modest weight loss, but could be useful for the right patient. May make sense if one meal is the problem, like dinner. Could also be an add on for someone already maxed out on a GLP-1 who still needs help but cannot tolerate a higher dose.
Value thought: To be determined... Weight loss in trials is on the lower end of the spectrum, but with more real world use it could be better optimized. Could make sense if the main struggle is fullness or one problem meal, like dinner.
Wegovy HD
What it is: Higher dose semaglutide injection
Dosing: Once weekly
Average weight loss: 18.8%
Cost notes: Starter doses around $149/month. Typical maintenance doses around $299/month.
Cody’s thoughts: Worth talking about if weight loss has stalled on Wegovy 2.4 mg and food noise or cravings are still hanging around. Could be an option if you do not want to switch to Zepbound or do not have coverage for it. Watch for side effects, including increased skin sensitivity.
Value thought: Strong value if the patient already tolerates semaglutide and needs more response without switching medications.
Oral Wegovy
What it is: Daily semaglutide GLP-1 tablet
Dosing: Once daily
Average weight loss: 13.6%
Cost notes: Starter doses around $149/month. Typical maintenance doses around $299/month.
Cody’s thoughts: Good option for those with needle phobia or if you worry about side effects lasting several days on a weekly injection. Since it is daily, side effects may feel more intermittent than continuous. Not ideal if remembering daily pills is hard. It has to be taken on an empty stomach 30 mins prior to your first meal. You must remember to eat within 30-60 mins to avoid more significant side effects.
Value thought: Good value if injections are the barrier and the patient can follow the empty stomach dosing rules.
Foundayo
What it is: Daily oral GLP-1 pill, orforglipron
Dosing: Once daily
Average weight loss: 11%
Cost notes: Starter doses around $149/month. Typical maintenance doses around $299/month.
Cody’s thoughts: If you have not tolerated semaglutide or tirzepatide, this could be worth discussing because it is a different drug. It is more convenient than oral Wegovy because it does not need to be taken on an empty stomach. But it has lower average weight loss and may not be a first choice for many patients.
Value thought: Low at current pricing. Injectables and oral Wegovy provide significantly more weight loss at very similar price. I don't anticipate writing many prescriptions for Foundayo unless price drops.
1. Epitomee
Epitomee is probably the one getting the most “wait, what?” reactions.
It is not a GLP-1. It is not semaglutide. It is not tirzepatide. It is not an injection. It is a prescription capsule device that expands in the stomach to help with fullness for adults with a BMI of 25 to 40 when used with diet and exercise.
Think of it as a tool for appetite and portions, not a hormone based GLP-1 medication.
Average weight loss
The average weight loss reported for Epitomee is 6.6%. That is more modest than the GLP-1 options on this list. But modest does not mean useless.
For the right patient, 6.6% can still matter. Especially if the person is looking for something lower intensity, does not want a GLP-1, or needs help with a specific eating pattern.
Cost
Cody’s current estimate is around $189 per month.
Pricing can change, so we always recommend checking current cost before making a decision. Because nothing says “fun” like thinking you know the price and then getting humbled by the pharmacy.
Side effects
Epitomee may be better tolerated for some patients because it does not work like a GLP-1. That said, anything that works in the stomach can still cause digestive symptoms for some people.
This is still something to discuss with a provider, especially if you have GI concerns, swallowing issues, a history of certain stomach problems, or other medical factors.
Cody’s thoughts
Epitomee could be useful for the right person, but has much lower expected weight loss as the stronger GLP-1 medications.
Where I could see it fitting:
Someone does pretty well most of the day, but one meal is the problem. Dinner is a common one.
It could also be worth discussing as an add on for someone already on a GLP-1 who is maxed on dose, still has some hunger, but cannot tolerate a higher dose.
It is not the big driver in the bag. But it might be a useful wedge. Yes, that was a golf reference. No, I will not apologize.
2. Wegovy HD
Oral Wegovy is the same active drug as Ozempic and Wegovy injection. It was the first oral GLP-1 approved for weight loss. Wegovy HD is higher dose semaglutide. It is still a GLP-1 medication. It is still an injection. It is still taken once weekly.
This is not where someone starts. This is more of a “we are already on Wegovy 2.4 mg and now we need to decide what comes next” conversation.
Wegovy HD is not currently approved for use in adolescents. The maximum dose remains 2.4mg for the 12–17 year old age range.
Average weight loss
Average weight loss is around 18.8%. That makes it one of the stronger options on this list. But higher dose does not automatically mean better for every patient.
Sometimes a higher dose helps. Sometimes the side effects are not worth it. Sometimes switching medications makes more sense. Sometimes the problem is not dose at all.
Cost
Starter doses are around $149 per month. Typical maintenance doses are around $299 per month.
Insurance coverage, pharmacy access, and manufacturer programs can change what someone pays.
Side effects
Wegovy HD can have the same general type of side effects we talk about with semaglutide. Common ones can include nausea, constipation, diarrhea, vomiting, reflux, stomach discomfort, and appetite changes. With a higher dose, side effects may be more noticeable for some patients.
Cody also watches for skin sensation changes, like tenderness, sensitivity, or odd skin discomfort. That is one of those things patients may not think to mention unless someone asks.
Cody’s thoughts
Wegovy HD may be worth discussing if someone has stalled on Wegovy 2.4 mg and still has food noise, cravings, or appetite coming back stronger than expected.
It could also make sense if someone does not want to switch to Zepbound or does not have coverage for Zepbound.
3. Oral Wegovy
Oral Wegovy is semaglutide in pill form. That is a big deal for people who want GLP-1 treatment but do not want injections.
Needle phobia is a real barrier for a lot of people. So is the anxiety of taking a weekly injection and worrying that side effects could hang around for days. A daily pill may feel less intimidating.
Unlike the injectable version, Wegovy tablet does not have approval for use in 12–17 year olds, nor does it have approval for metabolic associated steatotic liver disease (MASH), formerly known as “fatty liver”.
Average weight loss
Average weight loss is around 13.6%. That is less than Wegovy HD, but still a meaningful amount of weight loss for many patients.
Cost
Starter doses are around $149 per month. Typical maintenance doses are around $299 per month.
Novo has listed self pay pricing for oral Wegovy starting at $149 per month for lower doses, with higher doses listed at $299 per month.
Side effects
Side effects can be similar to other semaglutide medications. That may include nausea, constipation, diarrhea, vomiting, reflux, stomach pain, and appetite changes. But because this is taken daily, some patients may like that the side effect pattern feels more daily in and daily out.
For someone who gets nervous about a weekly injection lasting in their system for several days, that may feel easier to manage.
The catch
Oral Wegovy has rules. You take it on an empty stomach with water. Then you wait 30 minutes before eating, drinking, or taking other oral medications. Novo’s prescribing information includes daily tablet dosing and dose escalation instructions.
That means this is not the best fit for everyone.
Cody’s thoughts
Oral Wegovy may be a good option for patients with needle phobia or for people worried about side effects lasting multiple days after a weekly injection.
I also like it for the right patient who does better with daily dosing. Some people remember daily medications beautifully. Some people forget weekly things because once a week is not enough of a routine.
But if you cannot remember to take pills at the same time every day, or if the empty stomach instructions are going to be a mess, this may not be your best fit.
The best medication is the one you can take correctly.
4. Foundayo
Foundayo is a daily oral GLP-1 pill. The medication name is orforglipron.
It is different from semaglutide and tirzepatide, which is why it may be interesting for people who did not tolerate those options well.
It is also more convenient than oral Wegovy because it does not have the same empty stomach and 30 minute wait situation. Eli Lilly and Company says Foundayo can be taken without food or water restrictions.
Average weight loss
Average weight loss is around 11%. That is the lowest GLP-1 weight loss percentage on this list. That does not mean it has no place. It means we need to be honest about where it fits.
Cost
Starter doses are around $149 per month. Typical maintenance doses are around $299 per month.
Eli Lilly’s release says Foundayo starts at $149 per month at the lowest dose for self pay patients, and Reuters reported most patients are expected to pay around $349 per month, with refill incentives lowering costs to as low as $299.
Side effects
Foundayo can still have GLP-1 type side effects. That may include nausea, constipation, diarrhea, vomiting, indigestion, stomach pain, bloating, reflux, and appetite changes.
Like other GLP-1 medications, it is not something to treat casually just because it is a pill.
Cody’s thoughts
If someone has not tolerated semaglutide or tirzepatide, Foundayo could be worth discussing because it is a different drug.
It is a little more convenient than oral Wegovy because you do not have to take it on an empty stomach or wait 30 minutes to eat. That said, it has lower average weight loss than some other options and may be just as expensive as oral Wegovy for many patients. Because of that, it probably will not be a first choice for a lot of people.
But for the right patient, especially someone who wants an oral option and struggled with other GLP-1s, it deserves a conversation.
The bottom line
Epitomee, Wegovy HD, oral Wegovy, and Foundayo give us more options for our toolbox, which is a good thing. But more options also means more confusion, more screenshots, more “my cousin said,” and more late night searching.
So bring us the questions. Bring the names you have heard. Bring the screenshot from your group chat.
We can help you sort through what is worth considering, what is not a fit, what might be covered, what might cost too much, and what makes sense for your health.
