Semaglutide (Ozempic and Wegovy): uses, side effects, cost and how to get evaluated in Puerto Rico

Semaglutide is a GLP-1 receptor agonist. It mimics a hormone your body releases after you eat: it helps the pancreas release insulin when blood sugar rises, slows how fast the stomach empties and reduces appetite. It is sold under three brand names: Ozempic and Rybelsus for type 2 diabetes, and Wegovy for weight management.

Ozempic is injected under the skin once a week, on the same day each week, with a prefilled pen. The dose starts low (0.25 mg) and is usually raised every 4 weeks to 0.5 mg, 1 mg or 2 mg, depending on how you respond and how well you tolerate it.

Per its FDA label, Ozempic is approved for adults with type 2 diabetes to improve blood sugar along with diet and exercise, to lower the risk of heart attack, stroke or cardiovascular death in those with established heart disease, and to lower the risk of worsening kidney disease in those with type 2 diabetes and chronic kidney disease.

Both are made by Novo Nordisk and both contain semaglutide. What differs is what the FDA approved each one for, and the dose:

• Ozempic (injection): type 2 diabetes in adults, plus the heart and kidney risk reduction above. Doses up to 2 mg a week.
• Wegovy (injection): reducing excess body weight and keeping it off long term in adults with obesity, or with overweight plus at least one weight-related condition (such as high blood pressure or prediabetes), and in teens 12 and older with obesity; lowering the risk of heart attack and stroke in adults with heart disease and obesity or overweight; and treating metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis, without cirrhosis, in adults. The maintenance dose is 2.4 mg a week; for adults the label also includes 7.2 mg (Wegovy HD).

So when people search Ozempic for weight loss, the semaglutide product approved for that purpose is Wegovy. To see how semaglutide compares with tirzepatide (Mounjaro and Zepbound), read our Ozempic, Mounjaro, Zepbound and Wegovy comparison and the Mounjaro and Zepbound guide.

Yes, there is a Wegovy pill. The FDA approved Wegovy tablets to reduce excess body weight and keep it off long term in adults with obesity, or with overweight plus at least one weight-related condition, and to lower the risk of heart attack, stroke or cardiovascular death in adults with heart disease and obesity or overweight. It is taken once a day: you start at 1.5 mg for 30 days and step up every 30 days to the 25 mg maintenance dose.

The label says to take it on an empty stomach in the morning with a little water (up to 4 ounces), swallow it whole, and wait at least 30 minutes before eating, drinking anything else or taking other oral medicines.

For other oral options for weight, see our guide to weight loss pills. Semaglutide tablets for diabetes, Rybelsus, are a different product, covered in the next section.

Rybelsus is semaglutide in a once-daily tablet, made by Novo Nordisk. Per its FDA label (revised January 2026), it is approved, along with diet and exercise, to improve blood sugar in adults with type 2 diabetes, and to lower the risk of major cardiovascular events (heart attack, stroke or cardiovascular death) in adults with type 2 diabetes at high cardiovascular risk. The same label now also covers Ozempic tablets, another oral semaglutide product with different doses.

How it is taken: one tablet a day, in the morning on an empty stomach, with a little plain water (up to 4 ounces, about 120 mL), swallowed whole without splitting or chewing. Then wait at least 30 minutes before eating, drinking or taking other oral medicines. Rybelsus starts at 3 mg for 30 days (a starting dose that does not control blood sugar), then goes up to 7 mg and, if more control is needed, 14 mg. Ozempic tablets use 1.5 mg, 4 mg and 9 mg; the two are not interchangeable milligram for milligram.

Rybelsus carries the same boxed warning for thyroid C-cell tumors as injectable semaglutide: it is not used if you or a family member has had medullary thyroid carcinoma, or if you have multiple endocrine neoplasia syndrome type 2 (MEN 2). Its other risks are those in the side effects section, and the label advises stopping it at least 2 months before a planned pregnancy.

Rybelsus is not approved for weight loss, and it is not the same as the Wegovy pill: the Wegovy tablet is a different semaglutide product, with different doses (a 25 mg maintenance dose) and approved for weight. If you already take Rybelsus for diabetes, continuing it is reviewed in a follow-up visit (prescription refills), and the doctor decides whether it is right for you.

Ozempic is not FDA-approved for weight loss. When a doctor prescribes it only for that purpose, it is off-label use. Wegovy carries that approval, with body mass index (BMI) criteria and related health conditions.

If you have type 2 diabetes and take Ozempic, weight loss may be an added benefit, but the goal of treatment is your blood sugar, heart and kidneys. If you have prediabetes and overweight, that counts as one of the weight-related conditions in Wegovy’s criteria.

Either way, the doctor decides whether a medicine is right for you after evaluating you: your weight, your other conditions, your medicines, your family history and your goals.

The most common side effects involve the stomach and tend to show up when you start or raise the dose: nausea, diarrhea, vomiting, constipation and belly pain, plus heartburn, gas or burping, headache and tiredness. The Wegovy label also lists dizziness and hair loss.

The most important warnings on the FDA label:

In the STEP 1 trial (New England Journal of Medicine, 2021), 1,961 adults without diabetes and with a BMI of 30 or more, or 27 or more with a weight-related condition, took semaglutide 2.4 mg weekly or placebo for 68 weeks, alongside lifestyle changes. Average weight loss was 14.9% with semaglutide and 2.4% with placebo. Of those on semaglutide, 86.4% lost at least 5% of their body weight.

These are trial averages: everyone responds differently, and no one can promise you a number of pounds. Nausea and diarrhea were the most common side effects, usually mild to moderate and temporary.

When the medicine stops, weight tends to return. In the STEP 1 extension, one year after stopping semaglutide and the lifestyle program, participants regained on average two-thirds of the weight they had lost. In STEP 4, people who stayed on semaglutide after 20 weeks lost a further 7.9%, while those switched to placebo gained 6.9%.

The medicine costs extra, separate from the visit, and you pay for it at the pharmacy. What you pay depends on your health plan, your diagnosis (for example type 2 diabetes or weight management) and the pharmacy. The clinic does not bill insurance; if you have a plan, ask what it covers and whether it needs prior authorization.

For self-pay patients, Novo Nordisk publishes prices at its NovoCare Pharmacy. Per its page, accessed October 9, 2026: the Ozempic pen is US$349 a month for the 0.25 mg to 1 mg doses (and US$499 for 2 mg); the Wegovy pen is US$349 a month from 0.25 mg to 2.4 mg and US$399 for 7.2 mg; and the Wegovy pill runs from US$149 a month at the starting dose to US$299 at 9 mg and 25 mg. Patients new to NovoCare can get US$199 a month for 2 monthly fills of the 0.25 mg and 0.5 mg pen doses, through December 31, 2026.

The manufacturer can change or cancel these prices, eligibility rules apply, and its page does not say whether shipping is available in Puerto Rico. Check the current price with NovoCare or your pharmacy before you decide.

Compounded semaglutide is not FDA-approved, and the clinic does not prescribe it. The FDA explains that it does not review these products for safety, effectiveness or quality before they reach the market.

The FDA has also received reports of serious side effects, some requiring hospitalization, from dosing errors with compounded semaglutide injections, which are not FDA-approved. The clinic only prescribes FDA-approved brand medicines such as Ozempic and Wegovy.

If you take semaglutide and have severe, constant belly pain that spreads to your back, signs of a serious allergic reaction (swelling of the face, lips or throat, or trouble breathing), vomiting that keeps you from holding down fluids, or low blood sugar with confusion, go to the emergency room or call 911.

If someone injected too much, call Poison Control at 1-800-222-1222. See also our emergency guide.