GLP-1 alternatives include daily GLP-1 pills (the Wegovy pill and Foundayo), older prescription drugs such as phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), phentermine, orlistat and metformin, and bariatric surgery. The pills come closest to the injections, with about 11% to 14% weight loss in their main trials, while older drugs average roughly 2% to 10%.[6][7][2] There is no over-the-counter Ozempic, and supplements such as berberine produce only small changes.[15][18]
This guide is for people who cannot get, afford or tolerate a GLP-1 injection, or who want to know what else exists. For background on the drug class, start at our GLP-1 basics hub.
Why people look for an alternative
The most common reasons are practical rather than medical:
- Side effects: nausea, vomiting and constipation are the main reasons people stop GLP-1 drugs. In the 2026 BMJ analysis, stomach side effects were most increased with naltrexone-bupropion, oral semaglutide, orforglipron and tirzepatide, so switching drugs does not always solve the problem.[2]
- Needles: some people prefer a pill, which is now possible within the GLP-1 class.
- Cost and coverage: many insurance plans still exclude weight-loss drugs, and cash prices vary widely.
- Medical reasons: GLP-1 drugs are not for people with a personal or family history of medullary thyroid cancer or MEN 2, a warning that appears on the labels of the injections and the pills.[5][8]
- Not enough weight loss: see our guide to not losing weight on a GLP-1 before switching.
The right alternative depends on which of these applies to you.
GLP-1 alternatives at a glance
Results come from each drug’s main trial and are not head-to-head comparisons.
| Option | Form | Average weight loss in main trial | Prescription? |
|---|---|---|---|
| Tirzepatide (Zepbound) | Weekly injection | −20.9% at 72 weeks (15 mg)[3] | Yes |
| Semaglutide (Wegovy injection) | Weekly injection | −14.9% at 68 weeks (2.4 mg)[4] | Yes |
| Semaglutide (Wegovy pill) | Daily tablet | −13.6% at 64 weeks (25 mg)[6] | Yes |
| Orforglipron (Foundayo) | Daily tablet | −11.2% at 72 weeks (top dose)[7] | Yes |
| Phentermine-topiramate (Qsymia) | Daily capsule | −9.8% to −10.9% at 56 weeks (top dose)[11] | Yes (controlled) |
| Liraglutide (Saxenda, generics) | Daily injection | −6.4% at 68 weeks[9] | Yes |
| Naltrexone-bupropion (Contrave) | Tablets twice daily | −5.4% at 56 weeks[12] | Yes |
| Orlistat (Xenical; alli OTC) | Capsule with meals | 5.8 kg vs 3.0 kg on placebo over 4 years[14] | Xenical yes; alli no |
| Phentermine (Adipex-P, Lomaira, generics) | Daily tablet | Approved only for a few weeks[13] | Yes (controlled) |
| Metformin | Tablets | About −2% (not approved for weight loss)[16] | Yes |
| Bariatric surgery | Operation | Longest-term outcome data[17] | Surgical referral |
Is there an over-the-counter Ozempic?
No. Semaglutide, tirzepatide, liraglutide and orforglipron all require a prescription. FDA warns that products sold as GLP-1 drugs outside the normal supply chain may be unapproved, counterfeit or wrongly dosed.[20]
The only weight-loss drug FDA has approved for nonprescription sale is orlistat 60 mg (alli), for adults with overweight who also follow a reduced-calorie, low-fat diet. In 2026 FDA added a warning about kidney stones and kidney injury to its label.[15] Orlistat blocks fat absorption in the gut; it does not act on GLP-1.
Other GLP-1 options: pills and older injections
If the problem is the weekly injection, there are now two pills that work through the same GLP-1 receptor:
- Wegovy pill (oral semaglutide 25 mg): taken every morning on an empty stomach with a small sip of water, then 30 minutes before food or other drinks.[5] See our Wegovy pill cost guide.
- Foundayo (orforglipron): a non-peptide pill that can be taken with or without food.[8]
- Liraglutide: an older daily injection, now available as generics. Branded Saxenda is listed by FDA as being discontinued, with supply expected until January 2027.[10]
If the problem is cost, our GLP-1 cost without insurance guide compares current self-pay programs.
Older weight-loss drugs that are not GLP-1s
In April 2026 the American College of Physicians named semaglutide and tirzepatide first-line drugs for obesity, followed by phentermine-topiramate (second), liraglutide (third) and naltrexone-bupropion (fourth).[1]
- Qsymia (phentermine-topiramate): the most effective non-GLP-1 option in trials. It needs monthly pregnancy tests for people who can become pregnant and contains a Schedule IV controlled substance.[11]
- Contrave (naltrexone-bupropion): carries a boxed warning about suicidal thoughts, because bupropion is also an antidepressant. The label says to stop if you have not lost 5% of your weight after 12 weeks on the full dose.[12]
- Phentermine: a stimulant related to amphetamine, approved only as a short-term (a few weeks) aid. It is not for people with heart disease, uncontrolled high blood pressure or a history of drug misuse.[13]
- Orlistat: in the 4-year XENDOS trial, people on orlistat lost 5.8 kg versus 3.0 kg on placebo, but only 52% of the orlistat group finished 4 years of treatment.[14]
- Metformin: a diabetes drug, not approved for weight loss. In the Diabetes Prevention Program it lowered weight by about 2% compared with placebo, and that small loss lasted for years in people who kept taking it.[16]
A 2026 BMJ network meta-analysis found naltrexone-bupropion, liraglutide and phentermine-topiramate were among the drugs most often stopped because of side effects.[2] See stopping a GLP-1 if you are thinking about switching.
What about compounded GLP-1s?
Compounded semaglutide and tirzepatide are copies made by pharmacies rather than approved products. FDA declared the semaglutide shortage resolved in February 2025, which ended the grace periods that had let pharmacies make near-copies.[21] As of May 2026, FDA had received 990 adverse event reports linked to compounded semaglutide and more than 730 linked to compounded tirzepatide, including dosing errors.[20] They are not FDA-reviewed alternatives, so they are not listed in the table above.
Bariatric surgery
Surgery remains the option with the longest follow-up. In the Swedish Obese Subjects study, people who had bariatric surgery lived a median of 3.0 years longer than matched people who received usual care, though still 5.5 years less than the general population. About 2.9% needed repeat surgery.[17] Surgery and GLP-1 drugs have not been compared in a large randomized trial.
“Natural” GLP-1 alternatives: berberine, fiber and supplements
Supplements marketed as “nature’s Ozempic” do not come close to prescription GLP-1 drugs in trials:
| Supplement | Average effect vs control | Certainty |
|---|---|---|
| Berberine | −0.88 kg[18] | Small, mixed-quality trials |
| Psyllium fiber | −3.7 kg[19] | Moderate |
| Glucomannan | −1.4 kg[19] | Low |
| Green tea | −1.3 kg[19] | Low |
How to choose
- Needle-free but still a GLP-1: Wegovy pill or Foundayo.
- Cannot take any GLP-1 (for example, a history of medullary thyroid cancer or MEN 2): Qsymia or Contrave, if their own warnings do not apply.[11][12]
- Cost is the main barrier: generic liraglutide, metformin or phentermine, accepting smaller results.
- Severe obesity with complications: ask about a bariatric surgery referral.
A clinician should weigh your other conditions, medicines and goals. Most of these labels advise against combining weight-loss drugs.[11][13]
