GLP-1 Pills: What You Need to Know—A Pharmacist’s Perspective

As a board-certified plastic surgeon in Raleigh, NC, I spend a lot of time talking with women—and men—about weight loss, body contouring, and how the two intersect with plastic surgery. Recently, many of my patients have been asking the same question: “What about the new GLP-1 pills? Are they better than injections?”

To help answer this, I sat down with Jonathan Beam, PharmD, Director of Clinical Operations and Regulatory Affairs at Puramint Compounding Pharmacy, a trusted partner we work closely with. Here’s a clear, honest breakdown of GLP-1 pills, how they compare to GLP-1 injections, and what you should consider—especially if plastic surgery is on your radar.

GLP-1 medications (semaglutide)—whether pills or injections—work the same way in the body. They mimic a hormone that helps regulate appetite, blood sugar, and satiety. The biggest difference comes down to absorption.

• GLP-1 injections (like Wegovy)

  • About 90% bioavailable (The ability of a drug to be absorbed and used by the body)
  • Weekly dosing
  • More predictable absorption

• GLP-1 pill form (oral GLP or oral semaglutide)

  • Only 1–2% bioavailable
  • Daily dosing required
  • Absorption can vary from person to person

This means that even though the oral dose may look much higher on paper, your body actually absorbs far less of the medication compared to injections.

The side effects are similar for both oral and injectable GLP-1s, but the experience can feel different.

Common side effects include:

• Nausea
• Upset stomach
• Bloating
• Abdominal discomfort

With GLP-1 injections, nausea tends to happen most during dose increases and often improves over time. With GLP-1 pills, the medication sits in the stomach longer, which can lead to more upper-GI symptoms like reflux, stomach pain, and nausea—especially since the pill must be taken on an empty stomach.

Because oral GLP-1 medications are fragile peptides, how you take them matters a lot. Best practices:

• Take first thing in the morning
• Completely empty stomach
• Less than 4 ounces of water
• Wait at least 30 minutes before eating or drinking anything else

Food, coffee, or excess liquid can reduce absorption and effectiveness.

If you miss your GLP-1 pill:

• If remembered within 1–2 hours, you may take it
• If it’s later than that, skip the dose
• Do not double up the next day

Consistency is key. Try to take it at the same time every morning to minimize side effects and variability.

If you’re considering plastic surgery, GLP-1 medications—pill or injection—need to be managed carefully.

• Both oral and injectable GLP-1s have a long half-life (about one week)
• I typically recommend stopping them at least 2 weeks before surgery
• This helps ensure proper nutrition, safer anesthesia, and better healing

Weight loss drugs are powerful, but surgery requires your body to be well-nourished.

Many patients ask why weight loss drugs—including GLP-1 pills—cost so much (in some instances, close to $1,000 a month). The reality:

• These medications are expensive to research, manufacture, and test
• Insurance coverage is limited or nonexistent for many patients

In some cases, a compounding pharmacy may offer customized alternatives when medically appropriate—such as different doses or formulations for patients with sensitivities.

I can’t stress this enough: be careful with online or overseas pharmacies, especially for injectable weight loss drugs. Risks include:

Unknown ingredients

Incorrect dosing

Contamination (especially dangerous with injections)

Beyond safety, weight loss with GLP-1s requires medical guidance. Without proper oversight, patients—especially women in perimenopause or menopause—can lose lean muscle, leading to long-term metabolic and health problems.

Whether you’re using GLP-1 pills, GLP-1 injections, or considering plastic surgery, remember this:

• These medications support weight loss—they don’t replace nutrition, movement, or lifestyle changes
• Rapid weight loss without guidance can lead to muscle loss, hair thinning, and nutritional deficiencies
• A medical professional should help you decide when to stop, taper, or maintain

The goal isn’t just to lose weight—it’s to lose it safely, maintain results, and feel confident in your body long-term.

If you’re exploring GLP-1’s in pill or injectable form—and wondering how they fit into your aesthetic or surgical goals—I always recommend starting with a thoughtful, personalized conversation. Your health deserves nothing less.

We are always ready to help you in your body confidence journey! Call today for a consultation (919) 797-0996.