India Sees Shift from Oral to Injectable Weight-Loss Drugs, Impacting Rybelsus Sales

The Indian market for weight-loss therapies is witnessing a significant shift as more individuals opt for injectable drugs over oral medications. Novo Nordisk's once-daily oral diabetes and weight-loss drug, Rybelsus (semaglutide), which launched in India in 2022, has seen its sales level off. Data indicates a drop from a peak of 1.46 lakh units in November 2024 to 97,000 units in October 2025. This decline coincides with the introduction of injectable GLP-1 drugs earlier this year.

Doctors and experts attribute this reversal to several factors. Injectable GLP-1 drugs, such as Eli Lilly's Mounjaro (tirzepatide), offer higher efficacy, a wider range of dosage strengths, and greater convenience, leading to better patient compliance. Rybelsus, while effective for diabetes management and achieving 3-7% weight loss at its current 14 mg dose, has a plateau effect. The availability of higher-dose injectables like Mounjaro and Novo Nordisk's own Wegovy has led physicians to prescribe them for more significant weight-loss outcomes.

Eli Lilly's Mounjaro has quickly captured a substantial share of India's emerging GLP-1 market, generating ₹450 crore in sales within seven months. In contrast, Novo Nordisk's injectable Wegovy, launched in June, has seen slower uptake, with Mounjaro's monthly sales being significantly higher. The strict regimen required for Rybelsus, involving taking the pill with specific water amounts on an empty stomach, is also cited as a barrier for some patients compared to the ease of injectables.

Impact: This trend has a notable impact on the pharmaceutical sector, influencing sales strategies and market share for key players. While injectables currently cost between ₹14,000-27,000 per month and Rybelsus is priced lower at ₹10,000-13,000, cost sensitivity among middle-class consumers is expected to drive renewed interest in oral therapies if higher doses of Rybelsus (25 mg and 50 mg), currently under US FDA review, receive approval. Global trials show these higher doses achieve 10-11% weight loss and are anticipated to gain approval by early 2026, potentially leading to a second wave of growth for oral semaglutide, especially when more affordable generic versions become available after patent expiry. Patients maintaining weight loss with injectables might also switch back to orals for maintenance, particularly if cost becomes a significant factor.

Difficult Terms: GLP-1 drugs: Glucagon-like peptide-1 receptor agonists are a class of medications that mimic the effects of the GLP-1 hormone, helping to regulate blood sugar, slow digestion, and reduce appetite, making them useful for treating type 2 diabetes and obesity. Semaglutide: A specific GLP-1 receptor agonist used in drugs like Rybelsus and Wegovy for diabetes and weight management. Tirzepatide: A dual GIP and GLP-1 receptor agonist, used in drugs like Mounjaro, offering even greater efficacy in blood sugar control and weight loss. Rybelsus: An oral formulation of semaglutide developed by Novo Nordisk. Mounjaro: A brand name for tirzepatide developed by Eli Lilly and Company. Wegovy: A brand name for higher-dose semaglutide developed by Novo Nordisk, primarily for weight management. PharmaTrac: A market research firm that tracks pharmaceutical sales data in India.

Impact Rating: 7/10