GLP-1 update 2026: oral Wegovy, NAION risk and new ESC recommendations
Semaglutide tablets for weight management in the EU, NAION as a very rare side effect, GLP-1 therapies in the 2026 ESC guidelines, with sources.
By Medelix EditorialPublished: 2 min read
Since 2026, Wegovy (semaglutide) is also available in the EU as a once-daily tablet for weight management. EMA's human medicines committee (CHMP) recommended the extension on 22 May 2026 and described it as the first oral GLP-1 treatment for weight management ([1]). In the pivotal trial (307 adults, 64 weeks), participants taking the tablets lost on average 13.61% of their body weight, compared with 2.18% on placebo ([1]). Three more points matter in practice. NAION is a very rare side effect of semaglutide ([4]). The 2026 ESC guidelines include GLP-1-based therapy for heart failure with obesity and for CKD with type 2 diabetes ([5], [6]). And reimbursement rules for weight-management drugs differ from country to country.
As of October 2026. Information for healthcare professionals. The current summary of product characteristics takes precedence.
Oral Wegovy: what we know
- Indication: adults with obesity, or overweight with at least one weight-related comorbidity, as an adjunct to diet and physical activity ([1]).
- How to take it: once daily on an empty stomach, after at least 8 hours of fasting. Then wait 30 minutes before eating, drinking or taking other medicines ([1]).
- Most common side effects: gastrointestinal (nausea, diarrhoea, constipation, vomiting), mostly at the start of treatment ([1]).
Authorised indications at a glance (EU)
| Substance (product) | Weight management in adults | Other indications |
|---|---|---|
| Semaglutide s.c. (Wegovy) | BMI ≥30 kg/m², or ≥27 to <30 kg/m² with at least one weight-related comorbidity ([2]) | Adolescents aged ≥12 with obesity and body weight >60 kg. Stop and re-evaluate if BMI has not fallen by at least 5% after 12 weeks on 2.4 mg or the maximum tolerated dose ([2]) |
| Tirzepatide (Mounjaro) | BMI ≥30 kg/m², or ≥27 to <30 kg/m² with at least one weight-related comorbidity ([3]) | Type 2 diabetes in adults and in children and adolescents aged ≥10 ([3]) |
You can calculate BMI with the BMI calculator. In May 2026 the CHMP also recommended two hybrid liraglutide products, one of them for weight management ([8]).
Safety: NAION
In June 2025, EMA's safety committee (PRAC) concluded that non-arteritic anterior ischaemic optic neuropathy (NAION) is a very rare side effect of semaglutide, affecting up to 1 in 10,000 people. It applies to Ozempic, Rybelsus and Wegovy ([4]). Patients with sudden loss of vision or rapidly worsening eyesight should contact their doctor without delay. If NAION is confirmed, semaglutide should be stopped ([4]).
GLP-1 therapies in the 2026 ESC guidelines
- Heart failure: semaglutide or tirzepatide should be considered in patients with symptomatic HF, LVEF ≥45% and BMI ≥30 kg/m², regardless of diabetes status, to reduce body weight and improve exercise capacity and quality of life (class IIa, level B1) ([5]).
- CKD with type 2 diabetes: subcutaneous semaglutide 1.0 mg/week after titration is recommended within defined eGFR and uACR ranges to reduce CKD progression and cardiovascular events (class I, level A) ([6]). For kidney function, see the eGFR calculator.
For more, see our summary of the 2026 ESC guidelines.
Reimbursement
Coverage of weight-management drugs varies across Europe. In Germany, for example, § 34(1) of the Social Code Book V excludes drugs used mainly "for weight reduction or appetite suppression, for regulating body weight" from statutory health insurance ([7]). Treatment of type 2 diabetes follows different rules. Check your national regulations.
Sources
- EMA. First oral GLP-1 treatment for weight management (22 May 2026): https://www.ema.europa.eu/en/news/first-oral-glp-1-treatment-weight-management
- EMA. Wegovy – EPAR (product information, updated 21 Sep 2026): https://www.ema.europa.eu/en/medicines/human/EPAR/wegovy
- EMA. Mounjaro – EPAR: https://www.ema.europa.eu/en/medicines/human/EPAR/mounjaro
- EMA. Meeting highlights from PRAC, 2–5 June 2025 (NAION and semaglutide): https://www.ema.europa.eu/en/news/meeting-highlights-pharmacovigilance-risk-assessment-committee-prac-2-5-june-2025
- 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026. doi:10.1093/eurheartj/ehag100: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehag100
- 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease. Eur Heart J 2026. doi:10.1093/eurheartj/ehag098: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehag098
- § 34 SGB V (German Social Code Book V), gesetze-im-internet.de: https://www.gesetze-im-internet.de/sgb_5/__34.html
- EMA. Meeting highlights from CHMP, 18–21 May 2026: https://www.ema.europa.eu/en/news/meeting-highlights-committee-medicinal-products-human-use-chmp-18-21-may-2026