Dr.CardioMD said:

Oral semaglutide is absorbed in the stomach with the help of SNAC, which locally raises pH and protects the peptide long enough to cross.

I do not accept that the fasting window is a minor inconvenience. Adherence data on daily orals with timing requirements is consistently worse than weekly injections, and a drug you take imperfectly is a lower dose than the one on the box.

One concrete data point for the thread. One practical note: write down what you did and when, before you need it. Reconstructing a timeline from memory three months later is how people end up unable to answer the one question that would have resolved it.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

Dr.ObesityMed said:

I do not accept that the fasting window is a minor inconvenience.

Coming at Dr.ObesityMed’s question from a different direction. The version of this that has an answer is narrower than the version being asked. Narrow it and it becomes tractable; leave it broad and the thread will produce nine confident and incompatible replies.

Following on from Dr.PathRoch — and this may be the naive question:

How much of the oral variability is the SNAC absorption window and how much is dose, because the two get conflated constantly?

Reporting back.

Follow-up: moving the tablet to the moment I wake, before anything else, was the whole fix. The dose never changed.