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ForumsSemaglutide (Ozempic / Wegovy)Oral semaglutide 25mg vs 50mg — looking for input

Oral semaglutide 25mg vs 50mg — looking for input

pam_stl Thu, May 30, 2024 at 9:03 AM 55 replies 2,751 viewsPage 1 of 11
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pam_stl
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May 30, 2024 at 9:03 AM#1

On 25mg oral, four months in, and my results are closer to the low-dose injectable arm than to the numbers being quoted for 50mg.

The narrow version of the question is whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong.

Practical detail welcome, however dull — the duller the better.

24 19Dr.ObesityMed, HealthEcon_DC, PedsEndoPhilly and 21 others
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julia.endo
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May 30, 2024 at 9:55 AM#2

Taking the question as asked, rather than the general version of it. Oral semaglutide is absorbed in the stomach with the help of SNAC, which locally raises pH and protects the peptide long enough to cross. That mechanism is fragile: bioavailability is roughly 1% and highly sensitive to gastric contents, so a mouthful of coffee genuinely changes the exposure. This is why the label wants 30 minutes and no more than half a glass of plain water.

23 18mark_tokyo, hans_munich, jason_sac26 and 20 others
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COA_Karl
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May 30, 2024 at 10:47 AM#3
julia.endo 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.

Agreeing with julia.endo, and the qualification matters more than the agreement. Worth adding that the tablet is taken daily, so a missed dose costs far less than a missed weekly injection. That is a genuine advantage nobody lists.

Last edited: May 30, 2024 at 11:47 AM
22 17hyun_seoul, jim_asheville, matt_MKE and 19 others
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DerekSJ_a1c
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May 30, 2024 at 11:39 AM#4
pam_stl said:
On 25mg oral, four months in, and my results are closer to the low-dose injectable arm than to the numbers being quoted for 50mg.

Same position here, arrived at the long way round. Orforglipron is the more interesting oral story because it is not a peptide at all. Being a small molecule it does not need SNAC, does not need the fasting window, and has oral bioavailability in the tens of percent rather than about one.

Last edited: May 30, 2024 at 4:39 PM
21 16traveltech_sara, AttorneyGrant, DebRD_ATL and 18 others
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JenPlateau
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May 30, 2024 at 4:32 PM#5

Clinical perspective, offered as context rather than as advice. The distinction that resolves most of these threads is between what is true on average and what is true for one person. Both are real; they answer different questions and get quoted as if they were the same one.

Last edited: May 30, 2024 at 10:32 PM
20 15sarah_nash92, FitDadDave, RunnerRach and 17 others
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