Generic oral semaglutide — 12 month update

amsterdam_pete said:

The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to…

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.

Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Adding the numbers, since they settle part of this. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.

Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

sarah.morrison said:

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

There is a second half to this that has not been said yet. Steady state is the thing most people miss. The terminal half-life is about a week, so every dose step takes four to five weeks to fully express itself. Judging a step at day ten is judging the ascent, not the plateau, and it is the single commonest reason people escalate before they needed to.

One thing that is still open after Dr.SurgeonPGH’s answer:

Whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong?

OP back with an update, since a thread like this is useless without one.

I moved the tablet to the moment I wake up rather than trying to fit it around breakfast, and the difference in the following weeks was obvious. It was a timing problem, not a dose problem.