Oral semaglutide bioavailability optimization — what worked for you?

Dr.ObesityMed 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.

The figures, for anyone assembling their own picture. Worth knowing that the injection site changes very little. Abdomen, thigh and upper arm are bioequivalent for semaglutide, so a site change is not a plausible explanation for a bad week.

LarryQC_SD said:

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

Adding the part of the answer the thread has not reached. Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.

A narrower follow-up, since the general answer is now clear:

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

Closing the loop on my own question.

Update — I went back to the injectable. Not because the tablet did not work, but because the fasting window and my mornings were never going to agree.