Oral semaglutide 50mg (Rybelsus HD) — 12 month update

NurseKim_ATL 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.

The figures, for anyone assembling their own picture. 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.

Dr.SurgeonPGH 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.

Following on from Dr.MetabolicMD — 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.