Oral semaglutide bioavailability optimization — 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.

Adding the numbers, since they settle part of this. 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.

DebRD_ATL 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. The dose-response is real but shallow at the top. Across STEP 1 and STEP 4 the gap between 1.7mg and 2.4mg is a couple of percentage points of body weight on average, and the average is carrying a wide spread — plenty of people at 1.7mg sit above the 2.4mg mean. If a dose is working and tolerable, "working" is the relevant variable, not "maximal".

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

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.

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