Dr.PeteFamMed 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. 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.
LipidDoc_ATL said:I do not accept that the fasting window is a minor inconvenience.
Adding the part of the answer the thread has not reached. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.
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View ResultsFollowing on from mike_nyc — 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.
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.