Because the gut is a challenging environment for absorption, oral semaglutide doses are much higher — 25 milligrams (mg) daily — than standard 2.4-mg weekly injections.
“Even though the oral dose is higher, only a tiny fraction actually enters the bloodstream,” says W. Timothy Garvey, MD, professor of medicine and director of The University of Alabama at Birmingham’s Diabetes Research Center.
Velayati says your body absorbs only about 0.4 to 1 percent of semaglutide taken by mouth. “So if you take 100 units, less than one actually reaches the bloodstream. But that tiny amount is still enough to have a meaningful clinical effect,” she says. The higher oral dose of semaglutide ensures enough medication survives the stomach acid.
Dosage Timing
If you’re thinking about trying the new weight loss pill instead of the weekly injection, you may need to rethink your morning routine. Unlike the injection, which can be given at any time, the pill requires a strict fasting window. You need to take it on an empty stomach with no more than 4 ounces (oz) of plain water, and wait at least 30 minutes before eating breakfast or drinking a cup of coffee.
“The SNAC matrix changes the pH locally where it hits the stomach lining, and this allows absorption,” says Dr. Garvey. “Food prevents this interaction.”
If you eat too soon after taking the pill, food surrounds it in your stomach. That keeps the medication from touching your stomach lining the way it needs to in order to work, says Velayati. Similarly, drinking too much water can dilute the SNAC buffer, and the medication will simply be digested and wasted.
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