“Sublingual Semaglutide”, 2024-08-23 (; similar):
…the dose of oral semaglutide is dramatically larger than the dose when it’s injected—for diabetes it tops out at 14 mg/day or 98 mg/week, vs. injected for diabetes it tops out at 2 mg/week.
As it turns out, probably the cheapest source of semaglutide available on a per mg is… Rybelsus™ tablets, but you can’t put that into an injectable product.
We generally prepare it into a sublingual formulation, but figuring out the appropriate dose is tricky. It absorbs really well across the blood vessels under the tongue, but I’m not sure what % of a given dose does get across there, but my current guess is that ~8–14% of a dose gets across the sublingual mucosa if it’s held there long enough (2–5 minutes). That’s really hard to get people to actually do though.
But this method feels extremely useful to me for a number of reasons:
it is not “essentially a copy” of any currently existing formulation from Novo, so the “shortage loophole” is not an issue—this type of compounding is still very doable legally even if there’s no shortage.
Novo gets a cut of the price because I’m literally using their tablets.
it’s super-cheap comparatively—we can get 14 mg of semaglutide from a single tablet—the cost is ~$43/tablet if you use the $1,300/month divide by 30. Even if the absorption is only 8%, then you can still get basically a week’s worth of semaglutide out of a $43 tablet.
regarding cost—the comments about this being a short window of time in which pharmacies are trying to make money while the sun shines (or the shortage lasts) are correct. Pharmacies make out pretty darn well at the prices Scott listed.
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