Since its introduction, injectable GLP-1 drugs such as Ozempic have been in high demand. In addition to treating diabetes and obesity, these drugs have cardiovascular benefits, and there is evidence that they can curb addiction and even protect the body against some types of cancer, which only increases their appeal. But for people who hate needles, these medications have one obvious drawback: They require a weekly injection.
However, advertisements for imitation oral versions of GLP-1 drugs proliferate on platforms such as Instagram and Facebook. Following the Ozempic shortage in 2022, a thriving “compounding” industry and telehealth clinics offering copies of the drug emerged, which they were allowed to sell legally in the absence of brand-name GLP-1. However, unlike the giants that produce the originals, these specialized clinics and pharmacies offer versions of semaglutide and tirzepatide for weight loss that are administered orally. Their wide range includes lozenges, tablets, cheek gels, drops and dissolving strips, promising to deliver the same active ingredients as Ozempic and Wegovy without the need for painful injections.
The prospect is captivating, especially since these medications cost a fraction of the price of their brand-name counterparts, and are often shipped the next day the prospective patient completes the online questionnaire. For example, a month of semaglutide with vitamin B6 pills from telehealth company Strut costs $149 without insurance, compared to more than $1,000 from Wegovy.
Not all that glitters is gold
“As a pharmacist, I can appreciate the enthusiasm for the rise of oral semaglutide, as it is an easier route than injectables,” says Melinda Lee, who runs pharmaceutical packaging company Parcel Health, as well as an availability database. of GLP-1 drugs. Additionally, oral versions do not need refrigeration like injectable versions, making them easier to transport and store. While Lee understands the excitement, she remains skeptical: “Taking a drug orally may be more appealing than a needle, when it comes to GLP-1, but there’s no evidence yet that they’re as effective.”
Unlike the brand-name medications Ozempic, Wegovy, Mounjaro, and Zepbound, the compounded versions have not undergone rigorous clinical testing and are not approved by the FDA. And although by law they must contain the same active ingredient as the drug they imitate, these orally formulated medications may not work as well as injectable ones. Maria Daniela Hurtado Andrade, an obesity specialist at the Mayo Clinic in Jacksonville, Florida, does not recommend oral medications composed of GLP-1 to her patients: “I do not take them into account, I do not prescribe them and I do not approve of them.”
The only approved oral GLP-1 drug is Rybelsus, a type 2 diabetes pill from Novo Nordisk, the same company that makes semaglutide and sells it as Ozempic and Wegovy. Despite being an attractive option in oral form, its lower dose did not take off in the same way as Ozempic. Research suggests that it is less effective for weight loss and that Rybelsus has never been approved for that purpose.
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