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Sublingual Semaglutide: Semaglutide Troches and Lozenges

Apr 8, 2024
Sublingual Semaglutide: Semaglutide Troches and Lozenges

Worldwide, the prevalence of obesity continues to increase. This common, chronic, and complex disease is a major risk factor for type 2 diabetes, high blood pressure, abnormal blood lipids, obstructive sleep apnea, and gastroesophageal reflux disease.1 Wegovy, an FDA-approved form of semaglutide manufactured by Novo Nordisk, prescriptions have increased from 1,404 million in quarter one, 2022, to 9,614 million in quarter four, 2023, making it impossible for the company to keep up with demand.

Despite the fact that Wegovy is a highly effective weight-loss drug, some people who would benefit from it find the idea of self-injection to be unappealing. A common online query asks whether semaglutide troches or semaglutide lozenges are available. Could sublingual semaglutide be as effective for weight loss as injectable semaglutide?

Injectable and Oral Semaglutide

The U.S. Food and Drug Administration (FDA) has approved several forms of semaglutide to treat type 2 diabetes and obesity. Ozempic injections and Rybelsus tablets are approved to lower blood sugar in people with type 2 diabetes. Ozempic is also approved to reduce the risk of heart attacks, strokes, or death in people with type 2 diabetes and known heart disease.

Wegovy is FDA-approved for treating obesity when used with a reduced-calorie diet and exercise. In semaglutide clinical trials, participants taking semaglutide lost an average of 15% to 18% of their body weight over 68 weeks. Besides taking semaglutide, participants also consumed a reduced-calorie diet and took part in an exercise program.

Because there is a worldwide shortage of semaglutide, the FDA allows compounding pharmacies to produce compounded semaglutide for individuals with a prescription for the medication. Compounded semaglutide is produced in small batches to meet demand. It is not an FDA-approved form of the medication because it cannot go through clinical testing for each batch. Compounded semaglutide is commonly combined with vitamin B12 to reduce common gastrointestinal side effects.

What are Semaglutide Troches and Lozenges?

Rybelsus is the only FDA-approved oral semaglutide option. Rybelsus tablets should be taken with a sip of water (no more than 4 ounces) when you first wake up. After taking Rybelsus, wait 30 minutes before eating, drinking, or taking any other medications.

Since semaglutide is on the FDA shortage list, compounding pharmacies can manufacture and sell other forms of compounded semaglutide. A few online companies offer semaglutide in troche or lozenge form.

Troches are medicated lozenges that are typically placed under the tongue or between the cheek and gum. The medication in troches or lozenges is slowly absorbed through the lining of your mouth. It is important to use semaglutide troches or lozenges as prescribed; otherwise, the medication will not be fully absorbed.

A woman with a tape measure and weight loss pills Sublingual Semaglutide

Understanding the Mechanism of Action for Oral Semaglutide Troches and Lozenges

All glucagon-like peptide-1 (GLP-1) receptor agonists share the same mechanism of action. They bind to GLP-1 receptors in the brain and gastrointestinal tract to increase satiety and delay stomach emptying. When your stomach empties more slowly, you feel full longer.

In addition to reducing hunger and food noise that contribute to cravings and overeating, GLP-1 RAs, like semaglutide, stimulate your pancreas to produce more insulin and reduce glucagon release. Increasing insulin and reducing glucagon reduce blood sugar levels.  

Benefits of Sublingual Semaglutide

Sublingual forms of semaglutide are not FDA-approved or clinically tested. This makes it difficult to know whether the benefits seen in semaglutide clinical trials are also found when using semaglutide troches or lozenges.

Semaglutide benefits seen in clinical trials include the following:

  • Controls hunger
  • Reduces food cravings
  • Increases satiety after eating
  • Improves insulin sensitivity
  • Improves cholesterol levels
  • Reduces triglycerides
  • Increases weight loss
Infographics Semaglutide

Side Effects of Sublingual Semaglutide

Semaglutide is not appropriate for everyone. Some people may have an increased risk of side effects when taking this medication.

Semaglutide warnings and precautions

Anyone with a personal or family history of medullary thyroid carcinoma or a family or personal history of multiple endocrine neoplasia syndrome type 2 should not take semaglutide. In animal studies, semaglutide increased the risk of thyroid tumors. It is unclear whether the risk is also increased in humans.

Semaglutide may increase the risk of the following potentially serious medical conditions. Semaglutide warnings and precautions include:

  • Thyroid C-cell tumors
  • Acute pancreatitis
  • Low blood sugar
  • Acute kidney injury
  • Hypersensitivity reactions
  • Diabetic retinopathy in people with type 2 diabetes
  • Increase in heart rate
  • Suicidal ideation and behavior

Compounded forms of semaglutide, including semaglutide troches and lozenges, have not undergone clinical trials. Semaglutide side effects seen in clinical trials include:

  • Nausea (44%)
  • Diarrhea (30%)
  • Vomiting (24%)
  • Constipation (24%)
  • Stomach pain (20%)
  • Headache (14%)
  • Fatigue (11%)
  • Heartburn (9%)
  • Dizziness (8%)
  • Stomach bloating (7%)
  • Burping/flatulence (7%)
  • Low blood sugar in people with type 2 diabetes (6%)
  • Gas (6%)
  • Gastroenteritis (6%)
  • Acid reflux (5%)
  • Stomach irritation (4%)
  • Viral gastroenteritis (4%)
  • Hair loss (3%)

To reduce the risk of side effects when taking semaglutide, provide your doctor with your complete medical history, a full list of medications (over the counter and prescription) that you are taking, whether you have a history of problems with your pancreas or kidneys, a history of type 2 diabetes or have had depression, suicidal thoughts, or other mental health issues. Let them know if you are pregnant or planning to become pregnant. Semaglutide may harm an unborn baby, and it can pass through breast milk.

The Effectiveness of Sublingual Semaglutide

Since sublingual forms of semaglutide have not undergone clinical trials, it isn’t easy to evaluate their effectiveness.

Oral semaglutide, Rybelsus, has undergone clinical trials. In a review of studies, researchers concluded that oral forms of semaglutide were as effective as injectable forms when reducing blood sugar and meeting weight loss goals in people with diabetes taking insulin.4

A woman running on a treadmill in her home

The Importance of Lifestyle and Diet

Medications, such as semaglutide, are an important adjunct to lifestyle modifications for weight loss, such as consuming a reduced-calorie diet and increasing daily physical activity.

When taking semaglutide:

  • Reduce fatty foods in your diet. Semaglutide and fatty foods both slow how fast your stomach empties. Fatty foods can increase common side effects associated with semaglutide, such as nausea, vomiting, bloating, and stomach cramping.
  • Consume complex carbohydrates. Beans, vegetables, fruits, and whole grains are all rich in fiber. Nutrients from these foods are slowly digested and absorbed from the gut into the bloodstream. Complex carbohydrates are associated with a slower increase in blood sugar levels than refined carbohydrates.
  • Prioritize protein in your diet. Proteins also reduce the risk of blood sugar spikes and help enhance satiety. When your blood sugar spikes after eating a sugary meal, your pancreas responds by pumping more insulin into your bloodstream. This lowers your blood sugar. Sometimes, it overshoots, and your blood sugar is too low. To raise it again, your body feels hungry.
  • Limit your consumption of refined and highly processed foods. Highly processed foods are packed with sugar, saturated fats, and salt. These highly palatable foods are high in calories and tend to induce cravings.
  • Consume smaller, more frequent meals. This can help reduce semaglutide side effects and stabilize your blood sugar.
  • Stay well hydrated. Drink water throughout the day to reduce hunger and the risk of constipation.   
  • Incorporate physical activity throughout your day. If the expert’s recommendations to get at least 50 minutes of moderate-to-vigorous (or 75 minutes of vigorous activity) cardio exercise per week seem a bit overwhelming, start with incorporating smaller bursts of activity throughout the day.
  • Get plenty of high-quality sleep. Prioritize getting 7 to 9 hours of high-quality sleep each night. Sleep is an active process during which your body repairs damaged tissues, cleans the brain of waste, and produces hormones and other chemical messengers.

Semaglutide and other GLP-1 receptor agonists are excellent treatment options for obesity. Like all medications, they have risks and benefits. If you are interested in enrolling in an Invigor Medical weight loss program, start the process by completing your health forms. Semaglutide and other Invigor Medical weight loss programs include a doctor’s consultation, the medication, and any medical equipment you may need to administer the medication.  

Frequently Asked Questions

What are semaglutide troches and lozenges?

Semaglutide troches and lozenges are alternative forms of the medication available through compounding pharmacies or online companies. Troches are medicated lozenges typically placed under the tongue or between the cheek and gum for slow absorption.

How does sublingual semaglutide compare to injectable semaglutide for weight loss?

Sublingual semaglutide’s effectiveness for weight loss hasn’t been clinically tested or FDA-approved, unlike injectable semaglutide. While both may share similar benefits, without clinical trials, it’s uncertain if sublingual forms provide comparable weight loss outcomes.

What are the benefits of sublingual semaglutide?

The benefits of sublingual semaglutide, as observed in clinical trials with injectable forms, include hunger control, reduced cravings, increased satiety, improved insulin sensitivity, cholesterol level improvement, triglyceride reduction, and weight loss. However, these benefits have not been confirmed for sublingual administration.

What are the side effects of sublingual semaglutide?

The side effects of compounded semaglutide, including troches and lozenges, are not fully understood due to the lack of clinical trials. Common side effects from injectable semaglutide trials include nausea, diarrhea, vomiting, constipation, and stomach pain, among others

How effective is sublingual semaglutide for weight loss?

Since sublingual semaglutide hasn’t undergone clinical trials, its weight loss effectiveness remains uncertain. However, oral semaglutide (Rybelsus) has shown efficacy comparable to injectable forms in reducing blood sugar and achieving weight loss goals.

Disclaimer
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

Sublingual Semaglutide: Semaglutide Troches and Lozenges

Leann Poston, M.D.

Dr. Leann Poston is a licensed physician in the state of Ohio who holds an M.B.A. and an M. Ed. She is a full-time medical communications writer and educator who writes and researches for Invigor Medical. Dr. Poston lives in the Midwest with her family. She enjoys traveling and hiking. She is an avid technology aficionado and loves trying new things.


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