Compounding pharmacies are producing custom-made oral GLP-1 medications, including sublingual products, to meet patient needs due to shortages. However, there is a lack of evidence that these medications work effectively, and some practitioners advise against using them.
Compounding Pharmacies and Custom-Made Drugs
Compounding pharmacies have a long precedent in the US of making custom-made drugs to meet patient needs due to shortages or specific needs not met by available drugs.
Creating new delivery methods is not always easy, as reformulating an injectable drug into an oral version requires overcoming significant challenges. This includes developing absorption enhancers that can increase the bioavailability of large molecules like GLP-1 medications.
The Emergence of Sublingual Products
Some compounders acknowledge the limitation with GLP-1 pills and are making sublingual products instead, including drops placed under the tongue. These products claim to enhance the delivery of large molecules through the mucosal lining of the mouth into the bloodstream.
However, there is a lack of evidence that these oral compounded GLP-1 medications work. Most telehealth companies offering oral semaglutide and tirzepatide did not respond to requests for comment, while some practitioners advise against using them due to the limited evidence.
The Challenge of Oral Drug Delivery
Unlike most drugs, which are small molecules chemically synthesized into pill form, GLP-1 medications are large molecules not easily taken up by the gastrointestinal tract. This makes oral drug delivery challenging due to the harsh environment of the gut, which helps rid the body of toxins and microbes.
The only approved oral GLP-1 drug is Rybelsus, a pill for type 2 diabetes from Novo Nordisk. Research suggests it is less effective for weight loss, and it has never been approved for that purpose.
