Switching from Oral Wegovy to Reta

[Dos-Dox]

I have a friend looking to switch from Rx oral Wegovy (sema) to reta and is looking for recommendations for a protocol to switch. She’s on her 3rd month of the oral sema, 9 mg daily, and this is her first experience with a GLP. She’s scheduled to go up to 25 mg, but doesn’t love the skin sensitivity she already has and isn’t looking forward to continuing to shell out that much money to continue this prescribed protocol.

As you may know, the oral Wegovy has the SNAC coating, so trying to split the pills to titrate the sema down while titrating reta up may yield some unpredictable results.

I’ve seen lots stories about how people of switched from injectable sema or tirz to reta but haven’t seen many details about people switching from oral to reta.

I’ve only ever used reta, so I don’t have any solid advice for her. If any of you have recommendations, I’d be grateful to hear them.

 

[Skidude]

This is one I have not seen discussed, but an interesting predicament.

My first thought would be: if she is doing daily and cannot split can she slow to EOD initially and continue spacing while tapering down sema and titrating reta?

Looks like sema oral has 7 day half life and 6-7weeks to clear.

The half-life of oral Wegovy (semaglutide) is approximately 7 days (about 1 week), meaning it takes a week for your body to eliminate half of the active drug. Because of this long half-life, it takes about 5 to 7 weeks to completely clear the medication from your system after your last dose

 

[lessthanhalf]

While it does take a long time to clear the drug from you system, it is not really needed to wait that long to start a different GLP. Usually people just wait a week then start at the starting dose of the new drug. I guess you are a bit more likely to have side effects from some of the old drug being in the system still, but already being on a glp for a while means you are likely to have some tolerance to gi side effects as well, maybe balancing that out.

It might make sense if you want to be really careful to start reta at 1mg instead of 2mg for the first dose only, once 2 weeks has passed the semaglutide levels would be down to 1/4 of previous levels and much less likely to be an issue

It is interesting they get skin sensitivity from semaglutide, this was very rare in the initial studies and only became common in the very high dose trials of 7.2mg or 16mg injected versions. I wonder whether they have above average absorption of the pills? ( absorption is extremely variable at 0.4% to 1% ). Normally this side effect is more common with reta, although this does not make a lot of sense as it has to be caused by glp-1 if sema can cause it, and sema is more potent at glp-1, so it would make more sense for sema to cause it than reta. Hopefully that is not a problem with reta at low doses, otherwise they might need to use tirz instead.

 

[woundcarping]

Dos-Dox said:


I have a friend looking to switch from Rx oral Wegovy (sema) to reta and is looking for recommendations for a protocol to switch. She’s on her 3rd month of the oral sema, 9 mg daily, and this is her first experience with a GLP. She’s scheduled to go up to 25 mg, but doesn’t love the skin sensitivity she already has and isn’t looking forward to continuing to shell out that much money to continue this prescribed protocol.

As you may know, the oral Wegovy has the SNAC coating, so trying to split the pills to titrate the sema down while titrating reta up may yield some unpredictable results.

I’ve seen lots stories about how people of switched from injectable sema or tirz to reta but haven’t seen many details about people switching from oral to reta.

I’ve only ever used reta, so I don’t have any solid advice for her. If any of you have recommendations, I’d be grateful to hear them.

Click to expand...

Sema works on appetite control... that gives a fairly clear signal to adjust dosing with.

I have no practical knowledge of oral, but in general:

Stop taking oral

Start taking small doses of Reta watching for side effects tolerability and looking to mimic appetite control.

Going from Sema to Reta is going to be interesting in terms of appetite control. Also skin effects are more common with Reta, so that could be interesting.

 

[Dos-Dox]

Skidude said:


EOD initially and continue spacing while tapering down sema and titrating reta?

Click to expand...

EOD is a good thought for the taper down. Thank you for that.

lessthanhalf said:


It is interesting they get skin sensitivity from semaglutide

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woundcarping said:


Also skin effects are more common with Reta, so that could be interesting.

Click to expand...

I agree with the comments about the skin sensitivity. I was shocked to hear she was having it with sema.

As far as the starting dose, we’re planning for 0.5 mg for the first week just as the baby intro dose. She’d still be on her normal Wegovy dose at that point. Then maybe jump to 2 mg/week for at least a couple of weeks and see how things are going. I always insist people hold their doses for at least 4 weeks and then recommend they not titrate up until they have 2 consecutive weeks of zero weight loss, but she may need to be a little more aggressive since she’s already a GLP user, has a limited supply of her current Rx left (and doesn’t want to order another month’s supply).