Switching from Oral Wegovy to Reta

[Dos-Dox]

A friend of mine wants to move from prescription oral Wegovy (sema) over to reta, and she's asking for suggestions on how to structure that transition. She has completed 2 months of the oral sema and is now in month 3, taking 9 mg each day, and this is the first GLP she has ever tried. The plan is for her to increase to 25 mg next, but the skin sensitivity she's already dealing with bothers her, and she's not excited about paying such a high amount every month to stay on this prescribed regimen.

As you probably know, oral Wegovy comes with the SNAC coating, so if someone tries to break the pills apart to lower the sema dose gradually while raising reta, the outcome could be hard to predict.

I've come across plenty of accounts from people who made the jump from injectable sema or tirz to reta, but I haven't found much detail on what happens when someone goes from the oral version to reta.

Reta is the only one I've personally used, so I can't give her any confident guidance. If anyone here has ideas, I'd really appreciate hearing them.

 

[Skidude]

Haven't come across this scenario before, but it's certainly a fascinating situation.

My initial instinct: since she's dosing every day and can't divide the dose, could she first shift to every other day and then keep widening the gap, all while reducing sema and ramping up reta?

From what I can tell, oral sema has a 7 day half-life and needs 6-7 weeks to fully clear.

Oral Wegovy (semaglutide) has a half-life of roughly 7 days (around 1 week), which means half of the active drug leaves your body over the course of a week. Given that lengthy half-life, roughly 5 to 7 weeks are required for the medication to be entirely eliminated from your system following the final dose.

 

[lessthanhalf]

Clearing the drug from your system does take quite a while, but there isn't really a need to hold off that long before beginning another GLP. The typical approach is to pause for 1 week, then begin at the new drug's starting dose. I suppose residual amounts of the old drug could raise the odds of side effects somewhat, though having already spent time on a glp means some GI tolerance is probably present too, which might offset that.

If you'd rather be extra cautious, it could be reasonable to use 1mg of reta rather than 2mg for just the initial dose; after 2 weeks have gone by, semaglutide concentrations should have fallen to 1/4 of what they were, making problems far less probable.

It's curious that they experience skin sensitivity from semaglutide. That was quite uncommon in the early studies and only turned up frequently in the very high dose trials using 7.2mg or 16mg injected forms. Could they be absorbing the pills more than average? ( absorption varies enormously, from 0.4% to 1% ). Usually this side effect is seen more often with reta, though that doesn't quite add up, since if sema can trigger it, the cause must be glp-1, and sema has greater potency at glp-1, so sema causing it would make more sense than reta. With any luck it won't be an issue on low doses of reta, or else tirz might be the alternative they need.

 

[woundcarping]

Dos-Dox said:

A friend of mine wants to move from prescription oral Wegovy (sema) over to reta, and she's asking for suggestions on how to structure that transition. She has completed 2 months of the oral sema and is now in month 3, taking 9 mg each day, and this is the first GLP she has ever tried. The plan is for her to increase to 25 mg next, but the skin sensitivity she's already dealing with bothers her, and she's not excited about paying such a high amount every month to stay on this prescribed regimen.

As you probably know, oral Wegovy comes with the SNAC coating, so if someone tries to break the pills apart to lower the sema dose gradually while raising reta, the outcome could be hard to predict.

I've come across plenty of accounts from people who made the jump from injectable sema or tirz to reta, but I haven't found much detail on what happens when someone goes from the oral version to reta.

Reta is the only one I've personally used, so I can't give her any confident guidance. If anyone here has ideas, I'd really appreciate hearing them.

Appetite control is where Sema does its work... which means you've got a pretty obvious gauge for dialing the dose in.

Oral is outside my experience, but broadly speaking:

Quit the oral form

Begin Reta at low doses, monitoring tolerability and side effects, aiming to match the appetite suppression.

Moving from Sema over to Reta should be quite a ride where appetite control is concerned. And since skin reactions show up more often on Reta, that part may get interesting too.

 

[Dos-Dox]

Skidude said:

Haven't come across this scenario before, but it's certainly a fascinating situation.

My initial instinct: since she's dosing every day and can't divide the dose, could she first shift to every other day and then keep widening the gap, all while reducing sema and ramping up reta?

From what I can tell, oral sema has a 7 day half-life and needs 6-7 weeks to fully clear.

Oral Wegovy (semaglutide) has a half-life of roughly 7 days (around 1 week), which means half of the active drug leaves your body over the course of a week. Given that lengthy half-life, roughly 5 to 7 weeks are required for the medication to be entirely eliminated from your system following the final dose.

Thanks — EOD sounds like a smart approach for the taper.

lessthanhalf said:

Clearing the drug from your system does take quite a while, but there isn't really a need to hold off that long before beginning another GLP. The typical approach is to pause for 1 week, then begin at the new drug's starting dose. I suppose residual amounts of the old drug could raise the odds of side effects somewhat, though having already spent time on a glp means some GI tolerance is probably present too, which might offset that.

If you'd rather be extra cautious, it could be reasonable to use 1mg of reta rather than 2mg for just the initial dose; after 2 weeks have gone by, semaglutide concentrations should have fallen to 1/4 of what they were, making problems far less probable.

It's curious that they experience skin sensitivity from semaglutide. That was quite uncommon in the early studies and only turned up frequently in the very high dose trials using 7.2mg or 16mg injected forms. Could they be absorbing the pills more than average? ( absorption varies enormously, from 0.4% to 1% ). Usually this side effect is seen more often with reta, though that doesn't quite add up, since if sema can trigger it, the cause must be glp-1, and sema has greater potency at glp-1, so sema causing it would make more sense than reta. With any luck it won't be an issue on low doses of reta, or else tirz might be the alternative they need.

woundcarping said:

Dos-Dox said:

A friend of mine wants to move from prescription oral Wegovy (sema) over to reta, and she's asking for suggestions on how to structure that transition. She has completed 2 months of the oral sema and is now in month 3, taking 9 mg each day, and this is the first GLP she has ever tried. The plan is for her to increase to 25 mg next, but the skin sensitivity she's already dealing with bothers her, and she's not excited about paying such a high amount every month to stay on this prescribed regimen.

As you probably know, oral Wegovy comes with the SNAC coating, so if someone tries to break the pills apart to lower the sema dose gradually while raising reta, the outcome could be hard to predict.

I've come across plenty of accounts from people who made the jump from injectable sema or tirz to reta, but I haven't found much detail on what happens when someone goes from the oral version to reta.

Reta is the only one I've personally used, so I can't give her any confident guidance. If anyone here has ideas, I'd really appreciate hearing them.

Appetite control is where Sema does its work... which means you've got a pretty obvious gauge for dialing the dose in.

Oral is outside my experience, but broadly speaking:

Quit the oral form

Begin Reta at low doses, monitoring tolerability and side effects, aiming to match the appetite suppression.

Moving from Sema over to Reta should be quite a ride where appetite control is concerned. And since skin reactions show up more often on Reta, that part may get interesting too.

Regarding the skin sensitivity, I’m with the others who commented — it surprised me that she’s experiencing it on sema.

On the starting dose: our plan is 0.5 mg for week 1, treated as a gentle introduction. During that time she’d remain on her usual Wegovy dose. After that, possibly move up to 2 mg/week and stay there for a minimum of a couple of weeks to assess how it’s going. My standard advice is that people keep a dose for no less than 4 weeks, and I tell them not to increase until they’ve had 2 straight weeks with no weight loss — but given that she’s already using a GLP, has only a limited amount of her current Rx remaining, and doesn’t want to order another month, she might need to move somewhat faster.