The mechanism question has a clean answer for the peripheral effects and a much less clean answer for the central ones, and it is worth being explicit about which of those you are asking about.
Tirzepatide is an imbalanced dual agonist: it is more potent at the GIP receptor than at the GLP-1 receptor, which is the opposite of what most people assume from the way it is described. Whether the GIP contribution works through central appetite pathways, through adipose insulin sensitisation, or through modulating the GLP-1 signal is genuinely unsettled, and the honest position is that the clinical result is clear and the attribution is not.
Oral bioavailability of a 4 kDa peptide is essentially zero without help. Oral semaglutide is co-formulated with sodium N-(8-[2-hydroxybenzoyl]amino)caprylate, which raises local gastric pH and transiently increases transcellular permeability in a small area of gastric mucosa. It works, and it delivers roughly one per cent of the dose, which is why the oral tablet strengths are an order of magnitude above the injectable and why fasting and water volume are not optional details.
Oral semaglutide’s absorption mechanism via SNAC is described in the pharmacokinetic literature, and the ~1 per cent bioavailability figure with high inter- and intra-individual variability is why administration conditions are specified so tightly[1].
One qualification: none of the investigational agents discussed here is approved anywhere, and material supplied for research use is not approved for human use.
Do not convert doses between agents. There is no exchange rate, and constructing one is how people arrive at an order-of-magnitude error.
Is there a reason to prefer the second method over the first, other than cost? – a_lindgren 10 months ago add a comment