Semaglutide – Prescribers

Sublingual Compounded Semaglutide
Thank you for taking to time to learn about a compounded Semaglutide anhydrous suspension for sublingual administration available from The Medicine Shoppe Compounding Pharmacy that could be of value for your patients.

The Medicine Shoppe in Victor, NY is one of Central New York’s most comprehensive compounding pharmacies. We have been custom compounding since the mid 1990s helping patients in all of NY State. We offer free shipping on all our compounded medications or patients can come directly to our pharmacy. We pride ourselves on our customer service and there is always an experienced pharmacist to answer questions from prescribers and patients. While we are a network provider for a most insurance plans and do routinely bill compounds to insurance plans when possible, Please note that, based on the assessments we have made, this compounded medication will not covered by any insurance plans.

The usage of GLP-1 receptor agonists, such as semaglutide, has grown exponentially worldwide. This class includes both injectable and oral dosage forms. Many insurances now will not cover GLP-1 medications for weight loss. Also the oral absorption of GLP-1 receptor antagonists is extremely low. (less than 1% per the labeling for RYBELSUS® tablets). For these reasons, prescribers and their patients may prefer an alternative option such as compounded sublingual formulation of Semaglutide. Through our partnership with CMPD Licensing, LLC, an established and innovative compounding pharmacy that developed a proprietary anhydrous sublingual base, we are able to deliver such a compounded medication.

Updated Dosing Recommendations
As we have been producing Compounded Semaglutide in Sub Magna™ HMW base for 2 months now, we participated in a National Conference with other compounding facilities discussing updated dosing recommendations due to bioavailability findings. We now recommend higher dosing due to the findings that bioavailability is running at 10%-12% taken sublingually. (This is still 10 times higher than oral Semaglutide tablets as per the RYBELSUS® package insert).

Attached here are UPDATED e-scribe guidelines as well as a dosing discussion document. You can download and save or print either of these. New dosing recommendations reflect the following:

For GLP-1 naive patients we suggest that they should begin by taking 2mg/ml as follows:

• 0.25 ml for 7 days, 0.5ml for 7 days, 1ml for daily as their ongoing dosage, pending physician review for any further dose increase.

For patients who are currently or recently been on GLP-1 injections, depending on how long since usage, we suggest taking the 3mg/ml as follows:

• 0.25ml for 7 days, then increase incrementally every 3-7 days as tolerated until their goal dose of 1ml / day.

We are committed to finding the proper dosage to provide a meaningful outcome for your patients and believe that taking it slowly and titrating is the right way to establish this. We will continue to evaluate and update dosing as more information becomes available.

About the Proprietary Base
This proprietary base has been shown in in-vitro studies to enable the large molecule of Semaglutide to penetrate through the oral cavity (sublingual) and achieve a substantial delivery percentage of the applied dose – especially when compared to oral therapy. If you believe that this unique product would benefit your patients, we would love to discuss how this patent- pending formulation can help address patient needs where GLP-1 receptor agonists are useful. Information about the proprietary base used in this compound formulation and studies related to this formulation can be found here by following the links. We also have suggested prescribing methods attached here for your review.

Compounded Injectable Semaglutide
Due to strong patient requests for these injectable drugs, we now offer them as well as the compounded oral sub-lingual semaglutide that we have offered in the past. We carry this in a 2.5mg/ml concentration in 1ml and 2ml vial sizes sourced from a FDA registered outsourcing facility. This concentration will allow dosing to be easily titrated and measured according to established semaglutide dosing recommendations. See the following dosing chart.

Compounded Injectable Semaglutide Dosing

Attached here are e-scribe guidelines as well as a dosing discussion document. You can download and save or print either of these. If your system can’t e-scribe this, please call one of our pharmacists and we will assist you.

 

Rybelsus® is a registered trademark of Novo Nordisk A/S.

No compounded medication is reviewed by FDA for safety or efficacy.