Sublingual semaglutide: what the drops and dissolving tablets are

The FDA declared the semaglutide shortage over on February 21, 2025. Pharmacies lost the right to make copies of the injection: 503A pharmacies on April 22, 2025, and 503B outsourcing facilities on May 22, 2025 ^[5].

A 503A pharmacy still may not regularly make a drug that is "essentially a copy" of an approved one. One part of that test is whether the approved drug can be used by the same route ^[5]. Compounders read this as room for a different route: the approved semaglutide tablets are swallowed, so a tablet held under the tongue is argued to be something else. A prescriber can also document that a compounded product makes a significant difference for a specific patient ^[5]. Whether a sublingual form clears these tests has not been decided by any court or by FDA.

Outsourcing facilities cannot make semaglutide at all: it is on neither the 503B bulks list nor the shortage list ^[5].

There are two approved semaglutide tablets. Rybelsus treats type 2 diabetes. Wegovy tablets, approved on December 22, 2025, are for weight ^[3].

Both are swallowed, and both need help to work. Rybelsus is made with an absorption enhancer, salcaprozate sodium (SNAC). Even with it, only about 0.4% to 1% of the dose reaches the blood ^[2]. That is why the label asks for an empty stomach, no more than four ounces of water and 30 minutes before food or other pills ^[2].

It is also why the doses look so different. Wegovy tablets reach 25 mg a day. The Wegovy injection tops out at 2.4 mg a week ^[3]. The Wegovy label says not to split, crush, chew or dissolve the tablet ^[3].

A compounded sublingual product has none of that work behind it. Its vehicle, its strength and how much reaches the blood are whatever the pharmacy chose.

One study has measured sublingual semaglutide, and it was done in rats ^[4]. Researchers gave the drug under the tongue in a proprietary oil-free suspension, swallowed as a tablet, or by injection, and compared blood levels.

• Under the tongue, about 0.3% of the drug reached the blood compared with the injection (0.34% when made from crushed tablets, 0.29% from powder).
• Swallowed, it was 0.06% to 0.16%.
• Levels varied less from rat to rat under the tongue than when swallowed.

So sublingual dosing did better than swallowing in rats, and both delivered a fraction of a percent of what an injection does. The authors call it a proof of concept and say human studies are needed ^[4]. All of them work for PCCA, a company that supplies compounding pharmacies.

We searched PubMed for a human study of sublingual semaglutide, for absorption or for weight loss, and found none.

Without human data, there is no agreed dose. Each pharmacy sets its own strength, and sellers price by milligrams per month rather than by a dose shown to work.

Testing raises further doubts. Novo Nordisk, in its 2024 request to bar semaglutide from compounding, cited a compounded sublingual sample that held 170% of its labelled strength and another that held 42% ^[6]. Novo has a commercial interest in that argument. In the 2025 survey, only 18% of the compounded products listed a beyond-use date or storage conditions, and nearly half added other ingredients such as B12, glycine or ondansetron ^[1].

FDA has also warned that semaglutide sodium and semaglutide acetate, salt forms some pharmacies use, have no lawful basis in compounding ^[7].

• Which pharmacy makes it, and in which state? A seller that will not name it is asking for trust it has not earned. Our pharmacy disclosure guide shows who names theirs.
• Is it semaglutide base? Not the sodium or acetate salt.
• How many milligrams a day, and why that number? There is no published human dose to compare it with.
• What happens if it does not work? Ask whether you can move to an injection, and what the plan costs if you do.
• Is a swallowed tablet better for you? Wegovy tablets are approved for weight, and a prescriber can tell you whether insurance or the maker's cash program would cover them.