Late last month, Novo Nordisk said it was launching oral semaglutide in India, a drug described as the world’s only “peptide in a pill”, besides being a “game-changer” of sorts in diabetes management.

Semaglutide is a GLP-1 receptor analogue (GLP-1 RA), a class of diabetes drugs available in the injectable form, an inhibiting feature for those afraid of needles.

Oral semaglutide is a game-changer, because the innovative technology helps deliver the peptide without it getting affected by acid in the stomach, explains Dr V Mohan, Chairman at Chennai’s Dr Mohan’s Diabetes Specialities Centre. Earlier attempts by companies to make oral peptides (a chain of proteins) did not succeed as they were sensitive to acid, he adds.

“Oral semaglutide is a co-formulation of GLP-1RA semaglutide with an absorption enhancer SNAC which protects semaglutide from undergoing degradation in the stomach like other peptides and enhances its absorption,” the company said, adding that the drug is a result of 15 years of research. In India, it has been approved (in 2020) for glycaemic control in adults with Type 2 diabetes.

India is the sixth country where oral semaglutide has been launched, says Vikrant Shrotriya, Corporate Vice President and Managing Director, Novo Nordisk India. In fact, the company has jumped the injectable form and is directly bringing in the pill from Denmark, he told Business Line. The drug is priced at ₹10,000 a month, about one-fifth its price in the United States and comparable to the injectable version of similar drugs in India, he said.

India has also been part of the clinical trial of this product. The completed and ongoing global trials with oral semaglutide includes more than 10,000 patients of which more than 1,000 participants are from India, he said. In addition to glycemic control, oral semaglutide also demonstrates weight loss, besides being safe for the heart, the company said.

Specific instructions

While the drug has its benefits, Dr Mohan pointed out that it had very specific instructions on how it was to be taken: on a completely empty stomach, first thing in the morning; to be taken with 100 ml of water (“half a tumbler, not more or less”); followed by 30 minutes of no food or water. This, he said, was important to adhere to, given the technology of the drug. The only side-effect to watch out for was nausea, but that too only in the early days, he said.

Responding to a query on what stage of diabetes the drug needed to be taken he said, there was no harm in giving it earlier in the course of treatment in those with Type 2 diabetes, who also had risk factors including obesity or heart conditions.

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