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A drugdrug interaction study with the proton pump inhibitor, omeprazole, in healthy subjects noted that there was a slight non-statistically significant increase in semaglutide exposure when oral semaglutide was administered with omeprazole at the time of maximum anti-secretory effect, but this was not considered clinically relevant [36]

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A SARMOUNT-5 clinical study shows that Zepbound users lost 20.2% of body weight

Additionally, hypothyroidism often causes metabolic adaptations (reduced muscle mass, increased hunger signals, lower metabolic rate) that persist even after thyroid levels normalize

So compounding pharmacies stepped in to fill the gap, making their own versions of the drugs for more than two years