A randomized study investigating the effect of omeprazole on the pharmacokinetics of oral semaglutide

<p><b>Background</b>: Since the first oral glucagon-like peptide-1 analog comprises semaglutide co-formulated with an absorption enhancer, sodium N-(8-[2-hydroxybenzoyl] amino) caprylate, which induces a transient, localized increase in gastric pH, we have investigated whether a proton pump inhibitor affects the pharmacokinetics of oral semaglutide.</p> <p><b>Research design and methods</b>: A single-center, randomized, open-label, parallel-group trial investigated pharmacokinetic interactions of oral semaglutide with omeprazole (40 mg once-daily) in 54 healthy subjects. Primary endpoints were area under the plasma concentration-time curve over 24 h for semaglutide (AUC<sub>0−24h,semaglutide,Day10</sub>) and maximum concentration of semaglutide (C<sub>max,semaglutide,Day10</sub>) at day 10.</p> <p><b>Results</b>: Exposure of semaglutide appeared to be slightly increased, although not statistically significantly, with oral semaglutide plus omeprazole versus oral semaglutide alone (AUC<sub>0−24h,semaglutide,Day10</sub> [estimated treatment ratio 1.13; 90%CI 0.88, 1.45] and C<sub>max,semaglutide,Day10</sub> [estimated treatment ratio 1.16; 90%CI 0.90, 1.49]). Gastric pH was higher with oral semaglutide and omeprazole versus oral semaglutide alone. Adverse events were mild or moderate and, most commonly, gastrointestinal disorders.</p> <p><b>Conclusions</b>: There was a slight non-statistically significant increase in semaglutide exposure when oral semaglutide was administered with omeprazole, but this is not considered clinically relevant and no dose adjustment is likely to be required.</p>