Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. Bayview Pharmacy compounds it as a sublingual suspension — drops placed under the tongue — for patients whose provider has determined it is appropriate.
It is prescription-only and is prepared in small batches. Compounded semaglutide is not FDA-approved, and no sublingual form of semaglutide has been FDA-approved.
How does it work?
As a GLP-1 receptor agonist, semaglutide slows gastric emptying, increases feelings of satiety, and helps regulate blood sugar (MedlinePlus; StatPearls). The absorption and behavior of a compounded sublingual preparation have not been established by the FDA.
What is it used for?
Semaglutide is used within GLP-1 receptor agonist therapy under a provider's direction. Any use of a compounded sublingual preparation is at the discretion of the prescriber, who determines whether it is appropriate for you.
How a compounded sublingual preparation differs from the FDA-approved products
The FDA-approved semaglutide products are injectable (Ozempic, Wegovy) and an oral tablet (Rybelsus), each studied and approved with a specific dose and route. A compounded sublingual suspension is prepared by the pharmacy and has not undergone that FDA review; its absorption may differ from the approved products and is not FDA-established.
How is it used?
Your provider sets the strength, number of drops, and schedule. The suspension is placed under the tongue as directed. Do not change your dose without speaking to your provider.
Side effects & safety
The most common effects are gastrointestinal — nausea, vomiting, diarrhea, constipation, and decreased appetite (MedlinePlus). Use caution if you have a history of pancreatitis, gallbladder disease, or severe gastrointestinal disease. Tell your provider if you are pregnant or breastfeeding.
Who should not use it?
Semaglutide should not be used by people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN 2). Discuss your full medical history with your provider before starting.
How should it be stored?
Store as directed on the label, keep it out of the reach of children, and do not use it past the beyond-use date assigned by the pharmacy.
Why is this compounded?
Compounding allows a preparation tailored to a documented patient-specific need when a provider determines a commercially available product is not suitable. Eligibility is limited and is decided by your provider and the pharmacy.
Clinical details for prescribers
Regulatory status. Semaglutide is not a controlled substance. It is FDA-approved as injections and oral tablets; the compounded sublingual suspension is not FDA-approved, and FDA has issued communications regarding compounded semaglutide — counsel patients that this is a compounded, off-label route.
Formulation & dosing. Compounded as a sublingual suspension in 1, 2, 2.5, and 3 mg/mL, dosed by calibrated dropper. Commonly reported use is a once-daily sublingual dose held under the tongue 60–90 seconds before swallowing, starting low and titrating every 4 weeks as tolerated per the prescriber's protocol.
Counseling / clinical points:
- Contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2
- GI effects (nausea, vomiting, constipation) are the usual dose-limiting factor — slow titration helps
- Warn about pancreatitis symptoms and gallbladder disease; discontinue and evaluate if suspected
- Delayed gastric emptying can alter absorption of other oral medications — review the regimen
- Discontinue in pregnancy and in patients planning pregnancy per class labeling
Daily sublingual microdosing is a needle-free alternative pathway; monitoring and titration mirror the injectable class.
Sublingual Semaglutide is a compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your provider determines whether it is appropriate and sets the dose.
