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As a cofactor, cobalamins are essential for two cellular reactions: the mitochondrial methylmalonyl-CoA mutase conversion of methylmalonic acid (MMA) to succinate, which links lipid and carbohydrate metabolism, and the activation of methionine synthase, which is the rate-limiting step in the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate

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Alteration of the recommended dosing conditions resulted in increased oral semaglutide bioavailability with a longer post-dose fasting time and decreased bioavailability with co-administration of a greater water volume of 240 mL