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Study · Not a test of the peptide alone · 2025

3 results

Carnitine Deficiency Caused by Salcaprozic Acid Sodium Contained in Oral Semaglutide in a Patient with Multiple Acyl-CoA Dehydrogenase Deficiency.

Mikami-Saito Y, Maekawa M, Watanabe M, Hosaka S, Takahashi K, Totsune E, Arai-Ichinoi N, Kikuchi A, Kure S, Katagiri H, Wada Y

International journal of molecular sciences25 Mar 2025

PMID40243535 (opens in a new tab)PMCIDPMC11989126 (opens in a new tab)DOI10.3390/ijms26072962 (opens in a new tab)PepBankPUB-40243535
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Summary

Carnitine plays an essential role in maintaining energy homeostasis and metabolic flexibility. Various medications, such as pivalate-conjugated antibiotics, valproic acid, and anticancer agents, can induce carnitine deficiency, inhibit the utilization of fatty acid, and contribute to the development of hypoglycemia. No studies have linked oral semaglutide to carnitine deficiency. Herein, we report the case of a 34-year-old male patient with multiple acyl-CoA dehydrogenase deficiency who developed carnitine deficiency attributable to salcaprozic acid sodium (SNAC) in oral semaglutide. The patient was diagnosed with type 2 diabetes mellitus at 32 years of age and was treated with semaglutide injections. Hypoglycemic symptoms appeared after switching to oral semaglutide, and the mean levels of blood-free carnitine significantly decreased. Liquid chromatography-tandem mass spectrometry analysis revealed a peak corresponding to the SNAC-carnitine complex (m/z 423.24) in the urine exclusively during the oral administration of semaglutide. The MS/MS spectra at m/z 423.24 contained peaks consistent with those of the SNAC and carnitine product ions. Our results suggest that through complexation with carnitine, SNAC may induce carnitine deficiency. Healthcare providers should monitor for carnitine deficiency when administering SNAC-containing medications to at-risk individuals. Furthermore, this case can raise more significant concerns about the potential impact of pharmaceutical excipients like SNAC on metabolic pathways.
CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study3

No result from this study comes from a test of the peptide.

Studies that did not test the peptide alone3

In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking Semaglutide.

  1. 01HumanNot a test of Semaglutide aloneCase report or seriesSafety outcome

    In a 34-year-old man with multiple acyl-CoA dehydrogenase deficiency and type 2 diabetes, hypoglycemic symptoms appeared after the switch from injected to oral semaglutide; the authors attribute this to the SNAC excipient.

    In plain wordsIn one man with a rare metabolic disorder, low blood sugar symptoms began after switching to oral semaglutide; the authors blame the SNAC ingredient.

    Peptide
    Semaglutide
    Outcome
    IncreaseHypoglycemic symptoms after switch to oral semaglutide
    Study

    n = 1

    Outcome group
    Adverse events · Metabolic and weight

    Source sentences

    Summary
    Hypoglycemic symptoms appeared after switching to oral semaglutide, and the mean levels of blood-free carnitine significantly decreased.
    1 context sentence
    Summary · context
    Herein, we report the case of a 34-year-old male patient with multiple acyl-CoA dehydrogenase deficiency who developed carnitine deficiency attributable to salcaprozic acid sodium (SNAC) in oral semaglutide.

    In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.

  2. 02HumanNot a test of Semaglutide aloneCase report or seriesSafety outcome

    In the same patient, mean blood free carnitine fell significantly after the switch to oral semaglutide; the authors attribute this to SNAC complexing with carnitine.

    In plain wordsIn this man, blood carnitine levels dropped after switching to oral semaglutide; the authors link this to the SNAC ingredient.

    Peptide
    Semaglutide
    Outcome
    DecreaseBlood free carnitine level
    Study

    n = 1

    Outcome group
    Adverse events · Metabolic and weight

    Source sentences

    Summary
    Hypoglycemic symptoms appeared after switching to oral semaglutide, and the mean levels of blood-free carnitine significantly decreased.
    1 context sentence
    Summary · context
    Herein, we report the case of a 34-year-old male patient with multiple acyl-CoA dehydrogenase deficiency who developed carnitine deficiency attributable to salcaprozic acid sodium (SNAC) in oral semaglutide.

    In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.

  3. 03HumanNot a test of Semaglutide aloneCase report or seriesMechanism

    Liquid chromatography-tandem mass spectrometry detected a SNAC-carnitine complex (m/z 423.24) in the patient's urine only during oral semaglutide administration.

    In plain wordsIn this patient's urine, lab analysis found a SNAC-carnitine complex only while he took oral semaglutide.

    Peptide
    Semaglutide
    Outcome
    Not applicableSNAC-carnitine complex in urine
    Study

    n = 1

    Outcome group
    Adverse events · Pharmacology

    Measurements

    m/z of SNAC-carnitine complex
    423.24 m/z
    urine

    Source sentences

    Summary
    Liquid chromatography-tandem mass spectrometry analysis revealed a peak corresponding to the SNAC-carnitine complex (m/z 423.24) in the urine exclusively during the oral administration of semaglutide.
    1 context sentence
    Summary · context
    Herein, we report the case of a 34-year-old male patient with multiple acyl-CoA dehydrogenase deficiency who developed carnitine deficiency attributable to salcaprozic acid sodium (SNAC) in oral semaglutide.

    In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

  1. Version 2Current

    11 Oct 2026, 00:04 UTC

    Study results updated

  2. Version 1

    9 Oct 2026, 03:06 UTC

    First added · source update from Europe PMC

Subjects

Terms as the source lists them.

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