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Kathryn Horton, a board-certified internal medicine physician, stated it directly: "Tirzepatide is a synthetic peptide that is rapidly degraded by digestive enzymes within the gastrointestinal tract." The larger molecular size and chemical modifications that enable dual-receptor agonism "currently pose significant challenges for the development of an effective oral formulation." For sublingual delivery specifically, the absorption story is slightly different but still problematic

Most only stock single-use 10mL vials of sterile water, which lack the required preservative

Confusion over their use has led some Americans to seek over-the-counter replacements, such as an Arizona man who bought a nonpharmaceutical form of chloroquine phosphate, a common chemical used to clean fish tanks, which killed him and landed his now-widow in intensive care