What it's for (Indications)
- Semaglutide is primarily indicated as an adjunct to diet and increased physical activity for the treatment of Type 2 Diabetes Mellitus to improve glycemic control.
- It is also approved for chronic weight management (under specific brand names and formulations) and has demonstrated cardiovascular risk reduction in adults.
- Emerging evidence suggests potential for treatment of metabolic dysfunction-associated steatohepatitis (MASH).
Dosage Information
| Type | Guideline |
|---|---|
| Standard | Semaglutide is administered once weekly via subcutaneous injection or once daily as an oral tablet, depending on the product formulation and indication. For subcutaneous injection (e.g., Ozempic for Type 2 Diabetes): Initiate with 0.25 mg once weekly for 4 weeks. Then, increase to 0.5 mg once weekly for 4 weeks or longer. Further titration to 1 mg once weekly, or higher doses up to 2 mg, may be used for additional glycemic control, depending on regional product availability and patient response. For chronic weight management (e.g., Wegovy injection): Initiate with 0.25 mg once weekly for 4 weeks, and then gradually escalate the dose every 4 weeks to reach a maintenance dose, typically 2.4 mg once weekly. Injections should be administered on the same day each week, at any time of day, with or without meals, subcutaneously in the abdomen, thigh, or upper arm. For oral tablets (e.g., Rybelsus for Type 2 Diabetes): Take once daily on an empty stomach in the morning with up to 4 ounces of water. Tablets must be swallowed whole and not split, crushed, chewed, or dissolved. The precise dosage and titration schedule depend on the patient's condition, age, response to treatment, and specific product used; always consult a healthcare professional for personalized guidance. |
Safety & Warnings
Common Side Effects
- Common adverse reactions include nausea, vomiting, diarrhea, abdominal pain, and constipation.
- Other reported side effects include dizziness, fatigue, and headache.
- Serious adverse reactions can include acute pancreatitis (characterized by severe abdominal pain, potentially radiating to the back, with or without vomiting), acute gallbladder disease (including gallstones), hypoglycemia (especially when used with insulin or sulfonylureas), acute kidney injury (due to volume depletion), severe gastrointestinal adverse reactions, hypersensitivity reactions (e.
- g.
- , anaphylaxis, angioedema, rash), vision changes or complications of diabetic retinopathy, and increased heart rate.
- Pulmonary aspiration during general anesthesia or deep sedation has also been reported.
Serious Warnings
- Black Box Warning: WARNING: RISK OF THYROID C-CELL TUMORS. In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. Semaglutide is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
- Patients should be informed about the potential risk of thyroid C-cell tumors based on rodent studies; the human relevance is unknown, but semaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
- Caution is advised in patients with a history of pancreatitis; discontinue semaglutide if acute pancreatitis is suspected.
- Monitor for signs and symptoms of acute gallbladder disease.
- Monitor blood glucose levels closely, especially when co-administered with insulin or sulfonylureas, to mitigate the risk of hypoglycemia.
- Renal function should be monitored due to the risk of acute kidney injury, particularly in patients with pre-existing kidney disease or volume depletion.
- Use with caution in patients with a history of diabetic retinopathy, as complications have been observed.
- Inform your doctor about any history of heart, kidney, liver, or pancreatic disease.
- Discontinue semaglutide 24 hours before and after surgery, or as advised by your doctor, due to the risk of pulmonary aspiration during general anesthesia or deep sedation.
- Patients should not discontinue treatment without medical advice.
- Inform your doctor about all current medications and significant past medical history.
- Women planning pregnancy should ideally discontinue semaglutide at least 2 months before conception unless otherwise advised by a doctor.
- The effects in pregnant and nursing females are largely unknown; consultation with a healthcare provider is recommended.
- Alcohol consumption should be discussed with a doctor.
How it Works (Mechanism of Action)
Semaglutide is a GLP-1 analogue with 94% sequence homology to human GLP-1. It acts as a GLP-1 receptor agonist that selectively binds to and activates the GLP-1 receptor. GLP-1 is a physiological regulator of appetite and caloric intake, and its receptor is present in brain regions involved in appetite regulation. In diabetes, GLP-1 receptor activation leads to glucose-dependent insulin secretion, decreased glucagon secretion, and delayed gastric emptying. The exact mechanisms for cardiovascular risk reduction and MASH treatment are not fully established but may involve weight loss and other factors.