Everything You Need to Know About Semaglutide

How Semaglutide Works

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. It increases insulin production in the body by mimicking the GLP-1 hormone. GLP-1 is naturally produced in the intestinal tract and performs two main actions:

• Stimulates insulin release
• Inhibits glucagon release

To understand this effect, it's important to review the roles of insulin, glucose, and glucagon in balancing blood sugar:

• Insulin: Secreted by the pancreas when blood sugar is high, insulin signals the liver to convert glucose to glycogen, a stored glucose chain. It also encourages cells to absorb and use glucose.
• Glucose: A sugar used for energy. Without glucose, cells cannot function. Excess sugar can damage blood vessels and tissues.
• Glucagon: Released by the pancreas when blood glucose is low. It signals the liver to turn stored glycogen back into glucose for use.

In type 2 diabetes, the body does not release enough insulin or is resistant to its effects, leading to high blood sugar levels. Semaglutide helps by mimicking GLP-1, increasing insulin release and bringing blood sugar levels back to normal.

Semaglutide also helps with weight loss because GLP-1 receptor agonists slow the movement of food from the stomach into the small intestine. This makes patients feel full faster and for a longer time, curbing appetite and leading to less eating and subsequent weight loss.

Semaglutide Uses and Brand Names

Semaglutide is available under three different FDA-approved brand names, each with specific uses:

Ozempic: An injectable medication for type 2 diabetes management. It helps manage blood glucose levels and reduces the risk of major cardiovascular events in adults with type 2 diabetes and known heart disease.

Ozempic can also reduce the risk of kidney function decline, kidney failure, and death due to cardiovascular disease in adults with chronic kidney disease (CKD) and type 2 diabetes.

Rybelsus: An oral tablet used to treat type 2 diabetes. It helps control blood sugar levels and should be used with a reduced-calorie diet and increased physical activity.

Wegovy: An injectable drug to support weight management. It is used with diet and exercise to help reduce weight and keep it off in patients with obesity or at least one weight-related medical condition. Wegovy is also approved for weight loss and weight maintenance in patients 12 years and older with obesity.

Dosing Information

The dosage and administration of semaglutide vary depending on the specific brand and the patient's condition.

Ozempic

• Type 2 Diabetes and Reducing Risk of Heart Attack/Stroke:
  
  • Adults start with 0.25 mg injected under the skin once a week for 4 weeks. The doctor may increase the dose as needed, but it usually does not exceed 2 mg once a week.
  • The day of weekly administration can be changed if needed, as long as there are at least 2 days (>48 hours) between two doses.
  • If a dose is missed, administer Ozempic as soon as possible within 5 days after the missed dose. If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day.
  • Children: Use and dose must be determined by a doctor.
• Available Dosage Forms:
  
  • The Ozempic injection pen can deliver 0.25 mg or 0.5 mg doses. Each 1.5 mL pen contains 8 doses of 0.25 mg or 4 doses of 0.5 mg.
  • The Ozempic injection 1 mg dose pen delivers a 1 mg dose. Each 3 mL pen contains 4 doses.
  • The Ozempic injection 2 mg dose pen delivers a 2 mg dose. Each 3 mL pen contains 4 doses.

Wegovy

• Weight Management and Lowering Risk of Heart Attack/Stroke:
  
  • Adults and children 12 years and older start with 0.25 mg injected under the skin once a week for 4 weeks. The doctor may increase the dose every 4 weeks, but it usually does not exceed 2.4 mg once a week.
  • For children younger than 12 years of age, the use and dose of the medication must be determined by a doctor.
• Dosage Escalation Schedule:
  
  • Weeks 1-4: 0.25 mg weekly
  • Weeks 5-8: 0.5 mg weekly
  • Weeks 9-12: 1 mg weekly
  • Weeks 13-16: 1.7 mg weekly
  • Week 17 onwards: 2.4 mg weekly
  • If a dose is missed and the next scheduled dose is more than 2 days away, use it as soon as possible. If the next scheduled dose is less than 2 days away, skip the missed dose and continue the regular dosing schedule.
• Available Strengths:
  
  • 0.25 mg pen delivers one 0.25 mg dose (0.25 mg/0.5 mL)
  • 0.5 mg pen delivers one 0.5 mg dose (0.5 mg / 0.5 mL)
  • 1 mg pen delivers one 1 mg dose (1 mg / 0.5 mL)
  • 1.7 mg pen delivers one 1.7 mg dose (1.7 mg / 0.75 mL)
  • 2.4 mg pen delivers one 2.4 mg dose (2.4 mg / 0.75 mL)

Rybelsus

• Type 2 Diabetes:
  
  • Adults start with 3 mg once daily for 30 days. This dose is for treatment initiation and is not effective for glycemic control.
  • After 30 days, increase the dose to 7 mg once daily.
  • After at least 30 days on the 7 mg dose, if additional glycemic control is needed, the dose may be increased to 14 mg once daily. However, it is not recommended to take two 7 mg Rybelsus tablets to achieve a 14 mg dose.
  • If a dose is missed, skip the missed dose and take the next dose the following day.
• Available Strengths:
  
  • 3 mg, 7 mg, and 14 mg tablets
  • Take Rybelsus at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water only.
  • After 30 minutes, you may eat, drink, or take other oral medicines. Swallow tablets whole; do not split, crush, or chew them.

Who Can Take Semaglutide?

• Adults over 18 years old with type 2 diabetes can take semaglutide.
• NICE recommends Ozempic and Rybelsus for adults with type 2 diabetes when three medications have not effectively managed their diabetes or they cannot take the medications due to side effects or other medical conditions.
• Ozempic and Rybelsus are typically prescribed when someone has a BMI of 35kg/m2 or higher and additional psychological or medical conditions related to obesity.
• However, individuals with type 2 diabetes can be prescribed Ozempic or Rybelsus if they have a BMI below 35kg/m2 and using insulin would affect their job due to the risk of low blood sugar, or weight loss would improve other obesity-related health issues.
• NICE recommends that individuals from Black African, African-Caribbean, Asian, South Asian, Chinese, and Middle Eastern backgrounds receive Ozempic or Rybelsus at a lower BMI due to their risk of obesity-related health problems.
• NICE guidelines recommend Wegovy for adults who have a BMI of 30kg/m2 and over and at least one weight-related health condition, such as prediabetes or type 2 diabetes.
• The FDA recommends Wegovy for weight loss in people with a body mass index (BMI) of 27kg/m2 to 30kg/m2 or greater and at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol.

Who Should Not Take Semaglutide?

Semaglutide may not be suitable for everyone. You should not take semaglutide if you have:

• A known allergy to semaglutide or any of the ingredients in the medication
• A personal or family history of medullary thyroid carcinoma (a type of thyroid cancer)
• Multiple endocrine neoplasia syndrome type 2 (MEN 2)
• Diabetic ketoacidosis
• Severe gastroparesis (for Wegovy)
• Type 1 diabetes

Semaglutide should be used with caution, and you should consult your doctor if you have:

• A history of depression
• A history of pancreatitis
• Kidney disease
• Severe liver disease
• Eye disease or vision problems
• Stomach problems
• If you are breastfeeding

Potential Side Effects

Like all medications, semaglutide can cause side effects. The most common side effects are gastrointestinal issues, such as:

• Nausea
• Diarrhea
• Constipation
• Vomiting
• Abdominal pain
• Indigestion
• Belching
• Flatulence

These side effects are usually mild to moderate and temporary, often subsiding as the body adjusts to the medication. Starting with a lower dose and gradually increasing it can help reduce these side effects.

Other common side effects include:

• Headache
• Dizziness
• Fatigue
• Low blood sugar (in people with type 2 diabetes)

Serious side effects are rare but can include:

• Allergic reactions: Rash, itching, hives, swelling of the face, lips, tongue, or throat, difficulty breathing.
• Vision changes
• Mood changes: Unusual mood changes, thoughts of self-harm.
• Thyroid tumors: Swelling or a lump in the neck, trouble swallowing, a hoarse voice, or shortness of breath.
• Pancreatitis: Severe pain in the upper stomach spreading to the back, nausea, vomiting, fast heart rate.
• Gallbladder problems: Upper stomach pain, fever, clay-colored stools, jaundice (yellowing of the skin or eyes).
• Kidney problems: Swelling, urinating less, feeling tired or short of breath.

If you experience any serious side effects, seek immediate medical attention.

Managing Side Effects

Here are some tips for managing common side effects:

• For stomach side effects:
  
  • Eat more slowly
  • Eat smaller meals
  • Choose bland, low-fat foods like crackers, toast, and rice
  • Avoid greasy, fried foods, and sugary treats
  • Eat foods that contain water, like soup or gelatin
  • Do not lie down right after eating
  • Drink clear or ice-cold liquids
  • Get fresh air if you feel sick
• For hypoglycemia (low blood sugar):
  
  • Regularly test blood sugar levels if you also take diabetic medicines, including insulin or sulfonylureas.
  • Eat or drink something that will raise your blood sugar quickly, such as sugary foods or drinks, glucose tablets or gel, or sugary candy.
  • Check your blood sugar after 10-15 minutes.
  • Once your symptoms have improved, eat a healthy snack or meal to keep your blood sugar up.

Semaglutide and Weight Loss

Semaglutide has shown promising results for weight loss in individuals with obesity or who are overweight. Wegovy, specifically, is approved for chronic weight management.

Efficacy

Clinical trials have demonstrated that semaglutide, when combined with diet and exercise, can lead to significant weight loss. For example, in one study, half of the participants using semaglutide lost 15% of their body weight, and nearly a third lost 20%. In contrast, those who only made lifestyle changes lost about 2.4% of their weight.

However, it is important to note that participants tend to regain weight when they stop taking semaglutide. Therefore, long-term management includes continuous lifestyle changes and possibly ongoing medication.

Who Can Use Semaglutide for Weight Loss?

Semaglutide (Wegovy) is recommended for weight loss in individuals who meet the following criteria:

• Have a BMI of 30 kg/m2 or greater
• Have a BMI of 27 kg/m2 or greater with at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol.

Is Semaglutide Safe?

Semaglutide injections are considered safe when taken as directed by a healthcare provider. Common side effects are usually mild and temporary.

Semaglutide Alternatives

Several alternatives to semaglutide are available, each with its own active ingredients and mechanisms:

Mounjaro (Tirzepatide): Contains tirzepatide, a GLP-1 agonist that works in two ways to support long-term health goals. It slows down food movement through the stomach and helps prevent spikes in blood sugar. Tirzepatide can result in more weight loss compared to semaglutide.

Nevolat (Liraglutide): Contains liraglutide and works similarly to semaglutide by reducing appetite and promoting feelings of fullness. However, liraglutide is a once-daily injection, unlike the once-weekly injections of semaglutide.

LookMeds Compounded Semaglutide: A Viable Option

As the demand for semaglutide continues to rise, many individuals are exploring alternative sources beyond brand-name options. One such alternative is LookMeds’ compounded semaglutide, which offers a potential solution for those facing challenges with availability, pricing, or insurance coverage.

Why Consider LookMeds Compounded Semaglutide?

✔️ Availability – With widespread Ozempic and Wegovy shortages, compounded versions provide an alternative for those struggling to access FDA-approved medications.
✔️ Affordability – Compounded semaglutide may offer a lower-cost option for patients who do not have insurance coverage for GLP-1 receptor agonists or who face high out-of-pocket costs.
✔️ Customization – Some patients may benefit from tailored dosing schedules or additional formulations that are not available with standard semaglutide injections.

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How to Use Semaglutide

Semaglutide is administered differently depending on the brand:

Ozempic and Wegovy: Injected under the skin once per week at any time of the day, with or without food. Use on the same day each week.

Rybelsus: Taken orally once a day at least 30 minutes before intaking the day’s first food, beverage, or other oral medications, with no more than 4 ounces of plain water.

Your healthcare provider will show you where to inject semaglutide. Do not inject into the same place two times in a row.

Semaglutide Interactions

Semaglutide can interact with other medications, especially those for diabetes. It can slow down digestion, affecting how the body absorbs oral medications. Be sure to inform your doctor about all medications you’re taking, including prescriptions, over-the-counter drugs, vitamins, and herbal products.

Medications that may interact with semaglutide include:

• Insulin and other diabetes medications
• Certain antibiotics
• MAO inhibitors
• Steroid medications

Always consult with your healthcare provider to ensure that semaglutide is safe to use with your current medications.

Semaglutide Storage

Proper storage is essential to maintain the effectiveness of semaglutide:

• Ozempic:
  
  • Before first use, store in a refrigerator between 36ºF to 46ºF (2ºC to 8ºC).
  • After the first use, the pen can be stored for 56 days at controlled room temperature (59°F to 86°F; 15°C to 30°C) or in a refrigerator.
  • Keep the pen cap on when not in use.
  • Always remove and safely discard the needle after each injection.
• Wegovy:
  
  • Store the single-dose pen in the refrigerator from 36°F to 46°F (2°C to 8°C).
  • If needed, before removing the cap, the pen can be kept between 46°F and 86°F (8°C and 30°C) for up to 28 days.
  • Keep Wegovy in the original carton until the time of administration.
• Rybelsus:
  
  • Store at 68° to 77°F (20 to 25°C); excursions permitted to 59° to 86°F (15° to 30°C).
  • Store and dispense in the original bottle.
  • Store tablets in the original bottle until used to protect tablets from moisture.

Bottom Line

Semaglutide is a versatile medication used in managing type 2 diabetes and obesity. Understanding its mechanisms, uses, potential side effects, and proper administration is crucial for safe and effective treatment.

Always consult with a healthcare provider to determine if semaglutide is the right choice for your individual needs and to ensure appropriate monitoring and management.

Get started with semaglutide today.