INDICATIONS FOR USE

Semaglutide is an injectable medication approved for the management of type 2 diabetes mellitus to improve glycemic control in adults. It is also FDA approved for weight management in adults with obesity or overweight.

EVIDENCE RATING

✦✦✦ : FDA approved therapy with extensive human efficacy and safety data.

ROUTE OF ADMINISTRATION

• Subcutaneous injection

COMMON INITIAL DOSING REGIMENS

• Standard dosing: Start at 0.25 mg subcutaneously once weekly for 4 weeks. Titrate every 4 weeks to 0.5 mg, 1 mg, 1.7 mg, and finally to 2.4 mg weekly as tolerated.

• NOTE: Many patients do not require anything close to the standard dosing. We strongly believe that dosing smaller amounts more frequently results in better outcomes. Each regimen is personalized to the individual patient’s sensitivity and response.

MECHANISM OF ACTION

• Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. It mimics the effects of endogenous GLP-1 by stimulating insulin secretion in response to elevated glucose levels, suppressing glucagon secretion, and slowing gastric emptying. These actions improve postprandial glucose control and reduce appetite, leading to significant weight loss.

COMMON SIDE EFFECTS

• Gastrointestinal: Nausea, vomiting, diarrhea, constipation, and abdominal pain are common, especially during dose escalation.

• Metabolic: Hypoglycemia when used in combination with insulin or sulfonylureas.

• Injection Site: Localized reactions, such as erythema or swelling.

• Other: Fatigue, dizziness, and mild elevations in serum lipase levels.

• Severe Effects: Rare but serious adverse effects include acute pancreatitis, acute kidney injury (often secondary to severe dehydration), and gallbladder disease (e.g., cholecystitis or gallstones).

CONTRAINDICATIONS

• Absolute: Personal or family history of medullary thyroid carcinoma (MTC), multiple endocrine neoplasia syndrome type 2 (MEN 2), or hypersensitivity to semaglutide or its excipients.

• Relative: Severe gastrointestinal disease, a history of pancreatitis, or significant renal impairment. Patients with gallbladder disease should be monitored due to the risk of gallstone formation.

NOTES

• Our formulations of semaglutide are available compounded with Vitamin B6 (to decrease nausea).

• All compounds are obtained from licensed compounding pharmacies certified by their respective State Boards of Pharmacy. All batches of compounded medications are independently tested to ensure quality, sterility, and concentration.

• We can also obtain non-compounded semaglutide (Ozempic®) for patients at a significantly higher cost.