What is Semaglutide?

Semaglutide is a GLP-1 receptor agonist originally developed for the treatment of type 2 diabetes. Recently, it has gained significant attention for its effectiveness in promoting weight loss. By mimicking the GLP-1 hormone, semaglutide helps regulate appetite, leading to reduced calorie intake and, ultimately, weight loss.

How Semaglutide Works

Semaglutide works by:

• Increasing Insulin Secretion: It stimulates insulin release when blood sugar levels are high.
• Decreasing Glucagon Secretion: It lowers the levels of glucagon, which helps reduce glucose production in the liver.
• Slowing Gastric Emptying: This leads to a feeling of fullness for a longer period, reducing overall food intake.

Benefits of Semaglutide

• Effective Weight Loss: Clinical trials have shown significant weight reduction in participants using semaglutide compared to placebo.
• Improved Blood Sugar Control: Beyond weight loss, semaglutide helps maintain healthier blood sugar levels.
• Convenient Dosing: Available as a once-weekly injection, making it easier to incorporate into your routine.

Possible Side Effects of Semaglutide

While semaglutide is generally well-tolerated, some individuals may experience side effects. Common side effects include:

• Nausea: A frequent initial side effect that often decreases over time.
• Diarrhea: May occur as your body adjusts to the medication.
• Vomiting: Some users report episodes of vomiting, especially during the early stages of treatment.
• Constipation: Changes in bowel habits can occur.
• Abdominal Pain: Mild to moderate stomach discomfort may be experienced.

Less common but more serious side effects can include:

• Pancreatitis: Inflammation of the pancreas, characterized by severe abdominal pain.
• Kidney Problems: Some users may experience changes in kidney function.
• Allergic Reactions: Rarely, individuals may have allergic reactions to the medication.

Contraindications

Eligibility Requirements: Semaglutide is a prescription medication and requires a doctor's approval to dispense. A prescription requires a BMI of 30+ (27+ in special cases) to qualify. Semaglutide cannot be prescribed to anyone with the following conditions:

• History of angioedema
• Medullary thyroid carcinoma (MTC)
• Multiple endocrine neoplasia syndrome type 2 (MEN 2)
• Thyroid cancer
• Thyroid C-cell tumors
• Type 1 diabetes mellitus
• Hypoglycemia
• Pancreatitis
• Cholelithiasis
• Gallbladder disease
• Diabetic retinopathy
• Renal failure or impairment
• Depression or schizophrenia
• Suicidal ideation
• Pregnancy or reproductive risk
• Breastfeeding
• Geriatric patients

Box Warning

Semaglutide has been shown to induce dose-dependent and treatment-duration–dependent thyroid C-cell tumors in rodents. However, it remains uncertain whether semaglutide poses a similar risk of cancer in humans. Given this potential risk, semaglutide is contraindicated in patients with a personal or family history of MTC or MEN 2 syndrome. Patients prescribed semaglutide should receive counseling regarding the potential risk of thyroid cancers.

Precautions

Suicidal behavior has been reported with other medications prescribed for weight management. Therefore, it is advisable to avoid the use of semaglutide in individuals with a history of suicidal attempts or current suicidal ideation. Patients with suicidal ideations should seek immediate assistance.

Semaglutide can potentially slow gastric emptying and impede the absorption of other medications. The multiple-dose injection pen (Ozempic®) should not be shared among individuals to mitigate the risk of infection.

Semaglutide is contraindicated in patients with type 1 diabetes. As the effectiveness of semaglutide in combination with other weight loss medications is not established, concurrent use of this drug with other weight loss medications should be avoided.

Patients with a history of bariatric surgery face an increased risk of gastrointestinal complications when using semaglutide. Therefore, regular monitoring for such complications is recommended.

If the medication is discontinued after attaining weight loss, a risk of rebound weight gain exists. This was demonstrated in an extension of the STEP 1 trial, where participants, after discontinuing weekly subcutaneous semaglutide 2.4 mg and lifestyle interventions for 1 year, experienced a regain of approximately two-thirds of their initial weight loss.

Monitoring

Before initiating and periodically during treatment with semaglutide, patients should receive counseling regarding potential adverse effects or complications. They should also be instructed to report any concerns to their healthcare providers promptly.

Monitoring for complications should be conducted collaboratively by the patient and their clinician, focusing on the following aspects:

• Vigilance for hypoglycemia is essential, especially when semaglutide is used with other glucose-lowering agents.
• Due to a heightened risk of gastrointestinal adverse effects such as nausea, vomiting, diarrhea, and constipation, close monitoring of patients for these adverse reactions is essential, with meticulous adherence to dose escalation.
• Dehydration resulting from gastrointestinal adverse effects poses a potential risk of renal failure. Therefore, monitoring renal function is paramount, especially in individuals experiencing gastrointestinal adverse effects.
• Healthcare providers should assess the risk of gallbladder or ductal disease and pancreatitis in patients using semaglutide who exhibit characteristic signs or symptoms.
• A potential risk of diabetic retinopathy complications underscores the importance of monitoring for any changes in vision and providing exceptional care to patients with baseline retinopathy.
• Although the risk of thyroid tumors in humans remains unclear, patients and healthcare providers should remain vigilant for the development of any signs, such as a neck lump, hoarseness, dyspnea, or dysphagia while on semaglutide.