Semaglutide

OZEMPIC

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Pronunciation: sem-a-GLOO-tide (oe-ZEM-pik)

Semaglutide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Semaglutide ballicule

Semaglutide RYBELSUS / OZEMPIC / WEGOVY mascot mnemonic cartoon — Visual mnemonic: Semaglutide mascot
**“(Rebel, Olympic, & Wig governor) See my glue tide”**
Glasses on the mascots → “see my glue tide”
Rebel saying “You ain’t injectin’ me!” → Rybelsus is oral, unlike Ozempic/Wegovy

What it isGLP-1 receptor agonist for type 2 diabetes and chronic weight management.

Why this oneMore weight loss than liraglutide, and fewer cardiovascular events with or without diabetes.

What limits itGI intolerance drives discontinuation, so titrate slowly. Delayed gastric emptying matters before anesthesia.

Pearls

Also slows CKD progression in type 2 diabetes.
HFpEF with obesity: fewer symptoms, better function.
Labeled for noncirrhotic MASH with moderate–advanced fibrosis.
Oral tablet: take fasting with a sip of water, 30 minutes before food.

Semaglutide molecular structure (skeletal formula) — Molecular structure: Semaglutide

Semaglutide prescription history

Animated chart of estimated U.S. prescriptions per year, Diabetes meds (1923–2026). Semaglutide enters in 2018 (estimated).

FDA-approved for

type 2 diabetes (2017)
obesity (2021)

Off-label

NASH
cardiovascular risk reduction

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityGI intolerance, gallbladder disease and rare pancreatitis; hypoglycemia is uncommon without insulin or sulfonylureas.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Risk of thyroid C-cell tumors (rodent); contraindicated with personal/family history of MTC or MEN 2

FDA dosing	Population	Start	Target	Max
Type 2 diabetes — glycemic control (adjunct to diet/exercise)	Adults	0.25 mg SC once weekly x4 wk, then 0.5 mg once weekly	0.5 mg, 1 mg, or 2 mg once weekly	2 mg once weekly
T2DM with established CVD — reduce MACE risk	Adults	0.25 mg SC once weekly x4 wk, then 0.5 mg once weekly	Not separately labeled (glycemic-control regimen)	2 mg once weekly
T2DM with CKD — reduce sustained eGFR decline, ESKD, CV death	Adults	0.25 mg SC once weekly x4 wk, then 0.5 mg once weekly	1 mg once weekly (after ≥4 wk on 0.5 mg)	2 mg once weekly

Titration Increase after at least 4 weeks at each dose

Renal No dose adjustment (including kidney failure)

Hepatic No dose adjustment

Instructions

Inject SC once weekly (abdomen, thigh, upper arm), same day each week, any time, with or without meals; rotate sites
Inspect: clear and colorless; do not use if particulate/colored
With insulin: separate injections, never mix; same region OK but not adjacent
Weekly day may change if ≥2 days (>48 hours) between doses
Missed dose: give within 5 days; if >5 days, skip and resume schedule
Never share a pen between patients, even with a new needle

Available strengths

pen 0.25, 0.5, 1, 2 mg (SQ)

Contraindications

Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2

Cautions

Thyroid C-cell tumors
Acute pancreatitis — discontinue if suspected
Diabetic retinopathy complications
Never share pen between patients
Hypoglycemia with insulin secretagogues or insulin
Acute kidney injury from volume depletion
Severe GI reactions; not recommended in severe gastroparesis
Hypersensitivity reactions (anaphylaxis, angioedema)
Acute gallbladder disease
Pulmonary aspiration during general anesthesia/deep sedation

Adverse reactions

Nausea
Vomiting
Diarrhea
Abdominal pain
Constipation

Pregnancy Limited human data; animal studies suggest fetal risk — use only if benefit justifies risk; stop ≥2 months before planned pregnancy

Lactation No human milk data (present in rat milk); weigh breastfeeding benefits vs maternal need and infant risk

Cost

Semaglutide (OZEMPIC)

Strength		#/mo	CostPlus
0.25 mg	pen	per unit	not offered
0.5 mg	pen	per unit	not offered
1 mg	pen	per unit	not offered
2 mg	pen	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Semaglutide is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Other forms: Semaglutide oral (RYBELSUS) · Semaglutide (obesity) (WEGOVY) · Semaglutide oral (obesity) (WEGOVY (oral))

Generic entry2031 est.

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Memory aids: interaction avatars

Box: minimal PK interactions

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Self-check

Why titrate semaglutide slowly?
GI intolerance drives discontinuation.
What semaglutide effect matters before anesthesia?
Delayed gastric emptying.