Semaglutide
OZEMPIC, WEGOVY
What it isGLP-1 receptor agonist for type 2 diabetes and chronic weight management.
Why this oneIts injectable and oral diabetes formulations plus an obesity formulation give it unmatched reach within the class.
What limits itGI intolerance drives discontinuation, so titrate slowly. Delayed gastric emptying matters before anesthesia.
FDA-approved for
- type 2 diabetes (2017)
- obesity (2021)
Off-label
- NASH
- cardiovascular risk reduction
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 2 diabetes mellitus (Rybelsus) | Adults | 3 mg QD x30 days | 7 mg QD | 14 mg QD |
| Type 2 diabetes mellitus (Ozempic tablets) | Adults | 1.5 mg QD x30 days | 4 mg QD | 9 mg QD |
Titration Increase at ≥30-day (monthly) intervals
Renal No adjustment needed (including ESRD)
Hepatic No adjustment needed
Rybelsus and Ozempic tablets are not substitutable on a mg-to-mg basis
Instructions
- Take once daily on empty stomach in the morning with ≤4 oz water; no other liquids
- Swallow tablets whole; do not split, crush, chew, or dissolve
- Wait ≥30 min before eating, drinking, or taking other oral medications
- If a dose is missed, skip it and take the next dose the following day
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2
Cautions
- Acute pancreatitis — discontinue if suspected
- Diabetic retinopathy complications
- 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
- Abdominal pain
- Diarrhea
- Decreased appetite
- Vomiting
- Constipation
Pregnancy Insufficient human data; animal studies show fetal harm; discontinue ≥2 months before a planned pregnancy
Lactation Breastfeeding not recommended (SNAC present in human milk)
⚠ BOXED WARNING
- Thyroid C-cell tumors in rodents
Cost, est. cash$900–$1,400/month
Generic entry2031 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityGI intolerance, gallbladder disease and rare pancreatitis; hypoglycemia is uncommon without insulin or sulfonylureas.
Mechanism of action: Semaglutide ballicule
Open Semaglutide in the interactive console ↗
Memory aids: mascots and interaction avatars
Glasses on the mascots → “see my glue tide”
Rebel saying “You ain’t injectin’ me!” → Rybelsus is oral, unlike Ozempic/Wegovy
