Semaglutide is a medication classified as a GLP-1 (glucagon-like peptide-1) receptor agonist initially approved for patients with type 2 diabetes in adjunct with diet and exercise. The drug essentially mimics the endogenous peptide hormone produced in the gut in response to a meal. Once GLP-1 is secreted, it stimulates insulin release from pancreatic beta cells while simultaneously inhibiting the release of glucagon, thus, effectively lowering plasma glucose levels. FDA-approved semaglutide products indicated for type 2 diabetes include Ozempic (injectable) and Rybelsus (tablets). In addition to glycemic control, Ozempic can also reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes along with established cardiovascular disease. Ozempic is dosed once weekly and can be titrated up every 4 weeks for additional control if needed. Doses include 0.25 mg, 0.5 mg, 1 mg, and 2 mg. Rybelsus is taken daily, can also be titrated up if additional glycemic control is desired, and is available in 3 mg, 7 mg, and 14 mg tablets.
Recently, semaglutide has gained an immense amount of popularity due to its mechanism promoting weight loss. In June 2021, FDA approved Wegovy (injectable) in adults and children 12 years and older with obesity. Its use is indicated in adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adult patients with a BMI (body mass index) of 30 kg/m^2 or greater, or 27 kg/m^2 or greater in the presence of at least one weight-related comorbid condition, such as hypertension, type 2 diabetes mellitus, or dyslipidemia. Wegovy is also appropriate for pediatric patients aged 12 years and older with an initial BMI at the 95th percentile or greater according to age and sex. It aids in weight loss by suppressing appetite and delaying gastric emptying. Similarly to Ozempic, Wegovy can be injected once weekly and its strength can be increased every 4 weeks. Wegovy is available in prefilled single dose pens in strengths 0.25 mg, 1.7 mg and 2.4 mg. The most common adverse reactions experienced in both adult and pediatric patients are nausea, vomiting, diarrhea, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distension, eructation, hypoglycemia in type 2 diabetics, flatulence, gastroenteritis, GERD and nasopharyngitis.
Due to an increase in demand, all semaglutide products are currently under shortage. Compounded semaglutide products are not FDA-approved as they aren’t evaluated for safety, efficacy or quality.
Please consult the following links for more information:
https://pubmed.ncbi.nlm.nih.gov/26371721/ https://www.ozempic.com/ https://www.rybelsus.com/ https://www.wegovy.com/
Dayna John, PharmD Candidate 2024
