Generic Name

Semaglutide

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Classification

FDA Approved Indications

• Type 2 diabetes mellitus (Ozempic, Rybelsus)
• Chronic weight management in obesity or overweight with comorbidities (Wegovy)

Mechanism of Action

Semaglutide mimics the GLP-1 hormone, enhancing glucose-dependent insulin secretion, suppressing inappropriate glucagon secretion, slowing gastric emptying, and reducing appetite, which leads to improved glycemic control and weight loss.

Dosage and Administration

Adult: Ozempic: 0.5 mg once weekly, may increase to 1 mg weekly; Rybelsus: 3 mg daily for 30 days, then increase to 7 mg daily, up to 14 mg; Wegovy: 2.5 mg weekly, titrating up to 2.4 mg weekly.

Pediatric: Not approved for pediatric use.

Geriatric: Adjustments not typically necessary but monitor for renal impairment.

Renal Impairment: Use with caution; dosage adjustments may be required.

Hepatic Impairment: No specific adjustments recommended.

Pharmacokinetics

Absorption: Moderate oral bioavailability, greater absorption with higher doses.

Distribution: Bound to plasma proteins.

Metabolism: Metabolized via proteolytic cleavage, not via CYP enzymes.

Excretion: Excreted mainly via urine and feces.

Half Life: Approximately 1 week, allowing once-weekly dosing.

Contraindications

• Personal or family history of medullary thyroid carcinoma (MTC)
• Multiple endocrine neoplasia syndrome type 2

Precautions

• History of pancreatitis, gallbladder disease, or severe gastrointestinal disease; monitor for signs of pancreatitis and renal impairment; caution in patients with diabetic retinopathy; pregnancy and lactation should be avoided or used with caution.

Adverse Reactions - Common

• Nausea (High)
• Vomiting (Moderate)
• Diarrhea (Moderate)
• Abdominal pain (Moderate)

Adverse Reactions - Serious

• Pancreatitis (Rare)
• Hypoglycemia (particularly when used with insulin or sulfonylureas) (Rare)
• Thyroid C-cell tumors (observed in rodents) (Preclinical evidence, human risk unknown)

Drug-Drug Interactions

• Insulin, sulfonylureas (increase hypoglycemia risk)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use weekly injections or daily tablets as directed.
• Report severe nausea, vomiting, or signs of pancreatitis.
• Maintain follow-up appointments for monitoring.
• Adjust diet and exercise as per healthcare provider’s advice.

Special Considerations

Black Box Warnings:

• Thyroid C-cell tumors (including MTC)

Genetic Factors: Risks may vary based on genetic predisposition, especially regarding thyroid tumors.

Lab Test Interference: May affect certain lab tests, such as pancreatic enzymes.

Overdose Management

Signs/Symptoms: Severe nausea, vomiting, hypoglycemia, signs of pancreatitis.

Treatment: Supportive care, activated charcoal if ingestion was recent, monitor vital signs, and provide glucose or insulin as needed.

Storage and Handling

Storage: Store in a refrigerator (2°C to 8°C). Protect from light and heat; do not freeze.

Stability: Stable until the expiration date printed on the packaging when stored properly.