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Wegovy
semaglutide
Black Box Warnings .
Thyroid C-cell Tumor Risk
contraindicated in patients with medullary thyroid carcinoma (MTC) history or family history, or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2); dose-related and duration-dependent incr. in thyroid C-cell tumor incidence observed in rodents, but human relevance unknown; uncertain value of routine serum calcitonin or thyroid ultrasound monitoring; advise patients of potential MTC risk and thyroid tumor symptoms (e.g., neck mass, dysphagia, dyspnea, persistent hoarseness)
Adult Dosing .
Dosage forms: TAB: 1.5 mg, 4 mg, 9 mg, 25 mg; INJ (pen): 0.25 mg per injection, 0.5 mg per injection, 1 mg per injection, 1.7 mg per injection, 2.4 mg per injection
weight management, chronic - obese patients or overweight patients with weight-related comorbidity
- [SC route]
- Dose: 1.7-2.4 mg SC qwk; Start: 0.25 mg SC qwk x4wk, then 0.5 mg SC qwk x4wk, then 1 mg SC qwk x4wk, then 1.7 mg SC qwk x4wk, then may incr. to 2.4 mg SC qwk; Info: may delay dose titration x4wk if intolerance; may switch from 2.4 mg SC qwk to 25 mg PO qam 1wk after last injection
- [PO route]
- Dose: 25 mg PO qam; Start: 1.5 mg PO qam x30 days, then 4 mg PO qam x30 days, then 9 mg PO qam x30 days; Info: give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew tab; may delay dose titration if intolerance; may switch from 25 mg PO qam to 2.4 mg SC qwk (or 1.7 mg SC qwk if 25 mg PO qam not tolerated) day after last PO dose
cardiovascular event risk reduction - obese or overweight patients with established cardiovascular disease
- [SC route]
- Dose: 1.7-2.4 mg SC qwk; Start: 0.25 mg SC qwk x4wk, then 0.5 mg SC qwk x4wk, then 1 mg SC qwk x4wk, then 1.7 mg SC qwk x4wk, then may incr. to 2.4 mg SC qwk; Info: may delay dose titration x4wk if intolerance; may switch from 2.4 mg SC qwk to 25 mg PO qam 1wk after last injection
- [PO route]
- Dose: 25 mg PO qam; Start: 1.5 mg PO qam x30 days, then 4 mg PO qam x30 days, then 9 mg PO qam x30 days; Info: give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew tab; may delay dose titration if intolerance; may switch from 25 mg PO qam to 2.4 mg SC qwk (or 1.7 mg SC qwk if 25 mg PO qam not tolerated) day after last PO dose
metabolic dysfunction-associated steatohepatitis, patients with stage F2-F3 fibrosis
- [2.4 mg SC qwk]
- Start: 0.25 mg SC qwk x4wk, then 0.5 mg SC qwk x4wk, then 1 mg SC qwk x4wk, then 1.7 mg SC qwk x4wk; Info: may delay dose titration x4wk or decr. maintenance dose to 1.7 mg SC qwk if intolerance
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: INJ (pen): 0.25 mg per injection, 0.5 mg per injection, 1 mg per injection, 1.7 mg per injection, 2.4 mg per injection
weight management, chronic - obese patients
- [12 yo and older]
- Dose: 1.7-2.4 mg SC qwk; Start: 0.25 mg SC qwk x4wk, then 0.5 mg SC qwk x4wk, then 1 mg SC qwk x4wk, then 1.7 mg SC qwk x4wk, then may incr. to 2.4 mg SC qwk; Info: may delay dose titration x4wk if intolerance
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy (weight management or cardiovascular event risk reduction use)
- breastfeeding (PO form)
- medullary thyroid CA history
- medullary thyroid CA family history
- multiple endocrine neoplasia syndrome type 2
- caution: hypersensitivity to GLP-1 agonists
- caution: renal impairment
- caution: volume depletion
- caution: pancreatitis risk
- caution: pancreatitis history
- caution: diabetes mellitus
- caution: diabetic retinopathy
- caution: gastroparesis, severe
- caution: pregnancy (metabolic dysfunction-associated steatohepatitis use)
- caution: patients of childbearing potential
- caution: surgery
Drug Interactions .
Overview
semaglutide
GLP-1 agonist
- antidiabetic agent
- caution advised with oral drugs, especially narrow therapeutic index; oral/SC semaglutide delays gastric emptying, may alter absorption of concomitant oral drugs
- administer oral semaglutide at least 30 min before other oral drugs; combo may decr. oral semaglutide absorption, efficacy
Avoid/Use Alternative
- dulaglutide
- exenatide
- liraglutide
- lixisenatide
- semaglutide
- tirzepatide
Monitor/Modify Tx
- acebutolol
- alclometasone topical
- aloe
- alogliptin
- alpelisib
- amcinonide topical
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- asenapine
- ashwagandha
- asparaginase
- aspirin
- atazanavir
- benazepril
- berberine
- betamethasone
- betamethasone topical
- bismuth subsalicylate
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- brentuximab vedotin
- brexpiprazole
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- bromocriptine
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- corticotropin
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- decitabine
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- insulin
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- levothyroxine
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- pioglitazone
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- prednisolone
- prednisone
- pseudoephedrine
- quetiapine
- quinine
- repaglinide
- ribose
- risperidone
- ritonavir
- rosiglitazone
- sacrosidase
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- sirolimus albumin-bound
- sitagliptin
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- sotalol
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- teprotumumab
- tesamorelin
- testosterone
- thyroid
- timolol
- tipranavir
- torsemide
- tramadol
- trandolapril
- tranylcypromine
- triamcinolone
- triamcinolone topical
- triamterene
- triptorelin
- turmeric
- vamorolone
- vorinostat
- ziprasidone
Adverse Reactions .
Serious Reactions
- thyroid C-cell tumor (animal studies)
- medullary thyroid CA risk
- hypersensitivity reaction
- anaphylaxis
- angioedema
- acute kidney injury
- GI reaction, severe
- pancreatitis
- ileus
- intestinal obstruction
- cholelithiasis
- cholecystitis
- syncope
- hypoglycemia
- urolithiasis
- fractures
- perioperative aspiration
Common Reactions
- HR incr.
- nausea
- vomiting
- diarrhea
- constipation
- abdominal pain
- headache
- respiratory infection (peds patients)
- fatigue
- dyspepsia
- dizziness
- abdominal distension
- eructation
- gastroenteritis
- retinal disorder (patients with diabetes mellitus)
- hypoglycemia
- flatulence
- GERD
- dysesthesia (PO form)
- lipase incr.
- fractures
- gastritis
- cholelithiasis
- anxiety (peds patients)
- UTI (peds patients)
- alopecia
- dysesthesia
- rash
- urticaria
- hypotension
- amylase incr.
- ALT incr. (peds patients)
- injection site reaction (INJ form)
Safety/Monitoring .
Monitoring Parameters
HR; glucose at baseline if diabetes, then periodically
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy if weight management or cardiovascular event risk reduction use; weigh risk/benefit during pregnancy if metabolic dysfunction-associated steatohepatitis use; wt loss during pregnancy offers no benefit and may result in fetal harm; no human data available; possible risk of fetal harm, including teratogenicity and fetal death, based on animal data at <1x MRHD
Pregnancy Registry
enroll patients or encourage patients to enroll in Wegovy Pregnancy Registry at 1-877-390-2760 or www.wegovypregnancyregistry.com
Individuals of Reproductive Potential
D/C tx at least 2mo before conception in patients of childbearing potential
Lactation
Clinical Summary
PO Form: avoid use while breastfeeding; no human data available to assess risk of infant harm, though inactive ingredient excreted into milk; may interfere with infant nutrition based on drug's mechanism of action; no human data available to assess effects on milk production
INJ Form: weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; may interfere with infant nutrition based on drug's mechanism of action; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for semaglutide: proteolytic degradation; CYP450: none
Excretion: for semaglutide: urine (3% unchanged), feces; Half-life: 1wk
Subclass: GLP-1 Agonists, Cardiovascular ; Metabolic Dysfunction-Associated Steatohepatitis ; Obesity/Weight Management: GLP-1 Agonists
Mechanism of Action
for semaglutide: activates glucagon-like-peptide-1 (GLP-1) receptor, regulating appetite and caloric restriction, increasing insulin secretion, decreasing glucagon secretion, and delaying gastric emptying (incretin mimetic)
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Novo Nordisk A/S
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
subcutaneous solution:
- 1.7 mg/0.75 mL (1 carton, 4 prefilled 1.7 mg pens): $1,386.00
subcutaneous solution:
- 0.25 mg/0.5 mL (1 carton, 4 prefilled 0.25 mg pens): $1,386.00
subcutaneous solution:
- 0.5 mg/0.5 mL (1 carton, 4 prefilled 0.5 mg pens): $1,386.00
subcutaneous solution:
- 1 mg/0.5 mL (1 carton, 4 prefilled 1 mg pens): $1,386.00
subcutaneous solution:
- 2.4 mg/0.75 mL (1 carton, 4 prefilled 2.4 mg pens): $1,386.00
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