Select a medication above to begin.
Ozempic
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; INJ (pen): 2 mg per 3 mL, 4 mg per 3 mL, 8 mg per 3 mL
Special Note
- [prescribing info]
- Info: see Wegovy for FDA-approved weight management dosing
- [strength clarification]
- Info: 2 mg per 3 mL pen delivers 0.25 mg or 0.5 mg per injection; 4 mg per 3 mL pen delivers 1 mg per injection; 8 mg per 3 mL pen delivers 2 mg per injection
- [equivalency or interchangeability info]
- Info: semaglutide 1.5 mg, 4 mg, 9 mg tabs not interchangeable with 3 mg, 7 mg, 14 mg tabs; do not substitute on a mg to mg basis
diabetes mellitus, type 2
- [SC route, semaglutide-naive patients]
- Dose: 0.5-2 mg SC qwk; Start: 0.25 mg SC qwk x4wk, then incr. to 0.5 mg SC qwk, then may incr. to 1 mg SC qwk after at least 4wk, then may incr. to 2 mg SC qwk after at least 4wk; Max: 2 mg/wk; Info: give doses >48h apart
- [PO route, semaglutide-naive patients]
- Dose: 4-9 mg PO qam; Start: 1.5 mg PO qam x30 days, then incr. dose to 4 mg PO qam; Info: may incr. dose to 9 mg PO qam after at least 30 days on 4 mg PO qam; give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
- [PO route, conversion from semaglutide 7 mg PO qam]
- Dose: 4 mg PO qam; Start: day after last 7 mg dose; Info: give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
- [PO route, conversion from semaglutide 14 mg PO qam]
- Dose: 9 mg PO qam; Start: day after last 14 mg dose; Info: give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
- [PO route, conversion from semaglutide 0.5 mg SC qwk]
- Dose: 4-9 mg PO qam; Start: 1wk after last injection; Info: give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
cardiovascular event risk reduction - DM type 2 patients
- [SC route, semaglutide-naive patients]
- Dose: 0.5-2 mg SC qwk; Start: 0.25 mg SC qwk x4wk, then incr. to 0.5 mg SC qwk, then may incr. to 1 mg SC qwk after at least 4wk, then may incr. to 2 mg SC qwk after at least 4wk if additional glycemic control needed; Max: 2 mg/wk; Info: for patients with established cardiovascular disease; give doses >48h apart
- [PO route, semaglutide-naive patients]
- Dose: 4-9 mg PO qam; Start: 1.5 mg PO qam x30 days, then incr. dose to 4 mg PO qam; Info: for patients at high risk; may incr. dose to 9 mg PO qam after at least 30 days on 4 mg PO qam if additional glycemic control needed; give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
- [PO route, conversion from semaglutide 7 mg PO qam]
- Dose: 4 mg PO qam; Start: day after last 7 mg dose; Info: for patients at high risk; give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
- [PO route, conversion from semaglutide 14 mg PO qam]
- Dose: 9 mg PO qam; Start: day after last 14 mg dose; Info: for patients at high risk; give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
- [PO route, conversion from semaglutide 0.5 mg SC qwk]
- Dose: 4-9 mg PO qam; Start: 1wk after last injection; Info: for patients at high risk; give on empty stomach with up to 4 oz water >30min before food/drink/med; do not cut/crush/chew/dissolve tab
kidney disease progression and cardiovascular death risk reduction - DM type 2 patients with CKD
- [1 mg SC qwk]
- Start: 0.25 mg SC qwk x4wk, then incr. to 0.5 mg SC qwk, then incr. to 1 mg SC qwk after at least 4wk; Max: 2 mg/wk; Info: may incr. dose to 2 mg SC qwk after at least 4wk on 1 mg SC qwk if additional glycemic control needed; give doses >48h apart
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- breastfeeding (PO form)
- medullary thyroid CA history
- medullary thyroid CA family history
- multiple endocrine neoplasia syndrome type 2
- diabetes mellitus, type 1
- caution: hypersensitivity to GLP-1 agonists
- caution: renal impairment
- caution: volume depletion
- caution: gastroparesis, severe
- caution: pancreatitis risk
- caution: pancreatitis history
- caution: diabetic retinopathy
- 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
- bortezomib
- brentuximab vedotin
- brexpiprazole
- brigatinib
- bromocriptine
- budesonide
- bumetanide
- calaspargase
- canagliflozin
- capivasertib
- cariprazine
- carvedilol
- cassia cinnamon
- ceritinib
- chloroquine
- chlorothiazide
- chlorthalidone
- chromium
- ciprofloxacin
- clarithromycin
- clobetasol topical
- clocortolone topical
- clozapine
- colesevelam
- copanlisib
- corticotropin
- cortisone
- dabrafenib
- danazol
- darunavir
- decitabine
- deflazacort
- delafloxacin
- desogestrel (contraceptive)
- desonide topical
- desoximetasone topical
- dexamethasone
- diazoxide
- dienogest (contraceptive)
- diflorasone topical
- disopyramide
- drospirenone (contraceptive)
- eleuthero
- enfortumab vedotin
- ensartinib
- ephedra
- epinephrine
- ertugliflozin
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- ethionamide
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- everolimus
- fenugreek
- flaxseed
- fludrocortisone
- fluocinolone otic
- fluocinolone topical
- fluocinonide topical
- fluoxetine
- flurandrenolide topical
- fluticasone propionate topical
- fosamprenavir
- fosphenytoin
- furosemide
- garlic
- ginkgo
- ginseng, American
- ginseng, Asian
- glimepiride
- glipizide
- glyburide
- goserelin
- gymnema
- halcinonide topical
- halobetasol topical
- hydrochlorothiazide
- hydrocortisone
- hydrocortisone topical
- hydroxychloroquine
- iloperidone
- inavolisib
- indapamide
- insulin
- isocarboxazid
- isoniazid
- lanreotide
- leuprolide
- levofloxacin
- levonorgestrel (contraceptive)
- levothyroxine
- linagliptin
- linezolid
- liothyronine
- lisinopril
- lopinavir/ritonavir
- lorlatinib
- lumateperone
- lurasidone
- lutetium Lu 177 dotatate
- mecasermin
- medroxyprogesterone (contraceptive)
- megestrol
- methylprednisolone
- methyltestosterone
- metolazone
- metreleptin
- milk thistle
- milsaperidone
- mometasone topical
- moxifloxacin
- nadolol
- nateglinide
- nelfinavir
- niacin (vitamin B3)
- norelgestromin (contraceptive)
- norepinephrine
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- octreotide
- ofloxacin
- olanzapine
- paliperidone
- paltusotine
- pasireotide
- pegaspargase
- peginterferon alfa 2a
- pegvisomant
- pentamidine
- phenelzine
- phenylephrine
- phenytoin
- pindolol
- pioglitazone
- plozasiran
- pramlintide
- prednicarbate topical
- prednisolone
- prednisone
- pseudoephedrine
- quetiapine
- quinine
- repaglinide
- ribose
- risperidone
- ritonavir
- rosiglitazone
- sacrosidase
- saxagliptin
- segesterone (contraceptive)
- sirolimus albumin-bound
- sitagliptin
- somapacitan
- somatrogon
- somatropin
- sotagliflozin
- sotalol
- spironolactone
- sucralfate
- sunitinib
- temsirolimus
- 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
- perioperative aspiration
Common Reactions
- nausea
- vomiting
- diarrhea
- abdominal pain
- constipation
- diabetic retinopathy
- eructation
- appetite decr. (PO form)
- hypoglycemia (pen form)
- dyspepsia
- abdominal distension (PO form)
- GERD
- flatulence
- gastritis
- amylase incr.
- lipase incr.
- injection site reaction (pen form)
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; possible risk of fetal harm, including teratogenicity and fetal death, based on animal data at <1x MRHD
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; no human data available to assess effects on milk production
INJ Form: weigh risk/benefit while breastfeeding; inadequate human data available, though risk of infant harm not expected based on drug properties; 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: Diabetes: GLP-1 Agonists ; GLP-1 Agonists, Cardiovascular ; GLP-1 Agonists, Nephrological
Mechanism of Action
for semaglutide: activates glucagon-like-peptide-1 (GLP-1) receptor, increasing insulin secretion, decreasing glucagon secretion, and delaying gastric emptying (incretin mimetic)
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.