Thanks to social media influencers, tech moguls and Hollywood superstars, semaglutide (pronounced “sem-uh-gloo-tide") has been a talking point recently. Praised for its role in weight loss, this medication has captured widespread attention — but there’s much more to it than that. In today’s blog, we’ll explore everything you need to know about semaglutide, from how it works to its benefits and precautions.
How Semaglutide Works
Semaglutide is part of a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. It mimics the action of the naturally occurring GLP-1 hormone released in the body after eating. By activating GLP-1 receptors, semaglutide triggers several key processes that help with blood sugar control, appetite regulation, and weight management:
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Stimulating Insulin Production: Semaglutide encourages the pancreas to release more insulin, a hormone that helps lower blood sugar. Boosting insulin production improves blood glucose control, particularly after meals.
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Reducing Glucagon Levels: Semaglutide also reduces the release of glucagon, a hormone that increases blood sugar levels. Lower glucagon levels can better regulate blood glucose, especially in people with type 2 diabetes.
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Slowing Gastric Emptying: This medication delays the speed at which food leaves the stomach, creating a feeling of fullness that lasts longer. This slower gastric emptying not only helps to control blood sugar spikes after eating but also contributes to appetite control, as it reduces the urge to eat.
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Influencing Brain Signals: Semaglutide affects the brain’s signaling to reduce hunger and cravings. This effect on the brain may help with weight loss, as it lowers the desire to eat and can support healthier eating habits.
Uses of Semaglutide
Management of Type 2 Diabetes
Semaglutide is FDA-approved for helping adults with type 2 diabetes manage their blood glucose levels. When combined with a balanced diet and regular exercise, it can significantly improve blood sugar control through mechanisms like increasing insulin production and reducing glucagon levels.
Additionally, semaglutide has shown potential to reduce the risk of major cardiovascular events such as heart attacks and strokes, particularly in adults with type 2 diabetes and existing cardiovascular conditions. One study demonstrated a 26% reduction in the risk of major adverse cardiovascular events (MACE) for patients using semaglutide.
Weight Management
Semaglutide is also approved for long-term weight management in adults with obesity (BMI of 30 or higher) or those who are overweight (BMI of 27 or higher) with at least one weight-related health condition, such as high blood pressure or type 2 diabetes. Semaglutide supports significant weight loss in individuals who may have struggled with lifestyle changes alone by enhancing feelings of fullness, reducing appetite, and lowering overall food intake. For weight management, semaglutide is typically administered at a higher dose compared to its use for diabetes.
Dosage Forms and Administration
Semaglutide is available in both injectable and oral forms, allowing individuals to choose according to their specific health needs and preferences.
Injectable Form
The injectable form of semaglutide is marketed under two primary brand names:
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Ozempic® – Typically prescribed for managing type 2 diabetes.
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Wegovy® – Primarily used for weight management in individuals with obesity or certain weight-related health issues.
Administration Guidelines:
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Frequency: Both Ozempic® and Wegovy® are administered once weekly as a subcutaneous injection.
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Starting Doses:
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For Ozempic®, treatment begins with 0.25 mg weekly for 4 weeks, then typically increases to 0.5 mg weekly. Further dose increases, if needed for glycemic control, may reach up to 2 mg.
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For Wegovy®, the initial dose is 0.25 mg per week, with gradual increases every 4 weeks until reaching a maintenance dose of 2.4 mg.
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Injection Sites: Recommended sites include the abdomen, thigh or upper arm. Rotate injection sites within the same area to reduce the risk of lipodystrophy.
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Timing: The injection can be taken any time of day, with or without food, as long as it’s on the same day each week. If needed, the injection day can be adjusted as long as it has been at least 2 days since the last dose.
Oral Tablet Form
The oral form of semaglutide is marketed as Rybelsus® and is primarily prescribed for managing type 2 diabetes.
Administration Guidelines:
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Frequency: Rybelsus® is taken once daily.
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Starting Dose: The initial dose is 3 mg daily for 30 days, then increased to 7 mg. If additional glycemic control is needed, the dose may increase to 14 mg daily.
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Absorption Considerations:
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Take Rybelsus® at least 30 minutes before the first food, beverage or other oral medications of the day.
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Swallow the tablet whole with no more than 4 ounces of plain water.
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Avoid splitting, crushing, or chewing the tablet, as this may interfere with absorption.
Getting Started With Semaglutide
Tips for Initiating Treatment
Starting semaglutide treatment involves careful planning and collaboration with a healthcare provider to ensure safety and effectiveness. Here are some key tips to consider when initiating treatment.
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Consulting a Healthcare Provider: Before beginning semaglutide, it’s essential to have a thorough discussion with a healthcare provider. This consultation will typically include:
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A review of your medical history, especially any history of medullary thyroid cancer (MTC), pancreatitis, or multiple endocrine neoplasia syndrome type 2 (MEN 2).
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Discussion of any current medications, as semaglutide can interact with certain drugs.
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Assessment of cardiovascular risk factors and kidney function, which may affect dosing.
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A comprehensive initial consultation can help improve treatment adherence and lead to better outcomes.
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Starting Dosage: Semaglutide treatment should begin with a low dose to minimize side effects and gradually increase over several weeks to reach the target maintenance dose. This gradual approach helps reduce gastrointestinal side effects, which are common during the early stages of treatment.
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Lifestyle Changes: To maximize semaglutide’s benefits, it’s best to combine it with lifestyle modifications. These can include a calorie-restricted diet rich in nutrient-dense foods, regular physical activity, and stress management.
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Monitoring: Regular monitoring is essential to tracking progress and managing any side effects. This may include blood sugar checks and hemoglobin A1c (HbA1c) tests for diabetic patients, weekly weight tracking for those focusing on weight management, and routine check-ins with a healthcare provider.
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Support System: Consider involving family members or joining a support group to enhance motivation and adherence.
Potential Barriers to Treatment
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Cost and Insurance Coverage: Semaglutide can be expensive, with monthly out-of-pocket costs ranging from several hundred to over $1,000, depending on the specific formulation and insurance coverage. Patients may benefit from exploring insurance options and financial assistance programs to help manage costs.
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Side Effects Management: Gastrointestinal side effects, like nausea and stomach discomfort, are common in the early stages of treatment and during dose increases. Eating smaller meals, staying hydrated and avoiding heavy or greasy foods may help reduce these effects.
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Injection Hesitancy: For those prescribed injectable forms of semaglutide, self-injection can feel intimidating. Support from healthcare providers, including guidance on proper technique, can help ease discomfort and build confidence.
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Accessibility: Availability may vary by location, and some patients may need to check with multiple pharmacies or consider mail-order options. Shortages have affected certain formulations, so working with a licensed healthcare provider for safe and reliable access to semaglutide is essential. The U.S. Food & Drug Administration (FDA) has released a statement encouraging patients to obtain semaglutide with a prescription from a licensed healthcare provider.
Potential Side Effects
Semaglutide may cause a range of side effects, from mild to severe. It’s essential to be aware of these potential reactions and consult with a healthcare provider if they occur.
Common Side Effects
The most frequently reported side effects include:
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Nausea
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Vomiting
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Diarrhea
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Constipation
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Abdominal pain
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Decreased appetite
These gastrointestinal symptoms often lessen over time as the body adjusts to the medication.
Serious Side Effects
Although less common, some serious side effects may occur, including:
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Pancreatitis: Severe upper stomach pain that may spread to the back, often with nausea or vomiting.
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Kidney Issues: Symptoms may include swelling, reduced urine output, or fatigue.
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Hypoglycemia: Symptoms include dizziness, confusion, rapid heartbeat, and sweating, especially when taken with other diabetes medications.
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Allergic Reactions: These may involve hives, swelling of the face or throat, or difficulty breathing.
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Gallbladder Problems: Pain in the upper abdomen, fever, yellowing of the skin or eyes, or pale stools may indicate gallbladder issues.
Drug Interactions
Semaglutide may interact with several types of medications, so it’s important to discuss all current medications with a healthcare provider before starting treatment. Specific interactions to be aware of include:
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Oral Medications: Since semaglutide can slow digestion, it may alter the absorption of oral medications, including some birth control pills and certain antibiotics.
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Sulfonylureas and Insulin Secretagogues: Medications used to treat type 2 diabetes, like glipizide or glimepiride, can increase insulin production. When combined with semaglutide, they may heighten the risk of hypoglycemia. Blood glucose levels should be closely monitored, with dose adjustments as needed.
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Blood Thinners (Anticoagulants and Antiplatelets): Medications such as warfarin, clopidogrel and aspirin may interact with semaglutide, increasing the risk of bleeding complications and potentially reducing the effectiveness of the blood thinners.
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Thyroid Medications: Levothyroxine and liothyronine may have increased absorption when taken with semaglutide, so thyroid hormone levels should be monitored closely.
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Antiseizure Medications: Certain antiseizure drugs, like phenytoin and valproic acid, may be less readily absorbed when taken with semaglutide, potentially reducing their effectiveness.
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Other GLP-1 Receptor Agonists: Combining semaglutide with other GLP-1 receptor agonists is not recommended, as it can increase the likelihood of side effects without additional benefit.
Who Should Not Use Semaglutide
Semaglutide may not be suitable for everyone. Certain groups, such as pregnant or breastfeeding individuals, are advised to avoid this medication due to potential risks.
Pregnancy
Semaglutide is contraindicated during pregnancy due to possible risks to fetal development. Animal studies have shown that semaglutide may cause congenital disabilities, low birth weight and increased risk of miscarriage, although these effects have not been thoroughly studied in humans. Because of these potential risks:
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Men and women should stop using semaglutide at least two months before attempting to conceive, allowing time for the drug to clear from the body.
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Alternative, safer medications should be discussed with a healthcare provider, as maintaining proper blood glucose levels and avoiding weight loss during pregnancy is crucial for both maternal and fetal health.
Breastfeeding
The safety of semaglutide during breastfeeding remains uncertain:
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Injectable Forms (Ozempic®, Wegovy®): Limited data suggest that semaglutide may be present in breast milk, although it’s unclear what impact, if any, this might have on a nursing infant. Consult a healthcare provider to weigh the benefits of breastfeeding against any potential risks.
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Oral Form (Rybelsus®): Due to additional ingredients that may transfer into breast milk, breastfeeding is not recommended while taking Rybelsus.
Consultation with a healthcare provider is essential to discuss safer alternatives if semaglutide use is being considered during pregnancy or breastfeeding.
Storage and Handling
Proper storage and handling of semaglutide are essential to maintain its effectiveness. Guidelines differ for the injectable forms and the oral form.
Injectable Form (Ozempic®, Wegovy®)
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Refrigeration: Store unopened pens in the fridge (36°F to 46°F / 2°C to 8°C). Opened pens can be kept at room temperature (59°F to 86°F / 15°C to 30°C) or refrigerated, but use within 56 days (Ozempic®) or 28 days (Wegovy®).
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Light Protection: Keep pens in their original packaging to prevent light exposure.
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Disposal: Use a puncture-resistant container for used pens and needles; never reuse needles.
Oral Tablets (Rybelsus®)
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Room Temperature Storage: Store Rybelsus® at room temperature (68°F to 77°F / 20°C to 25°C) in its original bottle with a blue cap.
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Handling: Swallow whole with water; do not split, crush, or chew.
General Safety Tips
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Regularly check expiration dates on both forms and safely discard any expired or unused medication.
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Store semaglutide in a secure place that is out of sight and within reach of children.
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Do not flush unused semaglutide down the toilet. Instead, use a medication take-back program or consult your pharmacist.
Manage Side Effects With Barimelts®
Experiencing side effects can be challenging, but proactive steps can make a significant difference in managing them. To help patients navigate these common concerns, Barimelts® has recently launched new caplets designed to address the specific needs of bariatric and GLP-1 patients:
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Gastro Zen®: Promotes a calm, comfortable stomach and helps soothe and ease occasional digestive discomfort.*
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HMB Muscle Shield™: Helps reduce muscle breakdown after bariatric surgery or GLP1 medications.*
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Hair Health+: Promotes reduced hair thinning that can occur due to rapid weight loss or nutrient deficiencies.*
Unlike traditional supplements, these caplets are designed with a focus on bioavailability, addressing common symptoms that bariatric and GLP1 users experience throughout their journeys.
Barimelts provides general recommendations not to be construed as medical advice. Please consult your doctor.
* These statements have not been evaluated by the FDA. This product is not meant to prevent, treat or cure any disease.
