Semaglutide

OZEMPIC

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Pronunciation: sem-a-GLOO-tide (oe-ZEM-pik)

Semaglutide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Semaglutide ballicule

Semaglutide RYBELSUS / OZEMPIC / WEGOVY mascot mnemonic cartoon — Visual mnemonic: Semaglutide mascot
**“(Rebel, Olympic, & Wig governor) See my glue tide”**
Glasses on the mascots → “see my glue tide”
Rebel saying “You ain’t injectin’ me!” → Rybelsus is oral, unlike Ozempic/Wegovy

What it isGLP-1 receptor agonist for type 2 diabetes and chronic weight management.

Why this oneIts injectable and oral diabetes formulations plus an obesity formulation give it unmatched reach within the class.

What limits itGI intolerance drives discontinuation, so titrate slowly. Delayed gastric emptying matters before anesthesia.

Semaglutide molecular structure (skeletal formula) — Molecular structure: Semaglutide

FDA-approved for

type 2 diabetes (2017)
obesity (2021)

Off-label

NASH
cardiovascular risk reduction

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Risk of thyroid C-cell tumors; contraindicated with personal/family history of MTC or MEN 2

FDA dosing	Population	Start	Target	Max
Type 2 diabetes mellitus (Rybelsus)	Adults	3 mg QD x30 days	7 mg QD	14 mg QD
Type 2 diabetes mellitus (Ozempic tablets)	Adults	1.5 mg QD x30 days	4 mg QD	9 mg QD

Titration Increase at ≥30-day (monthly) intervals

Renal No adjustment needed (including ESRD)

Hepatic No adjustment needed

Rybelsus and Ozempic tablets are not substitutable on a mg-to-mg basis

Instructions

Take once daily on empty stomach in the morning with ≤4 oz water; no other liquids
Swallow tablets whole; do not split, crush, chew, or dissolve
Wait ≥30 min before eating, drinking, or taking other oral medications
If a dose is missed, skip it and take the next dose the following day

Available strengths

pen 0.25, 0.5, 1, 2 mg (SQ)

Contraindications

Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2

Cautions

Acute pancreatitis — discontinue if suspected
Diabetic retinopathy complications
Hypoglycemia with insulin secretagogues or insulin
Acute kidney injury from volume depletion
Severe GI reactions; not recommended in severe gastroparesis
Hypersensitivity reactions (anaphylaxis, angioedema)
Acute gallbladder disease
Pulmonary aspiration during general anesthesia/deep sedation

Adverse reactions

Nausea
Abdominal pain
Diarrhea
Decreased appetite
Vomiting
Constipation

Pregnancy Insufficient human data; animal studies show fetal harm; discontinue ≥2 months before a planned pregnancy

Lactation Breastfeeding not recommended (SNAC present in human milk)

Cost

Semaglutide (OZEMPIC)

Strength		#/mo	CostPlus
0.25 mg	pen	per unit	not offered
0.5 mg	pen	per unit	not offered
1 mg	pen	per unit	not offered
2 mg	pen	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Semaglutide is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Other forms: Semaglutide oral (RYBELSUS) · Semaglutide (obesity) (WEGOVY) · Semaglutide oral (obesity) (WEGOVY (oral))

Generic entry2031 est.

⚠ BOXED WARNING

Thyroid C-cell tumors in rodents

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger1 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityGI intolerance, gallbladder disease and rare pancreatitis; hypoglycemia is uncommon without insulin or sulfonylureas.

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Memory aids: interaction avatars

Box: minimal PK interactions

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