Semaglutide oral (obesity)

FDA label

Read the full label on DailyMed ↗

Titration Escalate every 30 days: 1.5 mg (days 1–30) → 4 mg (31–60) → 9 mg (61–90) → 25 mg (91+); delay escalation if not tolerated.

Renal No dosage adjustment needed (eGFR ≥30 to <90 mL/min studied); monitor renal function with volume-depleting GI reactions.

Hepatic No dosage adjustment needed (mild–severe hepatic impairment, Child-Pugh A–C, studied).

If the 25 mg maintenance tablet is not tolerated, consider switching to Wegovy injection 1.7 mg once weekly.

Instructions

• Take once daily on an empty stomach in the morning with up to 4 oz (120 mL) plain water only — no other liquids
• Swallow tablet whole; do not split, crush, chew, or dissolve
• Wait at least 30 minutes before eating, drinking, or taking other oral medications
• Do not take more than one tablet per day; if a dose is missed, skip it and take the next dose the following day
• Use with a reduced-calorie diet and increased physical activity
• If 25 mg once daily is not tolerated, consider switching to Wegovy 1.7 mg injection once weekly

Available strengths

• tab 1.5, 4, 9, 25 mg

Contraindications

• Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• Prior serious hypersensitivity reaction to semaglutide (anaphylaxis and angioedema reported)

Cautions

• Acute pancreatitis — discontinue if suspected
• Acute gallbladder disease (cholelithiasis, cholecystitis)
• Hypoglycemia when used with insulin or an insulin secretagogue — consider reducing their dose
• Acute kidney injury due to volume depletion — monitor renal function
• Severe gastrointestinal reactions — not recommended in severe gastroparesis
• Hypersensitivity reactions (anaphylaxis, angioedema) — discontinue if suspected
• Diabetic retinopathy complications in patients with type 2 diabetes
• Heart rate increase — monitor
• Pulmonary aspiration during general anesthesia or deep sedation (delayed gastric emptying)

Adverse reactions

• Nausea, diarrhea, vomiting, constipation, abdominal pain, abdominal distension, eructation, flatulence, dyspepsia, GERD, gastroenteritis
• Headache, fatigue, dizziness, dysesthesia
• Hypoglycemia in patients with type 2 diabetes
• Hair loss

Pregnancy May cause fetal harm; discontinue when pregnancy is recognized (for CV risk reduction or weight reduction). Discontinue at least 2 months before a planned pregnancy (long half-life).

Lactation Breastfeeding not recommended during treatment with Wegovy tablets (potential SNAC accumulation in the infant).