Formulary
Semaglutide: Indications, Dosing, Side Effects and Interactions
Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric...
MedNext Academy | 4 min read
Semaglutide: Indications, Dosing, Side Effects and Interactions
Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric...
Drug action
Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying.
Indications and dose
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate), or in combination with other antidiabetic drugs (including insulin) if existing treatment fails to achieve adequate glycaemic control**
- **Adult** (By Mouth): Initially 1.5 mg once daily for 1 month, then increased to 4 mg once daily for at least 1 month, taking more than 1 tablet to achieve the effect of a higher dose is not recommended, then increased if necessary to 9 mg once daily, taking more than 1 tablet to achieve the effect of a higher dose is not recommended.
**Weight management [in conjunction with dietary measures and increased physical activity in individuals with a BMI of 30 kg/m2or more, or in individuals with a BMI of 27 kg/m2or more in the presence of at least one weight-related co-morbidity],Cardiovascular risk reduction [in conjunction with dietary measures and increased physical activity in individuals with established cardiovascular disease and a BMI of 27 kg/m2or more]**
- **Adult** (By Subcutaneous Injection): Weight management [in conjunction with dietary measures and increased physical activity in individuals with a BMI of 30 kg/m 2 or more, or in individuals with a BMI of 27 kg/m 2 or more in the presence of at least one weight-related co-morbidity], Cardiovascular risk reduction [in conjunction with dietary measures and increased physical activity in individuals with established cardiovascular disease and a BMI of 27 kg/m 2 or more] 0.25 mg once weekly for at least 4 weeks, then increased if tolerated to 0.5 mg once weekly for at least 4 weeks, then increased if tolerated to 1 mg once weekly for at least 4 weeks, then increased if tolerated to 1.7 mg once weekly for at least 4 weeks, then maintenance 2.4 mg once weekly.
**Weight management [in conjunction with dietary measures and increased physical activity in individuals with a BMI in the 95th percentile or more, and body-weight above 60 kg] for Wegovy**
- **Child 12-17 years** (By subcutaneous injection): 0.25 mg once weekly for at least 4 weeks, then increased if tolerated to 0.5 mg once weekly for at least 4 weeks, then increased if tolerated to 1 mg once weekly for at least 4 weeks, then increased if tolerated to 1.7 mg once weekly for at least 4 weeks, then maintenance 2.4 mg once weekly.
Cautions
Diabetic retinopathy (in patients treated with insulin); general anaesthesia or deep sedation (risk of pulmonary aspiration due to delayed gastric emptying); history of pancreatitis; severe congestive heart failure (no information available)
Contraindications
When used for Type 2 diabetes mellitus Diabetic ketoacidosis
Side effects
General side-effects: Common or very common Appetite decreased (in patients with type 2 diabetes); burping; cholelithiasis; constipation; diarrhoea; fatigue; gastrointestinal discomfort; gastrointestinal disorders; nausea; vomiting; weight decreased (in patients with type 2 diabetes) Uncommon Pancreatitis acute; taste altered Specific side-effects: Common or very common With subcutaneous use Alopecia; diabetic retinopathy (in patients with type 2 diabetes); dizziness; headache; hypoglycaemia Rare or very rare With subcutaneous use Angioedema Side-effects, further information Discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain. If pancreatitis confirmed, do not restart treatment.
Interactions
**Other interactions (16):**
- Semaglutide delays gastric emptying and has the potential to impact the rate of absorption of concomitantly administered oral medicinal products.
- Semaglutide should be used with caution in patients receiving oral medicinal products that require rapid gastrointestinal absorption.
- Paracetamol Semaglutide delays the rate of gastric emptying as assessed by paracetamol pharmacokinetics during a standardised meal test.
- Paracetamol AUC 0-60min and C max were decreased by 27% and 23%, respectively, following concomitant use of semaglutide 1 mg.
- The total paracetamol exposure (AUC 05h ) was not affected.
- No clinically relevant effect on the rate of gastric emptying was observed with semaglutide 2.4 mg, following 20 weeks of administration of semaglutide, probably due to a tolerance effect.
Pregnancy
Manufacturer advises avoid-toxicity in animal studies.
Breast feeding
Manufacturer advises avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises caution (limited information in severe impairment).
Renal impairment
Manufacturer advises avoid in end-stage renal disease.
Medicinal forms
Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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