Semaglutide (semaglutide)
Also sold as: Ozempic (SC injectable, diabetes), Rybelsus (oral, diabetes), Wegovy (SC injectable, obesity), Semafit
Pregnancy
Cat X
Lactation
Avoid
Schedule
H
Forms
solution for injection 0.25mg/dose, 0.5mg/dose, 1mg/dose, 2mg/dose pre-filled pen (Ozempic/Wegovy) +1
Indications
- Type 2 diabetes mellitus — glycemic control (SC injectable and oral formulations)
- Cardiovascular risk reduction in T2DM with established CVD (SUSTAIN-6, SELECT trials)
- Obesity or overweight management: BMI ≥30 or ≥27 with weight-related comorbidity (Wegovy — 2.4mg SC weekly)
- Reduction in major adverse cardiovascular events in adults with established CVD and obesity/overweight (SELECT trial — Wegovy)
Adult Dosing
Type 2 diabetes mellitus — SC injectable (Ozempic)
0.25mg SC once weekly × 4 weeks → 0.5mg SC once weekly (minimum maintenance) → may increase to 1mg SC once weekly → maximum 2mg SC once weekly
Once weekly on same day each week; rotate sites (abdomen, thigh, upper arm)
Start at 0.25mg for tolerability; 0.5mg is minimum therapeutic dose; uptitrate based on glycemic response and tolerability
Obesity or overweight — SC injectable (Wegovy, BMI ≥30 or ≥27 with comorbidity)
0.25mg SC once weekly × 4 weeks → escalate by 0.25mg every 4 weeks → target 2.4mg SC once weekly (reached at week 16)
Once weekly; rotate injection sites
Reassess at 16 weeks at full dose — discontinue if <5% weight loss. Wegovy also reduces major CV events in obesity with established CVD (SELECT trial)
Type 2 diabetes mellitus — oral (Rybelsus)
3mg once daily × 4 weeks → 7mg once daily × 4 weeks → maximum 14mg once daily
Once daily, taken on an empty stomach with ≤120mL of water; wait ≥30 minutes before eating, drinking, or taking other medications
Start at 3mg for GI tolerability; 7mg is standard maintenance; 14mg for additional glycemic control
Pediatric Dosing
No approved indication for any semaglutide formulation (SC or oral) in paediatrics. Clinical trials ongoing.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any | No dose adjustment required for any degree of renal impairment (SC or oral formulations). Significant GI side effects (nausea, vomiting, diarrhoea) may lead to dehydration — monitor renal function in patients with CKD or pre-existing renal impairment. |
Hepatic Adjustment
No dose adjustment required for hepatic impairment. Patients with severe hepatic impairment have not been studied extensively; use with caution.
Pregnancy & Lactation
Pregnancy: Category X
Contraindicated in pregnancy — fetal harm observed in animal studies (decreased fetal weight, skeletal abnormalities). Must use effective contraception during semaglutide therapy. Discontinue at least 2 months before planned conception (long half-life of ~1 week means drug persists after last dose).
Lactation: Avoid
Present in animal milk. Unknown whether present in human breast milk. Potential for harm to nursing infant. Breastfeeding not recommended during therapy.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Oral medications (time-sensitive, Rybelsus specific) | Oral semaglutide (Rybelsus) must be taken first thing in the morning on an empty stomach. Other oral medications should be taken at least 30 minutes after Rybelsus to ensure proper absorption (semaglutide slows gastric emptying and the absorption enhancer SNAC may interact with co-administered drugs). | Minor |
| Warfarin / Oral anticoagulants | Delayed gastric emptying may affect warfarin absorption kinetics. Monitor INR closely when initiating or adjusting semaglutide dose. | Moderate |
| Insulin / Sulfonylureas | Additive risk of hypoglycemia. Reduce insulin (especially basal insulin) by 20% when initiating semaglutide. Reduce sulfonylurea dose to minimize hypoglycemia risk. | Moderate |
| Oral contraceptives | Delayed Cmax possible due to slowed gastric emptying. Overall contraceptive efficacy not significantly reduced, but note potential for reduced peak levels. | Minor |
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Side Effects
Common
- Nausea (very common, especially during dose escalation — typically improves over 4–8 weeks)
- Vomiting
- Diarrhea or constipation
- Abdominal pain and dyspepsia
- Decreased appetite (beneficial in obesity management)
- Injection site reactions (SC formulation)
- Fatigue
- Headache
- Eructation (burping) — notable with oral semaglutide
Serious / Discontinue If
- Acute pancreatitis — rare; stop immediately if suspected. Do not restart after confirmed pancreatitis.
- Medullary thyroid carcinoma (MTC) — C-cell tumors in rodent studies. Contraindicated in personal/family history of MTC or MEN2. Counsel patients to report neck lumps, hoarseness, dysphagia.
- Acute kidney injury — from severe dehydration due to GI adverse effects; maintain hydration
- Serious hypersensitivity reactions (anaphylaxis, angioedema) — rare
- Diabetic retinopathy complications — worsening of retinopathy reported in patients with pre-existing diabetic retinopathy during rapid HbA1c lowering (SUSTAIN-6). Ophthalmologic monitoring advised in patients with known retinopathy.
- Suicidal ideation and self-harm — reported with obesity dose (Wegovy); monitor mental health
- Gallbladder disease (cholelithiasis, cholecystitis) — risk increased with significant weight loss
Contraindications
- Personal or family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
- Known hypersensitivity to semaglutide
- Pregnancy
- Type 1 diabetes mellitus (not approved)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Ozempic 0.5mg/dose pen | Novo Nordisk | ₹2800/pen |
| Semafit 0.5mg | Sun Pharma | ₹1950/pen |
| Rybelsus 7mg tab | Novo Nordisk | ₹3200/30 tab |
Monitoring Required
- HbA1c every 3 months until stable, then every 6 months
- Body weight at each visit (especially for Wegovy — if <5% weight loss at 16 weeks on 2.4mg, reassess therapy)
- Ophthalmologic exam at baseline and periodically in patients with pre-existing diabetic retinopathy (retinopathy worsening risk with rapid HbA1c lowering)
- Renal function if significant GI side effects occur (dehydration)
- Heart rate (GLP-1 agonists increase heart rate; monitor in patients with tachyarrhythmia)
- Lipase/amylase if abdominal pain develops (pancreatitis screening)
- Thyroid palpation at each visit; serum calcitonin if neck symptoms (MTC surveillance)
- Mental health assessment (Wegovy indication — suicidal ideation)
- Gallbladder ultrasound if symptoms of cholelithiasis (right upper quadrant pain)
Patient Counseling Points
- Semaglutide injection (Ozempic/Wegovy): inject once a week, on the same day each week. You can change the day of the week if the last dose was ≥2 days ago.
- Rybelsus (oral tablet): take on an empty stomach as your very first action in the morning. Use no more than a small sip of water (120mL max). Wait at least 30 minutes before eating, drinking anything else, or taking other medicines.
- Nausea is very common when starting or increasing the dose — it usually improves after a few weeks. Eat smaller, bland meals and avoid fatty/spicy food to reduce nausea.
- Do not stop this medicine on your own — especially if prescribed for heart or kidney protection. Speak to your doctor first.
- ALERT: Go to the emergency room immediately if you develop severe, persistent abdominal pain with vomiting — this could be pancreatitis.
- Report any lumps, swelling, or pain in the neck, hoarseness, or difficulty swallowing to your doctor.
- If also taking insulin, your insulin dose will likely need to be reduced. Monitor blood sugar more closely when starting semaglutide.
- For Wegovy (obesity): this medicine works best with a calorie-reduced diet and regular physical activity. Weight loss is gradual — give it 16 weeks at full dose before assessing.
- Contraception: Women of childbearing potential must use effective contraception. Do not use during pregnancy. Stop semaglutide at least 2 months before trying to conceive.
- Store unused pens in the refrigerator. Once in use, Ozempic pens can be kept at room temperature (below 30°C) for up to 6 weeks.
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Clinically reviewed by: Dr. Priya Menon, MD, DM Endocrinology, AIIMS New Delhi
Last reviewed: 2026-04-01
References
- Marso SP, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (SUSTAIN-6). NEJM. 2016.
- Lincoff AM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). NEJM. 2023.
- Novo Nordisk. Ozempic (semaglutide) Prescribing Information. 2024.
- Novo Nordisk. Rybelsus (oral semaglutide) Prescribing Information. 2024.
- Novo Nordisk. Wegovy (semaglutide 2.4mg) Prescribing Information. 2024.