For a 61-year-old patient who has not had laboratory testing in over a year and is requesting weight‑loss medication such as Wegovy (semaglutide), what baseline labs and assessments are required before initiating therapy?

Baseline Laboratory Testing and Assessment Before Initiating Wegovy

Before prescribing Wegovy (semaglutide 2.4 mg) to your 61-year-old patient, you must obtain baseline labs including comprehensive metabolic panel (CMP), lipid panel, HbA1c, and thyroid function tests, along with measuring blood pressure, heart rate, and waist circumference. 1

Required Baseline Laboratory Tests

Essential Labs

• Comprehensive Metabolic Panel (CMP): Assess renal function (creatinine, eGFR) and electrolytes, particularly serum bicarbonate if considering combination therapy 2
• HbA1c: Screen for undiagnosed diabetes or prediabetes, as semaglutide has glucoregulatory benefits 1
• Lipid Panel: Establish baseline total cholesterol, LDL-C, HDL-C, and triglycerides for monitoring cardiometabolic improvements 3
• Thyroid Function Tests (TSH, free T4): Screen for thyroid disease, particularly given the contraindication for personal or family history of medullary thyroid carcinoma 2
• Liver Function Tests: Baseline hepatic function assessment

Critical Physical Measurements

• Weight and BMI: Document baseline for tracking response 3
• Waist Circumference: Important cardiometabolic marker 3
• Blood Pressure: Both systolic and diastolic 3
• Heart Rate: Baseline measurement as GLP-1 RAs can affect heart rate 1, 3

Essential Clinical Screening

Contraindications to Rule Out

Absolute contraindications that must be excluded before prescribing:

• Personal or family history of medullary thyroid carcinoma 2
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 2
• History of pancreatitis (use with extreme caution; some guidelines list as precaution rather than absolute contraindication) 2, 1

High-Risk Conditions Requiring Caution

• Gallbladder disease: GLP-1 RAs increase risk of cholecystitis and cholelithiasis 1
• Diabetic retinopathy: Particularly if patient has diabetes, as rapid glucose lowering may worsen retinopathy 1
• Renal impairment: Document baseline kidney function 1
• Cardiovascular disease history: Document but not a contraindication; SELECT trial showed cardiovascular benefits 4

Eligibility Criteria Verification

Your patient must meet one of these criteria 1:

• BMI ≥30 kg/m² (obesity), OR
• BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, cardiovascular disease)

Medication Reconciliation

Critical Drug Interactions to Assess

• Insulin or sulfonylureas: Dose reduction required to prevent hypoglycemia 2, 1
• Other GLP-1 receptor agonists: Cannot use concurrently 1
• DPP-4 inhibitors: Cannot use concurrently 1
• Medications requiring rapid absorption: Semaglutide delays gastric emptying 1

Pre-Treatment Counseling Requirements

Patient Education Points

Before prescribing, ensure the patient understands:

• Chronic therapy requirement: This is not a short-term medication; weight regain occurs with discontinuation 1
• Lifestyle modification necessity: Medication is adjunct to 500-kcal daily deficit diet and 150 minutes weekly physical activity 1
• Injection technique: Weekly subcutaneous administration 3
• Titration schedule: 16-week dose escalation from 0.25 mg to 2.4 mg weekly to minimize GI side effects 1, 3
• Common adverse effects: Nausea (44%), diarrhea (32%), vomiting (25%), constipation (23%) 2
• Warning signs: Severe abdominal pain (pancreatitis), visual changes, signs of gallbladder disease 1

Cost and Access Considerations

Address insurance authorization proactively: Wegovy requires prior authorization in most cases, and cost can exceed $1,000/month without coverage 1. Verify insurance coverage before prescribing to avoid patient disappointment and ensure treatment adherence.

Monitoring Plan After Initiation

Once labs return and patient is eligible, establish monitoring schedule:

• Week 4,8,12,16: During titration, assess tolerability and adjust schedule if needed 1
• Every 3 months: Weight, blood pressure, heart rate, HbA1c (if diabetic/prediabetic) 3
• Every 6-12 months: Comprehensive metabolic panel, lipid panel 3
• As needed: Assess for signs/symptoms of pancreatitis or gallbladder disease 1

Common Pitfalls to Avoid

• Don't skip the family history: Medullary thyroid carcinoma family history is an absolute contraindication 2
• Don't rush titration: Rapid dose escalation dramatically increases GI side effects and treatment discontinuation 1
• Don't forget hydration counseling: Particularly important if patient develops nausea/vomiting/diarrhea 2
• Don't prescribe without lifestyle intervention plan: Medication alone is insufficient; concurrent dietary and exercise modifications are required 1