What medical conditions is Wegovy (semaglutide) contraindicated in?

Contraindications for Wegovy (Semaglutide)

Wegovy (semaglutide) is absolutely contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN2). 1

Absolute Contraindications

1. Thyroid-related conditions:

   • Personal history of medullary thyroid carcinoma
   • Family history of medullary thyroid carcinoma
   • Multiple endocrine neoplasia syndrome type 2 (MEN2)
   • These contraindications are based on animal studies showing increased risk of thyroid C-cell tumors 1

2. Hypersensitivity:

   • History of serious hypersensitivity reaction to semaglutide 1
   • Severe allergic reactions to any component of the medication

3. Pregnancy and breastfeeding 1

Relative Contraindications and Cautions

Renal Conditions

• Severe renal impairment or end-stage renal disease (ESRD) for certain GLP-1 RAs like exenatide and lixisenatide 1
• For semaglutide specifically, use with caution in severe renal impairment 1
• Monitor renal function, especially in patients experiencing nausea and possible dehydration 1

Gastrointestinal Conditions

• History of pancreatitis (use with caution) 1
• Clinically meaningful gastroparesis (especially with shorter-acting GLP-1 RAs) 1
• Prior gastric surgery (use with caution) 1
• Acute gallbladder disease 1
• Cholelithiasis (use with caution) 1

Ophthalmologic Conditions

• Diabetic retinopathy complications (monitor carefully, especially in patients also treated with insulin) 1
• Semaglutide has been associated with diabetic retinopathy complications which may be related to rapid and marked glucose and A1C reductions 1

Other Considerations

• Suicidal ideation and behavior (monitor for) 1
• Potential for hypoglycemia when used with insulin or insulin secretagogues 1

Monitoring Recommendations

When prescribing Wegovy, implement the following monitoring:

1. Gastrointestinal symptoms: Monitor for nausea, vomiting, diarrhea, constipation, and abdominal pain, especially during dose titration 1

2. Pancreatitis: Discontinue if pancreatitis is suspected and do not restart if confirmed 1

3. Gallbladder disease: Monitor for symptoms of cholelithiasis or cholecystitis 1

4. Retinopathy: In patients with diabetes, especially those with existing diabetic retinopathy, careful monitoring is required 1

5. Renal function: Regular monitoring, particularly in patients experiencing dehydration due to gastrointestinal side effects 1

Clinical Pearls

• Gastrointestinal side effects are typically transient and can be mitigated by slow dose titration 1
• The risk of hypoglycemia is increased when used with insulin or insulin secretagogues; consider reducing doses of these medications 1
• Wegovy has demonstrated significant weight loss benefits (10-15% of body weight) in clinical trials, with improvements in cardiometabolic risk factors 1, 2
• When discontinuing Wegovy due to adverse effects, consider a slow taper rather than abrupt discontinuation to minimize rebound effects

By understanding these contraindications and implementing appropriate monitoring, clinicians can safely prescribe Wegovy to appropriate patients while minimizing risks and optimizing benefits for weight management.