What are the differences between Ozempic (semaglutide) and Wegovy (semaglutide)?

Differences Between Ozempic and Wegovy

Ozempic and Wegovy both contain the same active ingredient (semaglutide) but differ primarily in their FDA-approved indications and dosing: Ozempic is approved for type 2 diabetes management with doses up to 2 mg weekly, while Wegovy is specifically approved for weight management with doses up to 2.4 mg weekly. 1, 2

Key Differences

Indications

• Ozempic: Approved for glycemic control in type 2 diabetes
• Wegovy: Approved for chronic weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity

Dosing

• Ozempic:

  • Starting dose: 0.25 mg once weekly for 4 weeks
  • Maintenance doses: 0.5 mg, 1 mg, or 2 mg once weekly
  • Maximum dose: 2 mg weekly for diabetes management

• Wegovy:

  • Starting dose: 0.25 mg once weekly for 4 weeks
  • Dose escalation: 0.5 mg, 1 mg, 1.7 mg, and finally 2.4 mg weekly
  • Maximum dose: 2.4 mg weekly for weight management
  • Higher maximum dose than Ozempic 2

Formulation

Both medications:

• Contain the same active ingredient (semaglutide)
• Are administered subcutaneously once weekly
• Have similar pharmacokinetic properties:
  • Bioavailability: 89% for subcutaneous administration
  • Half-life: Approximately 1 week
  • Highly protein-bound (>99%)
  • Present in circulation for 5-7 weeks after the last dose 2

Clinical Efficacy

Weight Loss Effects

• Wegovy (2.4 mg): Produces significantly greater weight loss compared to lower doses

  • Average weight loss of 14.9% from baseline over 68 weeks 3
  • 86.4% of patients achieved ≥5% weight loss
  • 50.5% of patients achieved ≥15% weight loss

• Ozempic: Also produces weight loss, but less pronounced at its approved doses

  • At 1.0 mg: Average weight loss of 6.0 kg over 40 weeks
  • At 2.0 mg: Average weight loss of 6.9 kg over 40 weeks 4

Glycemic Control

• Ozempic: Primary focus on glycemic control

  • At 1.0 mg: HbA1c reduction of 1.9 percentage points
  • At 2.0 mg: HbA1c reduction of 2.2 percentage points 4

• Wegovy: While not primarily indicated for diabetes, also improves glycemic parameters as a secondary benefit

Cardiovascular Benefits

Both formulations have demonstrated cardiovascular benefits:

• Semaglutide has been shown to reduce major adverse cardiovascular events in patients with type 2 diabetes and established cardiovascular disease 1
• The SELECT trial showed that semaglutide 2.4 mg (Wegovy) reduced cardiovascular events in adults with obesity without diabetes 1

Side Effect Profile

Both medications share similar side effect profiles:

• Most common adverse effects are gastrointestinal:

  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Constipation 1

• Side effects are typically:

  • Dose-dependent
  • More pronounced during dose escalation
  • Tend to diminish over time with continued use
  • Can be mitigated by slow titration 1

Clinical Considerations

Insurance Coverage

• Ozempic: Often covered by insurance for diabetes management
• Wegovy: Coverage for weight management may be more limited

Practical Approach

When deciding between these medications:

1. For patients with type 2 diabetes: Ozempic is typically the first choice
2. For patients with obesity without diabetes: Wegovy is specifically designed for weight management
3. For patients with both conditions: Either medication may be appropriate, but dosing requirements may differ

Common Pitfalls to Avoid

• Dose confusion: Ensure patients understand the correct dosing schedule for their specific medication
• Medication substitution: These are not interchangeable despite containing the same active ingredient
• Discontinuation without tapering: Due to the long half-life, abrupt discontinuation may lead to prolonged effects
• Inadequate monitoring: Both medications require monitoring for gastrointestinal side effects and potential complications

Summary of Key Differences

• Same active ingredient (semaglutide) but different FDA-approved indications
• Different maximum doses (Ozempic up to 2 mg, Wegovy up to 2.4 mg)
• Different dosing schedules and titration protocols
• Wegovy produces greater weight loss due to higher maximum dose
• Similar side effect profiles and pharmacokinetic properties