Semaglutide Administration: Subcutaneous Injection Protocol
Semaglutide is administered as a subcutaneous injection once weekly at any time of day, with a titrated dosing schedule based on the treatment indication. 1
Administration Details
Semaglutide is delivered via subcutaneous injection using a pre-filled pen device. The administration protocol varies slightly depending on whether it's being used for glucose management in diabetes or weight management in obesity:
For Type 2 Diabetes Management:
- Initial dose: 0.25 mg subcutaneously once weekly for 4 weeks
- First titration: Increase to 0.5 mg once weekly after 4 weeks
- Second titration: If additional glycemic control is required, can increase to 1 mg once weekly after 4 weeks on the 0.5 mg dose 1, 2
For Weight Management:
- Initial dose: 0.25 mg subcutaneously once weekly for weeks 1-4
- First titration: Increase to 0.5 mg once weekly for weeks 5-8
- Subsequent titrations: Gradually increase to maintenance dose of 2.4 mg once weekly 3
Injection Technique
The subcutaneous injection can be administered in:
- Abdomen
- Thigh
- Upper arm 2
The injection sites should be rotated to prevent lipohypertrophy. The injection can be given at any time of day, with or without meals, maintaining a consistent day of the week for administration.
Pharmacokinetic Considerations
- Bioavailability: 89% when administered subcutaneously
- Peak concentration: Reached 1-3 days post-dose
- Half-life: Approximately 1 week, allowing for once-weekly dosing
- Steady-state: Achieved after 4-5 weeks of once-weekly administration 2
Renal and Hepatic Considerations
No dose adjustments are required for patients with renal or hepatic impairment, making semaglutide a versatile option for patients with these comorbidities 1, 2.
Important Clinical Considerations
- Semaglutide should be stored in a refrigerator (36°F to 46°F or 2°C to 8°C) before first use
- After first use, the pen can be stored at room temperature (below 86°F or 30°C) or in a refrigerator for up to 56 days
- The pen should be protected from light and not frozen
- Patients should be advised to inspect the solution before injection (should be clear and colorless) 2
Common Pitfalls and Caveats
- Gastrointestinal side effects: Up to 79.6% of patients may experience GI effects, particularly during dose escalation. The gradual titration schedule helps mitigate these effects 3, 4
- Missed doses: If a dose is missed, it should be administered as soon as possible within 5 days after the missed dose. If more than 5 days have passed, the missed dose should be skipped, and the next dose administered on the regularly scheduled day
- Perioperative considerations: Recent case reports suggest increased risk of regurgitation and aspiration during general anesthesia despite appropriate fasting, due to delayed gastric emptying 1
- Discontinuation before pregnancy: Semaglutide should be discontinued at least 2 months before a planned pregnancy due to its long washout period 2
By following this administration protocol, patients can maximize the benefits of semaglutide therapy while minimizing potential adverse effects.