What are the indications and usage for semaglutide (glucagon-like peptide-1 receptor agonist) injection?

Indications and Usage for Semaglutide Injection

Semaglutide injection is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease. 1

Primary Indications

• Type 2 Diabetes Management:

  • Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus 1
  • Can be used as monotherapy or in combination with other antidiabetic medications (including metformin with or without sulfonylureas) 1, 2

• Cardiovascular Risk Reduction:

  • Reduces the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease 1
  • Recommended by the American Diabetes Association for patients with established atherosclerotic cardiovascular disease (ASCVD) 3

Important Limitations of Use

• Not studied in patients with history of pancreatitis - consider alternative antidiabetic therapy in these patients 1
• Not indicated for:
  • Type 1 diabetes mellitus 1
  • Treatment of diabetic ketoacidosis 1
  • Weight management (Note: While semaglutide has demonstrated significant weight loss effects, the injectable form discussed here is specifically FDA-approved for diabetes, not obesity) 3, 1

Dosing Information

• Starting dose: 0.25 mg once weekly for 4 weeks 1

• Dose titration:

  • After 4 weeks, increase to 0.5 mg once weekly
  • If additional glycemic control is needed after at least 4 weeks on 0.5 mg, may increase to 1 mg once weekly 1
  • The American Diabetes Association recommends gradual increments every 4 weeks to minimize gastrointestinal side effects 3

• Administration:

  • Subcutaneous injection in abdomen, thigh, or upper arm
  • Can be administered at any time of day, with or without meals
  • If a dose is missed, administer within 5 days of the missed dose 1

Contraindications

• Personal or family history of medullary thyroid carcinoma 3, 1
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 3, 1
• Known hypersensitivity to semaglutide or any product components 1
• Pregnancy (contraindicated according to the American College of Obstetricians and Gynecologists) 3

Clinical Efficacy

• Achieves significant HbA1c reductions of 1.21-1.64% compared to 0.83% with insulin glargine 2
• Results in significant weight loss (3.47-5.17 kg) compared to weight gain (1.15 kg) with insulin glargine 2
• Associated with fewer hypoglycemic episodes compared to insulin glargine 2

Safety Considerations

• Most common adverse effects (occurring in ≥5% of patients):

  • Gastrointestinal: nausea (40%), vomiting (16%), diarrhea, abdominal pain, and constipation 3, 1

• Important warnings:

  • Risk of thyroid C-cell tumors (boxed warning) 1
  • Pancreatitis risk - discontinue if suspected 1
  • Diabetic retinopathy complications - monitor patients with history of diabetic retinopathy 1, 4
  • Hypoglycemia risk when used with insulin secretagogues or insulin 3, 1
  • Acute kidney injury - monitor renal function in patients with renal impairment who experience severe GI reactions 1
  • Hypersensitivity reactions 1
  • Delayed absorption of oral medications - monitor medications with narrow therapeutic index 3

Special Populations

• Renal impairment: No dose adjustment required, even in advanced renal insufficiency 3
• Women of reproductive potential: Discontinue at least 2 months before planned pregnancy due to long washout period 1
• Women using oral hormonal contraception: Should use or add non-oral contraception for 4 weeks after initiation and dose escalations 3

Semaglutide represents an important therapeutic option for type 2 diabetes management with the added benefit of cardiovascular risk reduction in patients with established cardiovascular disease.