What is the maximum time I can go without a weekly injection of semaglutide (glucagon-like peptide-1 receptor agonist)?

Maximum Time Without Weekly Semaglutide Injection

If you miss a weekly semaglutide injection, you should not go longer than 3 consecutive doses (3 weeks) without restarting the medication, as this may require reinitiating the titration schedule. 1

Understanding Semaglutide's Pharmacokinetics

• Semaglutide has a long half-life of approximately 1 week, which allows for once-weekly dosing 2
• The drug remains present in the circulation for about 5 weeks after the last dose 2
• Steady-state exposure is achieved following 4-5 weeks of once-weekly administration 2, 3

Guidelines for Missed Doses

• If 1-2 consecutive doses are missed, you can generally resume at the same dose if you previously tolerated the medication well 1
• If more than 2 consecutive doses are missed (more than 2 weeks), clinical judgment is required to determine the appropriate next steps 1
• If 3 or more consecutive doses are missed (3+ weeks), restarting the titration schedule should be considered 1

Titration Schedule for Restarting

If you need to restart the titration schedule after missing multiple doses, follow this progression:

• Start with 0.25 mg weekly for the first 4 weeks
• Increase to 0.5 mg weekly for 4 weeks
• Increase to 1.0 mg weekly for 4 weeks
• Increase to 1.7 mg weekly for 4 weeks
• Finally reach the maintenance dose of 2.4 mg after 16 weeks total 1

Considerations for Specific Situations

• Some patients achieve strong therapeutic response at submaximal doses and could continue at that dose long-term 1
• Patients with planned surgical procedures should be aware that GLP-1 receptor agonists like semaglutide delay gastric emptying, which may increase risk of aspiration during general anesthesia 1
• Several case reports document regurgitation and pulmonary aspiration in patients on semaglutide despite extended fasting periods before procedures 1

Safety Considerations

• Semaglutide can delay gastric emptying, which may impact the absorption of oral medications requiring rapid onset of action 1
• Common side effects include nausea, vomiting, diarrhea, constipation, and headache 1
• The drug is contraindicated in patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 1

Clinical Implications of Discontinuation

• Interruption of therapy may lead to loss of glycemic control in patients with diabetes 1
• For patients using semaglutide for weight management, interruption may result in weight regain 1
• The significant clinical benefits of semaglutide on cardiovascular outcomes may be compromised with extended interruptions 4

Remember that these guidelines are based on clinical expertise and pharmacokinetic properties of semaglutide. Always consult with your healthcare provider before making any changes to your medication regimen.