Guidelines for Taking Ozempic (Semaglutide)
When taking Ozempic (semaglutide), patients should follow a gradual dose titration schedule starting at the lowest dose and increasing every 4 weeks to minimize gastrointestinal side effects, while monitoring for hypoglycemia if on other glucose-lowering medications.
Proper Administration and Dosing
- Ozempic is administered as a once-weekly subcutaneous injection that can be given at any time of day, with or without meals 1
- Always use a new needle for each injection to reduce risk of contamination, infection, leakage, and blocked needles 1
- If a dose is missed and it has been less than 5 days, administer as soon as possible; if more than 5 days have passed, skip the missed dose and resume the regular schedule 2
- Store unused pens in the refrigerator (36°F to 46°F/2°C to 8°C); pens in use can be stored at room temperature for up to 56 days 1
Dose Titration Protocol
- For patients starting Ozempic, follow the recommended dose escalation schedule to minimize gastrointestinal side effects 2:
- Start at 0.25 mg once weekly for 4 weeks
- Increase to 0.5 mg once weekly for 4 weeks
- Further increase to 1.0 mg once weekly if needed for glycemic control
- Some patients may require 2.0 mg for optimal control
Medication Adjustments
- When starting Ozempic, consider the following medication adjustments 3:
- Discontinue any DPP-4 inhibitors before starting
- For patients on insulin or insulin secretagogues (sulfonylureas), consider reducing total daily insulin dose by approximately 20% to prevent hypoglycemia
- Consider discontinuing sulfonylureas or glinides when starting Ozempic
Monitoring Guidelines
- Monitor blood glucose more closely during the first 4 weeks of therapy, especially if on insulin or sulfonylureas 3
- For patients with type 2 diabetes and cardiovascular disease, Ozempic is recommended to reduce cardiovascular events, independent of baseline HbA1c 3
- For patients without diabetes but with overweight or obesity (BMI >27 kg/m²), semaglutide should be considered to reduce cardiovascular mortality, myocardial infarction, or stroke 3
Managing Side Effects
- Gastrointestinal effects are the most common side effects 1:
- Nausea, vomiting, diarrhea, abdominal pain, and constipation
- To mitigate nausea, recommend small portion sizes for meals 3
- Monitor for symptoms of hypoglycemia, especially if combined with insulin or insulin secretagogues 1
- Watch for signs of dehydration, which can lead to kidney problems; ensure adequate fluid intake 1
Special Precautions
- Do not use Ozempic with other GLP-1 receptor agonists or DPP-4 inhibitors 3
- Use caution in patients with diabetic gastroparesis or active gallbladder disease 3
- If 3 or more consecutive doses are missed, consider restarting the titration schedule 2
- Advise patients to undergo appropriate eye examinations before starting therapy if not done within the last 12 months 3
Disposal Instructions
- Dispose of used Ozempic pens and needles in an FDA-cleared sharps disposal container 1
- The Ozempic pen should be disposed of after 56 days, even if it still contains medication 1
Efficacy Considerations
- Semaglutide has demonstrated greater reductions in HbA1c and weight compared to other GLP-1 receptor agonists and insulin glargine 4, 5, 6
- Semaglutide has shown beneficial effects on kidney function, with reductions in urinary albumin-to-creatinine ratio (UACR) in patients with pre-existing microalbuminuria or macroalbuminuria 7