From the Guidelines
Yes, a patient experiencing nausea on Wegovy 1 mg can remain at this dose for an additional month to allow her body to adapt before increasing to the next dose level, as gradual dose titration may help mitigate adverse effects such as nausea and vomiting, according to the American Gastroenterological Association recommendations 1. The approach of dose stabilization is supported by the fact that semaglutide, the active ingredient in Wegovy, may delay gastric emptying, leading to nausea and vomiting, but these effects can be minimized with gradual dose titration 1. Some key considerations for the patient during this additional month at 1 mg include:
- Staying well-hydrated
- Eating smaller meals
- Avoiding fatty or spicy foods
- Considering taking the injection at bedtime if currently taking it in the morning If nausea remains severe despite these measures, the patient should contact her healthcare provider, as anti-nausea medications might be helpful 1. It's also important to note that the selection of the medication or intervention should be based on the clinical profile and needs of the patient, including comorbidities, patients’ preferences, costs, and access to the therapy 1. The AGA suggests using semaglutide 2.4 mg with lifestyle modifications for the long-term treatment of obesity, but it also acknowledges the importance of individualizing treatment based on patient needs and tolerability 1.
From the FDA Drug Label
The delay of early postprandial gastric emptying, thereby reducing the rate at which glucose appears in the circulation postprandially.
The FDA drug label does not answer the question.
From the Research
Nausea and Dose Adaptation
- Nausea is a common adverse event associated with semaglutide, particularly during the initial treatment period 2, 3, 4, 5, 6.
- The studies suggest that nausea is typically transient and mild-to-moderate in severity, and it often subsides with time 2, 4, 6.
- There is no specific guidance on whether a patient can stay on a 1 mg dose of Wegovy (semaglutide) for an additional month to adapt to the dose.
- However, the studies indicate that slow up-titration of the dose can help mitigate gastrointestinal adverse events, including nausea 3.
- It is essential to note that the dosage and administration of semaglutide should be individualized and guided by a healthcare professional.
Efficacy and Safety of Semaglutide
- Semaglutide has been shown to be effective in reducing body weight and improving glycemic control in patients with type 2 diabetes and obesity 2, 4, 5, 6.
- The safety profile of semaglutide is consistent with the GLP-1RA drug class, with gastrointestinal adverse events being the most common 2, 4, 5, 6.
- The risk of hypoglycemia is low, and cardiovascular safety has been shown to be noninferior to placebo 5, 6.