Can a Patient Start Ozempic While on 3HP Regimen?
Yes, a patient can start Ozempic (semaglutide) while on a 3HP regimen, as there are no known drug interactions between semaglutide and the 3HP tuberculosis treatment regimen (isoniazid and rifapentine). 1
Key Considerations Before Initiating
The 3HP regimen (weekly isoniazid and rifapentine for 12 weeks for latent tuberculosis) does not interact with GLP-1 receptor agonists like semaglutide. However, several clinical factors require attention when starting Ozempic:
Dosing Protocol
Start at 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg weekly for 4 weeks, followed by 1.0 mg weekly if additional glycemic control is needed for diabetes management. 1
The gradual titration is specifically designed to reduce nausea, vomiting, and other gastrointestinal adverse effects, which are the most common side effects. 1
Never advance doses too quickly, as this significantly increases gastrointestinal side effects and treatment discontinuation. 1
Critical Drug Interaction Management
If the patient is taking insulin or sulfonylureas concurrently, reduce the dose of these medications to minimize hypoglycemia risk when starting Ozempic. 1
Do not combine Ozempic with other GLP-1 receptor agonists or DPP-4 inhibitors. 1
Monitoring Requirements
Monitor renal function in the first several weeks of therapy, particularly in patients with impaired renal function at baseline, as therapy may cause a modest and likely reversible decrease in eGFR. 2
Patients should have a recent eye examination prior to semaglutide initiation if they have a history of diabetic retinopathy, as an increased risk of diabetic retinopathy complications has been noted with semaglutide. 2
Common Pitfalls to Avoid
Failing to adjust concomitant diabetes medications (particularly insulin and sulfonylureas) increases hypoglycemia risk. 1
Patients initiated on semaglutide should be informed that transient nausea and vomiting are relatively common side effects that can be minimized by starting with the lowest dose and eating smaller portions. 2
If 3 or more consecutive doses are missed, restart the entire titration schedule from 0.25 mg weekly. 1
Special Population Considerations
No dose adjustment is required for patients with renal impairment, including end-stage renal disease or dialysis. 1
No dose adjustment is required for patients with hepatic impairment. 1