From the Guidelines
Ozempic (semaglutide) is recommended to be prescribed at an initial dose of 0.25 mg once weekly for 4 weeks, with subsequent dose increases to 0.5 mg and 1 mg weekly as needed for glycemic control, based on the most recent evidence from the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1.
Key Considerations for Ozempic Prescription
- The initial dose of 0.25 mg once weekly serves as a starter dose to minimize gastrointestinal side effects, which are common with GLP-1 receptor agonists.
- After the initial 4-week period, the dose can be increased to 0.5 mg once weekly, and further increased to 1 mg weekly if additional glycemic control is needed, as supported by the evidence from the SUSTAIN-6 trial 1.
- Ozempic should be injected subcutaneously in the abdomen, thigh, or upper arm on the same day each week, with flexibility in the time of day and injection site.
- Patients should store unopened pens in the refrigerator and, once in use, can keep them at room temperature for up to 56 days, as per the guidelines.
Mechanism of Action and Efficacy
- Ozempic works by mimicking GLP-1, a hormone that stimulates insulin secretion, suppresses glucagon release, slows gastric emptying, and reduces appetite, making it effective for both blood sugar control and weight management in type 2 diabetes patients.
- The efficacy of semaglutide in reducing cardiovascular events has been demonstrated in the SUSTAIN-6 trial, which showed a significant reduction in the risk of major adverse cardiovascular events compared to placebo 1.
Safety and Monitoring
- Common side effects of Ozempic include nausea, vomiting, diarrhea, abdominal pain, and constipation, which typically improve over time.
- Patients should be monitored for signs of pancreatitis, and the medication should be discontinued if suspected, as cautioned in the guidelines 1.
- The medication should also be used with caution in patients with prior gastric surgery, including bariatric surgery, and in those with a history of serious hypersensitivity reactions.
From the FDA Drug Label
- 3 Females and Males of Reproductive Potential Discontinue OZEMPIC in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide [see Use in Specific Populations (8.1)]. The FDA drug label does not provide a direct recommendation for Ozempic prescriptions. However, it advises discontinuing OZEMPIC in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide.
- Key points:
- Discontinue OZEMPIC at least 2 months before a planned pregnancy.
- No direct recommendation for Ozempic prescriptions is provided.
- The decision to prescribe Ozempic should be made on a case-by-case basis, considering the individual patient's needs and circumstances 2.
From the Research
Ozempic Prescriptions Recommendation
- Ozempic, also known as semaglutide, is a medication used to treat type 2 diabetes and has been shown to be effective in reducing HbA1c levels and promoting weight loss 3.
- The recommended dosage of semaglutide is 1.0 mg or 2.0 mg once weekly, with the 2.0 mg dose being superior in reducing HbA1c levels and promoting weight loss 3.
- Semaglutide has been shown to have a similar safety profile to other GLP-1 receptor agonists, with the most common adverse events being gastrointestinal disorders 4.
- However, there have been reports of acute pancreatitis associated with semaglutide use, although the evidence is limited and more research is needed to fully understand the risk 5, 6.
- The use of oral semaglutide has been shown to be associated with a lower risk of major adverse cardiovascular events in patients with type 2 diabetes and high cardiovascular risk 7.
- When prescribing semaglutide, clinicians should be aware of the potential risks and benefits and monitor patients closely for any adverse events, particularly gastrointestinal disorders and acute pancreatitis 4, 5, 6.