Pre-Initiation Requirements for Ozempic (Semaglutide)
Before starting Ozempic, you must screen for personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), confirm the patient is not pregnant, and assess baseline renal and hepatic function. 1, 2
Mandatory Contraindication Screening
Thyroid Cancer Risk Assessment
- Ozempic is contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2. 1, 2
- The FDA warns of thyroid C-cell tumor risk observed in rodent studies, though human relevance remains undetermined. 1
- Directly ask about any personal history of thyroid cancer and specifically inquire about family history of MTC or MEN 2 syndrome. 2
Pregnancy Status
- Pregnancy is an absolute contraindication to Ozempic therapy. 2
- Confirm negative pregnancy status in women of childbearing potential before initiation. 2
- Ensure reliable contraception is in place during treatment. 2
Required Baseline Laboratory Assessments
Renal Function
- Obtain baseline eGFR or creatinine clearance before starting therapy. 2
- No dose adjustment is required for any degree of renal impairment, including end-stage renal disease, but baseline assessment is still necessary to monitor for potential acute kidney injury from GI-related dehydration. 1, 2
Hepatic Function
- Assess baseline liver function tests before initiation. 2
- No dose adjustment is required for hepatic impairment, but baseline values are needed for future monitoring. 1
Additional Metabolic Parameters
- Obtain hemoglobin A1c to establish baseline glycemic control. 2
- Check lipid panel, particularly in patients with dyslipidemia. 2
Clinical History Assessment
Pancreatitis Risk
- Screen for history of pancreatitis or current risk factors. 3
- Do not initiate Ozempic in patients at high risk for pancreatitis. 3
- Discontinue if pancreatitis is suspected during treatment. 3
Gallbladder Disease
- Evaluate for history of cholelithiasis or cholecystitis. 3
- Avoid use in patients with active biliary disease or those at high risk. 3
Diabetic Retinopathy
- Perform close monitoring of retinopathy status in high-risk patients, particularly those with diabetes duration ≥10 years or older age. 3
Gastroparesis
- Ozempic is not recommended for patients with pre-existing gastroparesis due to delayed gastric emptying effects. 3
Medication Review and Adjustment Planning
Hypoglycemia Risk Mitigation
- If the patient is on insulin or insulin secretagogues (sulfonylureas, meglitinides), plan to reduce these doses when initiating Ozempic to minimize hypoglycemia risk. 3, 2
- The combination of GLP-1 receptor agonists with these medications significantly increases hypoglycemia risk. 3
Narrow Therapeutic Index Medications
- Identify any oral medications with narrow therapeutic index (e.g., warfarin, levothyroxine) that may require closer monitoring due to delayed gastric emptying affecting absorption. 2
Patient Education Before Initiation
Expected Side Effects
- Counsel patients about common gastrointestinal side effects including nausea, vomiting, diarrhea, and constipation. 3, 1
- Advise on dietary modifications to mitigate GI effects: reduction in meal size, mindful eating practices (stopping when full), and decreasing intake of high-fat or spicy foods. 3
Administration Training
- Ensure proper training on subcutaneous injection technique before the first dose. 4
- Ozempic is administered once weekly on the same day each week, at any time of day, with or without meals. 1
Special Population Considerations
Cardiovascular Disease
- No special pre-initiation requirements exist for patients with cardiovascular disease, as semaglutide provides cardiovascular benefits. 1
- Monitor blood pressure and heart rate, as modest increases may occur. 2