What are the guidelines for an Ozempic (semaglutide) follow-up plan?

Ozempic Follow-Up Plan Guidelines

Patients on Ozempic require structured monitoring every 4 weeks during dose titration, with ongoing surveillance at 3-6 month intervals once at maintenance dose, focusing on weight, glycemic control, gastrointestinal symptoms, and renal function. 1

Initial Titration Phase Monitoring (Weeks 0-8)

Dose Escalation Schedule

• Start at 0.25 mg subcutaneously once weekly for 4 weeks (this dose is for initiation only, not therapeutic) 2
• Increase to 0.5 mg once weekly after the initial 4 weeks 2
• If additional glycemic control is needed after at least 4 weeks on 0.5 mg, escalate to 1 mg once weekly (maximum dose) 2

Required Monitoring During Titration

• Body weight assessment every 4 weeks during dose escalation to track therapeutic response 1
• Gastrointestinal symptom evaluation at each visit - specifically assess for nausea (44% incidence), vomiting (25%), diarrhea (32%), and constipation (23%) 1
• If GI symptoms are severe, maintain current dose longer before escalating rather than advancing on schedule 1
• For patients with type 2 diabetes, monitor glucose levels more frequently during dose adjustments to assess glycemic response and adjust concomitant medications 1

Maintenance Phase Monitoring (After Reaching Target Dose)

Routine Follow-Up Intervals

• Reevaluate every 3-6 months once at stable maintenance dose 3, 1
• Continue surveillance until treatment goals are achieved or adverse events necessitate intervention 3

Parameters to Monitor at Each Visit

Metabolic Markers:

• HbA1c levels (expect 1.5-1.9% reduction from baseline) 4
• Fasting and postprandial glucose if applicable 1
• Body weight (expect 5-10% reduction from baseline in diabetes patients, 14.9% in obesity patients) 1, 4

Cardiovascular Parameters:

• Blood pressure monitoring (semaglutide reduces systolic BP) 5
• Heart rate assessment 5

Renal Function:

• Monitor eGFR and urine albumin-to-creatinine ratio, particularly in patients with diabetic kidney disease 6
• No dose adjustment required for any degree of renal impairment, including severe impairment 7, 8

Gastrointestinal Tolerance:

• Ongoing assessment of nausea, vomiting, diarrhea, abdominal pain, and constipation 7
• Most GI effects are mild-to-moderate and transient, typically resolving with continued treatment 7

Special Monitoring Considerations

Thyroid Surveillance

• Counsel patients about medullary thyroid carcinoma (MTC) symptoms including neck mass, dysphagia, dyspnea, or persistent hoarseness 2
• Routine serum calcitonin monitoring or thyroid ultrasound is of uncertain value and not recommended 2
• If serum calcitonin is measured and exceeds 50 ng/L, further evaluation is warranted 2

Pancreatitis Risk

• Acute pancreatitis occurred in 0.3 cases per 100 patient-years in trials 2
• Educate patients to report severe abdominal pain 2
• Consider alternative therapies in patients with prior pancreatitis history 2

Diabetic Retinopathy

• Monitor for worsening diabetic retinopathy, particularly in patients with existing retinopathy 5
• Odds ratio for diabetic retinopathy versus placebo was 1.32 (95% CI 0.98-1.77) 5

Hypoglycemia Risk

• When used with insulin or sulfonylureas, monitor closely for hypoglycemia and consider dose reduction of these agents 7, 8
• Semaglutide monotherapy does not increase hypoglycemia risk 5

Treatment Response Assessment

Glycemic Control Evaluation

• Evaluate glycemic response after reaching each dose level (0.5 mg and 1 mg) 7
• Some patients achieve adequate control at 0.5 mg (7 mg for oral formulation) and can remain at that dose long-term 7, 8

Weight Management Evaluation

• For weight management indication: if patient has not lost at least 4% of body weight after 16 weeks of treatment, consider discontinuation 7, 8

Long-Term Management Considerations

Treatment Duration

• Semaglutide should be considered lifelong therapy to maintain weight loss and metabolic benefits 1
• Discontinuation results in significant weight regain and worsening of cardiometabolic risk factors 1

Cardiovascular Benefits Monitoring

• In patients with established cardiovascular disease, semaglutide reduces major adverse cardiovascular events (CV death, non-fatal MI, non-fatal stroke) 3, 2
• This benefit is independent of glycemic control 3

Concomitant Medication Management

• Do not use with other GLP-1 receptor agonists or DPP-4 inhibitors 7
• For females using oral contraceptives, advise switching to non-oral method or adding barrier method during initiation and dose escalation 8

Common Pitfalls to Avoid

• Never advance dose if patient has intolerable GI symptoms - extend time at current dose instead 1
• Do not discontinue prematurely for mild GI effects - these typically resolve with continued treatment 7
• Ensure proper injection technique education - rotate injection sites weekly within same body region 2
• Verify pen storage - unused pens refrigerated at 36-46°F; in-use pens can be room temperature but must be discarded after 56 days regardless of remaining medication 2
• If dose missed >5 days, skip and resume regular schedule rather than doubling up 2