Drug Action
Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying.
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Drug reference
Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying.
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Type 2 diabetes mellitus [monotherapy (if metformin inappropriate) or in combination with other antidiabetic drugs] ▶BY SUBCUTANEOUS INJECTION ▶Adult: Initially 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly for at least 4 weeks, then increased if necessary to 1 mg once weekly, for information on use with other antidiabetic drugs— consult product literature
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DUE TO INTERACTIONS ▶Manufacturer advises dose of concomitant insulin or sulfonylurea may need to be reduced.
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Diabetic ketoacidosis. severe congestive heart failure (no information available)
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Diabetic retinopathy (in patients treated with insulin). history of pancreatitis
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Scottish Medicines Consortium (SMC) decisions SMC No. SMC2092 The Scottish Medicines Consortium has advised (January 2019) that semaglutide (Ozempic ®) is accepted for restricted use within NHS Scotland for the treatment of adults with insufficiently controlled type 2 diabetes mellitus in addition to other oral antidiabetic medicines, or as an add-on to basal insulin, as an alternative glucagon-like peptide-1 receptor agonist option. Endocrine system
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MHRA/CHM ADVICE: GLP-1 RECEPTOR AGONISTS: REPORTS OF DIABETIC KETOACIDOSIS WHEN CONCOMITANT INSULIN WAS RAPIDLY REDUCED OR DISCONTINUED (JUNE 2019) Serious and life-threatening cases of diabetic ketoacidosis have been reported in patients with type 2 diabetes mellitus on a combination of insulin and the glucagon-like peptide-1 (GLP-1) receptor agonist exenatide, liraglutide, or dulaglutide, particularly after discontinuation or rapid dose reduction of concomitant insulin. The MHRA has not currently received any UK reports of diabetic ketoacidosis with the GLP-1 receptor agonists lixisenatide and semaglutide but this risk cannot be excluded. Healthcare professionals are advised that any dose reduction of insulin should be done in a stepwise manner with careful blood glucose self- monitoring, particularly when GLP-1 receptor agonist therapy is initiated. Patients should be informed of the risk factors for and signs and symptoms of diabetic ketoacidosis, and advised to seek immediate medical attention if these develop.
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→Appendix 1: semaglutide
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▶Common or very common Appetite decreased. burping. cholelithiasis. constipation. diarrhoea. dizziness. fatigue . gastrointestinal discomfort. gastrointestinal disorders. hypoglycaemia (in combination with insulin or sulfonylurea). nausea. vomiting. weight decreased ▶Uncommon Taste altered SIDE-EFFECTS, FURTHER INFORMATION Discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain.
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Manufacturer advises women of childbearing potential should use effective contraception during and for at least two months after stopping treatment.
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Manufacturer advises avoid—toxicity in animal studies.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises caution (limited information in severe impairment).
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Manufacturer advises avoid in end- stage renal disease. l HANDLING AND STORAGE Manufacturer advises store in a refrigerator (2–8°C)—after first use can also be stored below 30°C; keep cap on pen to protect from light.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Ozempic (Novo Nordisk Ltd) A Semaglutide 1.34 mg per 1 ml Ozempic 0.25mg/0.19ml solution for injection 1.5ml pre-filled pens | 1 pre-filled disposable injection P £73.25 DT = £73.25 Ozempic 0.5mg/0.37ml solution for injection 1.5ml pre-filled pens | 1 pre-filled disposable injection P £73.25 DT = £73.25 Ozempic 1mg/0.74ml solution for injection 3ml pre-filled pens | 1 pre- filled disposable injection P £73.25 DT = £73.25 BLOOD GLUCOSE LOWERING DRUGS › MEGLITINIDES
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Manufacturer advises patients and their carers should be told how to recognise signs and symptoms of acute pancreatitis and advised to seek immediate medical attention if symptoms develop. Missed doses Manufacturer advises if a dose is more than 5 days late, the missed dose should not be taken and the next dose should be administered at the normal time.
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Initially 0.25 mg once weekly for 4 weeks, then
First-line fragment. Read the complete Indications and Dose section above.
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