WEGOVY 2.4/MG 1/PENFILL @

Indications

Off-Label Uses

Off-label: type 2 diabetes management (semaglutide is approved for T2D as Ozempic/Rybelsus, not Wegovy) and metabolic-associated steatotic liver disease/steatohepatitis (NAFLD/NASH/MASH) in selected patients (investigational/off-label).

Dosage & Administration

Dosing by Condition

For Wegovy indications (chronic weight management and MACE risk reduction): 0.25 mg SC once weekly x4 weeks, then 0.5 mg x4 weeks, then 1 mg x4 weeks, then 1.7 mg x4 weeks, then 2.4 mg once weekly maintenance from week 17 onward.

Maximum Dose

2.4 mg subcutaneously once weekly

Children's Dosage

Not approved for pediatric use

Dose Adjustment Notes

Escalate dose every 4 weeks to improve gastrointestinal tolerability; if a dose is not tolerated during escalation, consider delaying the dose increase for 4 additional weeks. If the 2.4 mg maintenance dose is not tolerated, reduce temporarily to 1.7 mg once weekly for up to 4 weeks, then attempt to re-escalate; discontinue if 2.4 mg cannot be tolerated. No dose adjustment is recommended for renal or hepatic impairment, but monitor renal function if severe GI reactions/dehydration occur.

Side Effects

Common Side Effects

Nausea, vomiting, diarrhea, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distension, eructation, flatulence, gastroesophageal reflux disease (GERD), gastritis.

Side Effect Frequency

Very common (≥10%): nausea, diarrhea, vomiting, constipation, abdominal pain. Common (1-10%): dyspepsia, eructation, flatulence, gastroesophageal reflux disease, abdominal distension, dizziness, headache, fatigue, injection-site reactions; hypoglycemia mainly when used with insulin/sulfonylurea; cholelithiasis. Uncommon/rare: acute pancreatitis, acute gallbladder disease, hypersensitivity reactions (including anaphylaxis/angioedema), suicidal ideation/behavior, NAION.

Safety & Warnings

Warnings & Precautions

Key warnings/precautions: thyroid C-cell tumor risk (contraindicated in MTC/MEN2); pancreatitis (discontinue if suspected/confirmed); gallbladder disease; hypoglycemia with insulin/secretagogues; acute kidney injury risk with dehydration (monitor renal function during severe GI events); hypersensitivity reactions (discontinue if occurs); suicidal ideation/behavior monitoring; increased heart rate; caution in patients with diabetic retinopathy (especially with type 2 diabetes); not a substitute for insulin and not for type 1 diabetes.

Age Restriction

Approved for adults only (≥18 years)

Driving Warning

Safe

Drug Interactions

Interaction Severity

MAJOR/CLINICALLY SIGNIFICANT: Concomitant insulin or insulin secretagogues (e.g., sulfonylureas) increases hypoglycemia risk-consider dose reduction and monitor glucose. MODERATE: Oral drugs may have altered absorption due to delayed gastric emptying (clinically relevant for some narrow-therapeutic-index agents; monitor as appropriate).

Special Populations

Pregnancy

Risk Summary: Available data with Wegovy use in pregnant women are insufficient to evaluate for a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes.

Breastfeeding

Consult Doctor

Children

Not approved for pediatric use

Storage & Patient Advice

Stopping the Medicine

Can be stopped without tapering; counsel that appetite/weight regain is common after discontinuation and discuss a long-term weight-management plan with the prescriber.

Overdose

Symptoms: severe nausea/vomiting and possible hypoglycemia (especially with insulin/sulfonylureas). Management: supportive/symptomatic care, monitor glucose and hydration/electrolytes; no specific antidote; seek urgent medical attention.

Patient Counseling

Teach once-weekly subcutaneous injection (abdomen/thigh/upper arm) with site rotation; take on the same day each week, any time, with or without meals. Explain gradual dose titration every 4 weeks to reduce nausea/vomiting and advise dietary strategies (smaller, lower-fat meals). Warn about pancreatitis symptoms (severe persistent abdominal pain), gallbladder symptoms, hypoglycemia risk if used with insulin/secretagogues, and thyroid tumor warning (report neck mass/hoarseness; avoid if MTC/MEN2). Do not share pens/needles; store refrigerated (2-8°C) per SFDA storage conditions; discuss pregnancy avoidance and that weight regain may occur if stopped.

Pharmacology

Mechanism of Action

GLP-1 receptor agonist that reduces appetite and energy intake via central mechanisms, slows gastric emptying, and improves glycemic control by increasing glucose-dependent insulin secretion and decreasing glucagon secretion.

Duration of Effect

Approximately 1 week (supports once-weekly dosing).

Half-Life

Approximately 7 days (about 165-184 hours).

Bioavailability

Subcutaneous bioavailability approximately 89%.

Metabolism

Metabolized by proteolytic cleavage of the peptide backbone and sequential beta-oxidation of the fatty-acid side chain; not metabolized by CYP450 enzymes.

Excretion

Eliminated via proteolytic degradation and beta-oxidation with metabolites excreted in urine and feces; minimal unchanged drug is excreted.

Protein Binding

>99% protein bound, primarily to albumin.

Product Information

Available Dosage Forms

Solution for injection in pre-filled pen (subcutaneous injection)

Composition per Dose

Each dose (0.75 mL): semaglutide 2.4 mg; excipients: disodium phosphate dihydrate, propylene glycol, phenol, water for injections, hydrochloric acid/sodium hydroxide (pH adjustment)

Generic Availability

No

OTC Alternatives

No OTC alternative

Diabetes Type

Type 2

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