Semaglutide

Semaglutide (Ozempic, Wegovy, Rybelsus) is a prescription GLP-1 medication used for weight loss and weight management, type 2 diabetes treatment, or to reduce the risk of chronic kidney disease and major cardiovascular events in certain patients with type 2 diabetes. Semaglutide (Wegovy) is also used to treat metabolic dysfunction-associated steatohepatitis (MASH), without cirrhosis of the liver.

Semaglutide injections are self-administered once weekly as an injection under the skin, and semaglutide pills are taken once daily.

Semaglutide works by reducing appetite, delaying gastric emptying, increasing insulin release, and lowering the amount of glucagon released. Semaglutide is a GLP-1 receptor agonist that mimics the behavior of the GLP-1 hormone, which is naturally released after eating.

Semaglutide brand names are Ozempic, Rybelsus, and Wegovy, all made by Novo Nordisk. There is no generic semaglutide available. Semaglutide FDA approval was first granted on December 5, 2017, for the brand Ozempic.

Each semaglutide brand or formulation is FDA-approved for specific conditions and patient populations.

Semaglutide FDA-approved uses for each brand are Ozempic (type 2 diabetes, reducing cardiovascular event risks, reducing risk of kidney function decline), Wegovy (weight management, reducing cardiovascular event risks, non-cirrhotic MASH), and Rybelsus (type 2 diabetes, reducing cardiovascular event risks).

Semaglutide should be used in addition to a reduced-calorie diet and increased physical activity.

What is Ozempic used for?

Ozempic tablets and injections are FDA-approved in adults for:

• type 2 diabetes to improve blood sugar control
• reducing the risk of a major cardiovascular event (such as heart attack, stroke, or death) in type 2 diabetic patients who are at high risk for these events

Ozempic injection is also FDA-approved in adults for:

• reducing the risk of kidney function decline, kidney failure, and cardiovascular death in patients with type 2 diabetes and chronic kidney disease (CKD)

What is Wegovy used for?

Wegovy tablets and injections are FDA-approved in adults for:

• weight loss and weight management in adults with obesity or adults who are overweight and have a weight-related medical problem (e.g., blood pressure, type 2 diabetes, or high cholesterol)
• reducing major cardiovascular event risks (such as heart attack, stroke, or death) in adults with established CV disease and either obesity or overweight

Wegovy injection is also FDA-approved for:

• weight loss and weight management patients with obesity who are 12 years and older
• non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis), this is an accelerated approval.

What is Rybelsus used for?

Rybelsus oral tablets are FDA-approved in adults for:

• type 2 diabetes in adults to help control blood sugar levels.
• reducing the risk of major cardiovascular events (such as heart attack, stroke, or death) in type 2 diabetic patients with known heart disease.

Also, see Wegovy vs Ozempic: Which is right for you?

Semaglutide works by:

• Stimulates insulin production in the pancreas
• Reduces sugar production in the liver
• Slows down digestion, so food stays in the stomach longer
• Decreases appetite and food intake

These combined actions help you feel full longer, eat less, and maintain better control over blood sugar levels. As a result, semaglutide supports weight loss, improves blood sugar management, and helps reduce the risk of cardiovascular events.

Semaglutide's mechanism of action mimics a natural hormone in the body called GLP-1 (glucagon-like peptide-1), which is released after eating to help regulate appetite and blood sugar levels.

The way semaglutide works for kidney-related risk reduction is not fully understood.

Semaglutide belongs to the drug class called GLP-1 receptor agonists.

The cost of semaglutide varies depending on your insurance plan and which pharmacy you use.

Refer to our Ozempic price guide page for more information about the Ozempic cost. You may also be eligible for an Ozempic coupon or savings card.

Refer to our Wegovy price guide page for more information about the Wegovy cost. You may also be eligible for a Wegovy coupon or savings card.

Refer to our Rybelsus price guide page for more information about the Rybelsus cost. You may also be eligible for a Rybelsus coupon or savings card.

Semaglutide injection directions

Semaglutide injections (Ozempic and Wegovy) are injected under the skin, usually once per week at any time of the day, with or without food. Use an injection on the same day each week.

Read and follow all instructions you have been given. Ask your doctor or pharmacist if you need help.

Prepare an injection only when you are ready to give it. Call your pharmacist if the medicine looks cloudy, has changed colors, or has particles in it.

Your healthcare provider will show you where to inject semaglutide. Do not inject into the same place twice in a row. If you are visually impaired, the Wegovy FlexTouch pen is not recommended for self-injection.

If you choose a different weekly injection day, start your new schedule after at least 2 days have passed since the last injection you gave.

Do not use different brands of semaglutide at the same time.

Semaglutide tablets directions

Semaglutide oral tablets (Ozempic, Wegovy, Rybelsus) are taken once a day at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water only. After 30 minutes of taking the tablet, you may eat, drink, or take other oral medicines. Swallow tablets whole. Do not split, crush, or chew tablets.

General semaglutide use

Blood sugar can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals.

Low blood sugar (hypoglycemia) can make you feel very hungry, dizzy, irritable, or shaky. To quickly treat hypoglycemia, eat or drink hard candy, crackers, raisins, fruit juice, or non-diet soda. Your doctor may prescribe glucagon injections in case of severe hypoglycemia.

Tell your doctor if you have frequent symptoms of high blood sugar (hyperglycemia), such as increased thirst or urination. Ask your doctor before changing your dose or medication schedule.

Your treatment may also include diet, exercise, weight control, medical tests, and special medical care.

You may get dehydrated during prolonged illness. Call your doctor if you are sick with vomiting or diarrhea, or if you eat or drink less than usual.

Never share an injection pen, even if you changed the needle. Sharing an injection can pass infection or disease from person to person.

The Ozempic injection pen contains more than one dose. After your first use, store the pen with the needle removed in a refrigerator or at room temperature. Protect from heat and light. Keep the cap on when not in use. Throw the pen away 56 days after the first use or if less than 0.25 mg is shown on the dose counter.

Do not reuse a needle. Place it in a puncture-proof "sharps" container and dispose of it following state or local laws. Keep out of the reach of children and pets.

Semaglutide has a boxed warning for the risk of thyroid C-cell tumors. A boxed warning is the strongest safety-related warning issued by the FDA. Semaglutide may cause serious side effects, including possible thyroid tumors and thyroid cancer.

Call your doctor at once if you have signs of a thyroid tumor, such as swelling or a lump in your neck, trouble swallowing, a hoarse voice, or shortness of breath.

You should not use semaglutide if you have multiple endocrine neoplasia type 2 (tumors in your glands) or a personal or family history of medullary thyroid cancer.

Semaglutide also has warnings for pancreatitis, diabetic retinopathy complications, hypoglycemia that can be severe, acute kidney injury, acute gallbladder disease, hypersensitivity reactions, and pulmonary aspiration during general anesthesia or deep sedation. For Wegovy, there are also warnings for a heart rate increase and suicidal behaviour or ideation. For Rybelsus, there is also a warning for severe gastrointestinal side effects.

You should not use semaglutide if you are allergic to it, or if you have:

• multiple endocrine neoplasia type 2 (tumors in your glands);
• a personal or family history of medullary thyroid carcinoma (a type of thyroid cancer); or
• diabetic ketoacidosis (call your doctor for treatment).

Tell your doctor if you have ever had:

• a stomach or intestinal disorder;
• pancreatitis;
• are planning surgery or other procedure that uses anesthesia or deep sedation;
• kidney disease; or
• eye problems caused by diabetes (retinopathy).

In animal studies, semaglutide caused thyroid tumors or thyroid cancer. It is not known whether these effects would occur in people. Ask your doctor about your risk.

Pregnancy

Men and women should stop using semaglutide at least 2 months before they plan to get pregnant. Ask your doctor for a safer medicine to use during this time. Controlling diabetes is very important during pregnancy, as is gaining the right amount of weight. Even if you are overweight, losing weight during pregnancy could harm the unborn baby.

There is a pregnancy exposure registry for women who use Wegovy during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry or contact Novo Nordisk at 1-877-390-2760 or www.wegovypregnancyregistry.com.

Breastfeeding

Ask a doctor if it is safe to breastfeed while using Ozempic or Wegovy injections. Breastfeeding is not recommended during treatment with Wegovy tablets.

You should not breastfeed while using Rybelsus.

Common semaglutide side effects

Common semaglutide side effects may include upset stomach, heartburn, burping, gas, bloating, nausea, vomiting, stomach pain, loss of appetite, diarrhea, constipation, stomach flu symptoms, low blood sugar (in people with type 2 diabetes), headache, dizziness, tiredness, hair loss, and changes in skin sensations.

Stomach or gastrointestinal side effects are common, but they tend to be mild and clear up in a few weeks and usually will not interfere with long-term treatment. Stomach side effects can be more common with higher doses.

Tips for managing stomach side effects

Following these tips may help you manage stomach semaglutide side effects:

• Eat more slowly
• Eat smaller meals
• Choose more bland, low-fat foods (like crackers, toast, and rice)
• Avoid eating greasy, fried foods or sugar treats
• Eat foods that contain water (like soup or gelatin)
• Do not lie down right after eating
• Drink clear or ice-cold liquids
• If possible, go outside for fresh air if you feel sick to your stomach
• Ryebelsus is not recommended in patients with severe gastroparesis.

Tips for managing low blood sugar levels (hypoglycemia) side effects

• Test blood sugar levels regularly if you are also taking diabetic medicines, including insulin or sulphonylureas (e.g., glibenclamide/glyburide, glipizide, and gliclazide) and when you increase your semaglutide dose.
• Your prescriber might reduce your dose of insulin or sulphonylureas if needed to reduce the risk of hypoglycemia
• Symptoms of low blood sugar levels include:
• Treatment for hypoglycemia
• Severe hypoglycemia may require a glucagon injection.

Serious semaglutide side effects

Get emergency medical help if you have signs of an allergic reaction: hives, itching, dizziness, fast heartbeats, difficulty breathing, swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• vision changes;
• unusual mood changes, thoughts about hurting yourself;
• pounding heartbeats or fluttering in your chest;
• a light-headed feeling, like you might pass out;
• signs of a thyroid tumor - swelling or a lump in your neck, trouble swallowing, a hoarse voice, feeling short of breath;
• symptoms of pancreatitis - severe pain in your upper stomach spreading to your back, nausea with or without vomiting, fast heart rate;
• gallbladder problems - upper stomach pain, fever, clay-colored stools, jaundice (yellowing of the skin or eyes);
• low blood sugar - headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery;
• kidney problems - swelling, urinating less, feeling tired or short of breath; or
• stomach flu symptoms - stomach cramps, vomiting, loss of appetite, diarrhea (may be watery or bloody); or severe stomach problems like severe constipation, fecal impaction, or intestinal obstruction.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Ozempic Dosing Information

Ozempic Injection Recommended Dosage

• Start Ozempic with a 0.25 mg subcutaneous injection (injection under the skin) once weekly for 4 weeks. The 0.25 mg dosage is intended for treatment initiation and is not effective for glycemic control.
• After 4 weeks on the 0.25 mg dosage, increase the dosage to 0.5 mg once weekly.
• If additional glycemic control is needed after at least 4 weeks on the 0.5 mg dosage, the dosage may be increased to 1 mg once weekly.
• If additional glycemic control is needed after at least 4 weeks on the 1 mg dosage, the dosage may be increased to 2 mg once weekly. The maximum recommended dosage is 2 mg once weekly.
• Administer Ozempic once weekly, on the same day each week, at any time of the day, with or without meals.
• The day of weekly administration can be changed if necessary, as long as the time between two doses is at least 2 days (>48 hours).
• If a dose is missed, administer Ozempic as soon as possible within 5 days after the missed dose. If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once-weekly dosing schedule.

Ozempic is available as single-patient-use injections, and there are multiple strength options:

• 0.25 mg or 0.5 mg dose pen (4 doses of 0.25 mg and 2 doses of 0.5 mg, or 4 doses of 0.5 mg)
• 1 mg dose pen (4 doses per pen)
• 2 mg dose pen (4 doses per pen)

Each Ozempic pen carton contains 4 NovoFine Plus needles with 1mg and 2mg pens and 6 NovoFine Plus needles with the 0.25/0.5mg dose pen. Each injection is pre-filled and intended for use by one patient only.

Ozempic Pill Dosing Information

Starting Ozempic Dosage (Initiation phase):

• Days 1 through 30: 1.5 mg orally once daily (this dose is not effective for glycemic control).

Escalation and Maintenance Ozempic Dosage:

• Days 31 to 60: 4 mg orally once daily.
• Day 61 or thereafter if:

Wegovy Dosing Information

Wegovy injection dosing information

Initiate Wegovy injection with a dose of 0.25 mg injected subcutaneously once weekly and follow the dose escalation schedule below to minimize gastrointestinal adverse reactions.

Initial Wegovy Injection Dose Escalation Schedule (all indications)

• Week 1 to week 4: 0.25mg once a week
• Week 5 to week 8: 0.5mg once a week
• Week 9 to week 12: 1mg once a week
• Week 13 to week 16: 1.7mg once a week

Maintenance injection dose guidance

Adult weight reduction maintenance dose:

• 1.7 mg or 2.4 mg (recommended) injected subcutaneously once weekly.
• Dose may be increased to 7.2 mg subcutaneously once weekly on patients who tolerate the 2.4 mg dosage for at least 4 weeks and additional weight reduction is clinically indicated.
• Maximum dose 7.2 mg once weekly
• Consider treatment response and tolerability when selecting the maintenance dosage

Pediatric patients' weight reduction maintenance dose (patients aged 12 years and older):

• Either 2.4 mg (recommended) or 1.7 mg once weekly.
• Consider treatment response and tolerability when selecting the maintenance dosage

Cardiovascular risk reduction maintenance dose:

• Either 2.4 mg (recommended) or 1.7 mg once weekly, based on patient response and tolerance.

Non-cirrhotic metabolic dysfunction–associated steatohepatitis (MASH) with moderate to advanced liver fibrosis maintenance dose:

• 2.4 mg injected once weekly.
• If a patient does not tolerate the 2.4 mg once-weekly maintenance dose, the dose may be reduced to 1.7 mg once weekly.
• Re-escalation to 2.4 mg once weekly may be considered if the lower dose is tolerated.

In patients with type 2 diabetes, monitor blood glucose prior to starting Wegovy and during Wegovy treatment.

Wegovy Injections Strengths available:

• Wegovy 0.25 mg pen delivers one 0.25 mg dose (0.25 mg/0.5 mL)
• Wegovy 0.5 mg pen delivers one 0.5 mg dose (0.5 mg / 0.5 mL)
• Wegovy 1 mg pen delivers one 1 mg dose (1 mg / 0.5 mL)
• Wegovy 1.7 mg pen delivers one 1.7 mg dose (1.7 mg / 0.75 mL)
• Wegovy 2.4 mg pen delivers one 2.4 mg dose (2.4 mg / 0.75 mL)
• Wegovy 7.2 mg pen delivers one 7.2 mg dose (7.2 mg/0.75 mL)

Wegovy Tablets Dosing Information

• Initial dose: 1.5 mg once daily for 30 days.
• Titration: Follow the dosage escalation schedule, titrating every 30 days to achievethe maintenance dosage.
• Maintenance dose: 25 mg orally once daily for cardiovascular risk reduction and weight reduction in adults.

Rybelsus Dosing Information

Take Rybelsus at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water only. After 30 minutes of taking the tablet, you may eat, drink, or take other oral medicines. Swallow tablets whole. Do not split, crush, or chew tablets.

Rybelsus Recommended Dosage R1 formulation

• Start Rybelsus with 3 mg once daily for 30 days. The 3 mg dose is intended for treatment initiation and is not effective for glycemic control.
• After 30 days on the 3 mg dose, increase the dose to 7 mg once daily.
• Dose may be increased to 14 mg once daily if additional glycemic control is needed after at least 30 days on the 7 mg dose.
• Taking two 7 mg Rybelsus tablets to achieve a 14 mg dose is not recommended.
• If a dose is missed, the missed dose should be skipped, and the next dose should be taken the following day.

Rybelsus tablets strengths are available in 3mg, 7mg, and 14mg

Rybelsus Recommended Dosage R2 formulation

• Start Rybelsus with 1.5 mg once daily for 30 days. The 1.5 mg dose is intended for treatment initiation and is not effective for glycemic control.
• After 30 days on the 1.5 mg dose, increase the dose to 4 mg once daily.
• Dose may be increased to 9 mg once daily if additional glycemic control is needed after at least 30 days on the 4 mg dose.
• If a dose is missed, the missed dose should be skipped, and the next dose should be taken the following day.

Rybelsus tablets strengths are available in 1.5 mg, 4 mg, and 9 mg

Switching Patients between Ozempic and Rybelsus

• Patients treated with Rybelsus 14 mg daily can be transitioned to Ozempic subcutaneous injection 0.5 mg once weekly. Patients can start Ozempic the day after their last dose of Rybelsus.
• Patients treated with once-weekly Ozempic 0.5 mg subcutaneous injection can be transitioned to Rybelsus 7 mg or 14 mg. Patients can start Rybelsus up to 7 days after their last injection of Ozempic. There is no equivalent dose of Rybelsus for Ozempic 1 mg.

For Rybelsus: Skip the missed dose and use your next dose at the regular time.

For Ozempic injection: Use the medicine as soon as you can and then go back to your regular schedule. If you are more than 5 days late for the injection, skip the missed dose and return to your regular schedule.

For Wegovy injection: Use the medicine as soon as you can and then go back to your regular schedule. If your next dose is due in less than 2 days (48 hours), skip the missed dose and return to your regular schedule. Call your doctor if you miss more than 2 doses in a row of Wegovy injection. You may need to restart the medicine at a lower dose to avoid stomach problems.

For Wegovy tablets: If you miss a dose of Wegovy tablets, skip the missed dose and go back to your regular schedule for the next dose.

Do not use two doses of semaglutide at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose may cause severe nausea, vomiting, or low blood sugar.

Semaglutide can slow your digestion, and it may take longer for your body to absorb any medicines you take by mouth.

Tell your doctor about all your other medicines, especially insulin or other diabetes medicines, such as dulaglutide, exenatide, liraglutide, Byetta, Trulicity, Victoza, and others.

Other drugs may affect semaglutide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.

Ozempic

• Prior to first use, Ozempic should be stored in a refrigerator between 36ºF to 46ºF (2ºC to 8ºC). Do not store in the freezer or directly adjacent to the refrigerator cooling element. Do not freeze Ozempic and do not use Ozempic if it has been frozen.
• After the first use of the Ozempic pen, the pen can be stored for 56 days at controlled room temperature (59°F to 86°F; 15°C to 30°C) or in a refrigerator (36°F to 46°F; 2°C to 8°C). Do not freeze.
• Keep the pen cap on when not in use. Ozempic should be protected from excessive heat and sunlight.
• Always remove and safely discard the needle after each injection and store the Ozempic pen without an injection needle attached. Always use a new needle for each injection.

Wegovy Injection

• Store the single-dose pen or syringe in the refrigerator from 2°C to 8°C (36°F to 46°F). Do not store Wegovy in the freezer or directly beside the refrigerator cooling element. Do not freeze Wegovy and do not use it if it has been frozen. If needed, prior to cap removal, the single-dose pen or syringe can be kept from 8°C to 30°C (46°F to 86°F) for up to 28 days. Protect Wegovy from light. Wegovy must be kept in the original carton until time of administration. Discard the Wegovy single-dose pen or syringe after use. For the Wegovy FlexTouch single-patient-use pen, store in the refrigerator until first use. After first use, store between 59°F to 86°F (15°C to 30°C) or in the refrigerator for up to 56 days. Keep the pen cap on when not in use and remove the needle after each injection.

Wegovy, Ozempic, Rybelsus Tablets

• Store Wegovy tablets at room temperature between 68°F and 77°F (20°C to 25°C) in their original closed bottle until you are ready to take one. Do not store in any other container.
• Store in a dry place away from moisture.

Active ingredient: semaglutideInactive ingredients:

Ozempic injection: disodium phosphate dihydrate, propylene glycol, phenol, and water for injections. Ozempic has a pH of approximately 7.4. Hydrochloric acid or sodium hydroxide may be added to adjust pH.

Ozempic tablet: magnesium stearate and salcaprozate sodium

Wegovy injection: disodium phosphate dihydrate, sodium chloride, and water for injection. Phenol and propylene glycol are also inactive ingredients in the single-patient-use Wegovy FlexTouch. Hydrochloric acid or sodium hydroxide may be added to adjust pH.

Wegovy tablets: salcaprozate sodium (SNAC) and magnesium stearate

Rybelsus R1 formulation: magnesium stearate, microcrystalline cellulose, povidone, and salcaprozate sodium (SNAC).

Rybelsus R2 formulation: magnesium stearate and salcaprozate sodium (SNAC).

Ozempic, Wegovy, and Rybelsus are Manufactured by Novo Nordisk A/S, DK-2880 Bagsvaerd, Denmark.