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Semaglutide
FDA ApprovedSince 2017
Also known as Ozempic, Wegovy, Rybelsus
Function
Primary
Type 2 Diabetes · Obesity
Secondary
Cardiovascular risk reduction
Mechanism
GLP-1 receptor agonist — stimulates glucose-dependent insulin secretion, suppresses glucagon, slows gastric emptying, and reduces appetite via CNS pathways.
Evidence
Clinical RCT (Phase III)
Research
Phase III SUSTAIN/STEP programs
Dosing
Range
0.25–2.4 mg/week (SQ); 3–14 mg/day (oral)
Frequency
Weekly (SQ); Daily (oral)
Route
Subcutaneous · Oral
Administration & Technique
Subcutaneous (Ozempic / Wegovy)
Standard for weight loss and T2D. Once weekly, same day.
DevicePre-filled pen (fixed-dose click) or U-100 insulin syringe for compounded vials.
TechniqueAbdomen, thigh, or upper arm. Prime pen per label. Rotate sites weekly. Refrigerate pen; room temp ≤ 56 days once in use.
Oral (Rybelsus)
T2D only; not approved for weight loss.
Device3, 7, or 14 mg tablet.
TechniqueFirst thing on waking, empty stomach, ≤120 mL plain water. Wait 30 min before food, other meds, or more water — bioavailability drops sharply otherwise.
Cycling
Continuous dosing; titrate every 4 weeks. No formal cycle — chronic therapy with stepwise dose escalation.
Timing & Interactions
When to take
Once weekly, same day each week, any time of day, with or without food. If a dose is missed and the next dose is >48 hrs away, take it; otherwise skip.
Do not combine with
- ·Tirzepatide, Liraglutide, Exenatide, Retatrutide, Survodutide, CagriSema — do NOT stack GLP-1s
- ·Sulfonylureas / insulin without dose reduction — hypoglycemia
- ·Personal or family history of medullary thyroid carcinoma / MEN2 — contraindicated
Complements
- ·Cagrilintide (as CagriSema) — amylin + GLP-1 synergy
- ·5-Amino-1MQ or MOTS-c for metabolic adjuncts (research)
- ·Adequate protein intake + resistance training to preserve lean mass
Storage & Reconstitution
Powder (Pre-Reconstitution)
Manufactured pens: refrigerate 2–8°C until first use.
After Reconstitution
Per FDA label: after first use, store at 2–8°C or up to 30°C for up to 56 days. Discard after that.
Notes
Do not freeze. Protect from light.
Benefits
- ·Sustained weight reduction (10–15%)
- ·HbA1c reduction ~1.5–2.0%
- ·Reduced MACE in T2D with CV disease
- ·Improved cardiometabolic markers
Risks
- ·Nausea, vomiting, diarrhea
- ·Pancreatitis (rare)
- ·Gallbladder disease
- ·Thyroid C-cell tumor warning (rodent data)
Contraindications
- ·Personal/family history of medullary thyroid carcinoma
- ·MEN-2 syndrome
- ·Severe gastroparesis
- ·Pregnancy
Regulatory
FDA-Approved Rx
Veterinary Use (Pets)
Not approved for veterinary use. Anecdotal use in obese dogs / cats is emerging but off-label with meaningful GI-adverse-effect risk.
Dogs (Canine)
DoseEmpirical — starting 0.02 mg/kg weekly, titrate
RouteSubQ
UseSevere obesity refractory to diet/exercise.
Not veterinary-approved. Pancreatitis risk in predisposed breeds (Schnauzers, Yorkies).
Cats (Feline)
DoseNot recommended
Routen/a
UseCats are obligate carnivores — GLP-1 physiology differs; risk > benefit.
Do not use.
FDA has issued warnings about compounded GLP-1s in veterinary use.
Full veterinary reference →