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

Cycling

Continuous dosing; titrate every 4 weeks. No formal cycle — chronic therapy with stepwise dose escalation.

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

Functional Groups

Weight Loss

Cited Works

Marso SP et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes (SUSTAIN-6). N Engl J Med. 2016;375:1834-44.source
Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med. 2021;384:989.source

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