What is Semaglutide?

How Semaglutide Works

Semaglutide works by acting like a key digestive hormone in the body called glucagon-like peptide-1. This hormone is involved in regulating blood sugar levels, signaling the body to produce more insulin after a meal. Insulin helps the body use glucose, or sugar, for energy. GLP-1 can also reduce the secretion of glucagon from the pancreas, which causes the liver to release less sugar.

In addition to managing blood sugar levels, semaglutide can also slow digestion, which can lead to feelings of fullness and reduced appetite. It may also directly curb appetite by acting on certain areas of the brain. A controlled appetite on semaglutide can lead to significant weight loss.

Unlike newer medications such as tirzepatide that work as dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonists, semaglutide acts on one hormonal pathway. However, it’s still an effective drug that has a long half-life and meaningful benefits.

FDA-Approved Uses and Indications

Dosing & Titration Schedules

Semaglutide is taken as a subcutaneous injection (under the skin) once weekly or a daily oral tablet. The dosage of semaglutide depends on what it’s being used for. 

In general, semaglutide is prescribed at higher doses for weight loss than it is for type 2 diabetes. In most cases, semaglutide is started at a lower dose and gradually increased over time to help reduce the risk and severity of side effects.

How Well Does It Work? (What the Trials Show)

Semaglutide has been shown to be effective in various clinical trials that led to its approval. It consistently lowers blood sugar levels (measured by A1c) and helps reduce overall body weight when used as prescribed. 

In trials with patients with diabetes, semaglutide lowered A1c levels by 1% to 1.5% on average, while also reducing body weight by several kilograms. In trials with patients with obesity, the higher dose of semaglutide led to an average weight loss of up to around 15%. However, some patients lost even more than that.

Safety, Side Effects & Warnings

Semaglutide is generally a safe medication with mild side effects when taken as prescribed and monitored by a healthcare provider. Most side effects occur at the start of treatment or when increasing the dosage. The most common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Upset stomach

These common side effects are usually temporary and can often be managed with lifestyle or dietary changes. More serious side effects are rare but may include:

• Pancreatitis, or inflammation of the pancreas
• Vision changes
• Low blood sugar, or hypoglycemia
• Dehydration, which may lead to serious kidney problems
• Severe gastrointestinal or stomach problems
• Gallbladder problems
• Food or liquids in the lungs while being under anesthesia (pulmonary aspiration)

In addition, severe allergic reactions are possible in people who have a hypersensitivity to semaglutide or any inactive ingredients in the medication. Symptoms may include a skin rash, trouble breathing, and swelling of the mouth, face, or throat. 

Semaglutide also carries a black box warning for thyroid C-cell tumors based on animal studies. It’s not recommended for people with a personal or family history of thyroid cancer or a condition called multiple endocrine neoplasia syndrome type 2. However, real-world studies suggest no increased thyroid cancer risk. Your healthcare provider should discuss this risk with you before prescribing and may monitor for symptoms during treatment.

Drug Interactions and Special Populations

Drug interactions are possible with semaglutide, although they’re not as extensive as with other medications. Still, it’s important to keep the following potential interactions in mind:

• Insulin and sulfonylureas: Taking semaglutide with these medications could increase the risk of hypoglycemia. In some cases, a healthcare provider may recommend lowering the dose of insulin or the sulfonylurea in question to reduce the risk.
• Oral medications: Because semaglutide slows the emptying of the stomach, it may affect how well oral drugs are absorbed into the body. While this doesn’t change the overall drug exposure in the body, it could be something to consider while taking drugs that have a narrow therapeutic index, such as warfarin, where timely absorption matters. 
• Oral birth control pills: Delayed gastric emptying with semaglutide could severely affect the absorption of oral contraceptives. In other words, semaglutide could make them less effective. A backup birth control method is recommended for at least 4 weeks after starting semaglutide and after each increase in dosage. 

Discussing all medications being taken, including prescription drugs, over-the-counter medicines, and herbal supplements, is key before starting semaglutide. While alcohol doesn’t directly interact with semaglutide, mixing the two could increase the risk of low blood sugar and worsen potential side effects like nausea or an upset stomach. 

Semaglutide may not be right for everyone and should be used with caution in certain groups.

• Pregnant women
• Breastfeeding women
• People with a history of pancreatitis
• People with kidney disease
• People with a personal or family history of medullary thyroid carcinoma or MEN2
• Older adults

Using semaglutide could lead to a greater risk of adverse reactions in these populations. Therefore, it’s best to consult a healthcare provider to discuss treatment options.

Access, Cost, and Coverage

Semaglutide is not currently available as an approved generic medication. It’s typically purchased under the brand names Ozempic, Wegovy, or Rybelsus. For this reason, the costs may be inaccessible for many people who prefer generic medications.

Insurance plans are more likely to cover Ozempic and Rybelsus for type 2 diabetes. Although policies may be changing in the future, coverage for weight-loss medications can be scarce. Since plans can differ, it’s best to consult the insurance plan directly or check the formulary for pricing details.

Without insurance, the costs of brand-name versions could be up to or over $1,000 per month. However, savings options are available in the form of discount cards, financial assistance programs, and compounded semaglutide. 

Policy Lab has partnered with OnlineSemaglutide to offer access to compounded GLP-1 medications like semaglutide and tirzepatide at a reduced cost. Compounded semaglutide contains the same active ingredients and offers similar benefits to the brand-name version, helping to regulate appetite and promote weight loss.

Semaglutide and the Bigger Picture: Clinical Trials and Patient Access

Medications like semaglutide aren’t available on the market overnight. They have to be approved through rigorous clinical trials that can involve thousands of patients. These studies look at more than whether a drug works. They track side effects and beneficial outcomes that can be applied to everyday life.

For many people, clinical trials could open the door to potential treatment options. Research studies often need to recruit patients to investigate new dosing forms or uses. 

For people interested in the science behind new treatment options or participating in research studies, Policy Lab is an online resource that connects potential participants with clinical trials. In addition, the site offers educational resources and lets users search a large database of studies with criteria for eligibility to join studies and what to expect.

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