---
title: General info on GLP-1 Agonists (Semaglutide) at Portrait
description: Semaglutide
---

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# General info on GLP-1 Agonists (Semaglutide) at Portrait

### What to say to patients (verbally and/or over social media)

- **It is very important from a legal standpoint that we never say that we are offering Ozempic, Wegovy, or (the oral tablet form) Rybelsus**

- From the FDA’s perspective, patients should not use a compounded drug if an approved drug is available to treat a patient 
    - Semaglutide compounding has been permitted due to the ongoing intermittent drug shortages
    - Here is a [helpful FDA memo](https://drive.google.com/file/d/1Y8rnZcaPvFiOVzgQBAea2RyjydBJd7X5/view?usp=sharing)
- Shipping compounded semaglutide in CA is not permitted 
    - The company has sourced synthetic GLP-1, the peptide which semaglutide mimics in the body
    - Expected equitable clinical efficacy but without the higher price point for patients

### Background

- Semaglutide is the generic name for branded Ozempic, Wegovy and Rybelsus
- Rx was intended as an antidiabetic medication used for the treatment of type 2 diabetes, but has found its place as an anti-obesity medication used for long-term weight management

### Package Insert

- Available [here](https://www.novo-pi.com/wegovy.pdf)

### MOA

- Semaglutide works as a glucagon-like peptide-1 (GLP-1) receptor agonist. The effect is to reduce food intake by lowering appetite and slowing down digestion in the stomach, ultimately helping to reduce body fat and weight.

### Side Effects

- Mainly around GI effects 
    - nausea, diarrhea, vomiting, constipation, abdominal pain, indigestion/heartburn, abdominal distension, belching, hypoglycemia (low blood glucose) in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).
    - may also cause pancreatitis, gastroparesis, and bowel obstruction

### Contraindications

- Black Box Warning 
    - Personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN 2)
- Type 1 or type 2 diabetics who are insulin-dependent
- History of thyroid cancer
- History of pancreatitis
- Rx to be discontinued 2 months before attempting pregnancy

### Monitoring

- S/s depression or behavioral changes, suicidality
- Glucose at baseline if the patient is a diabetic, then when dose is increased
- Watch for gastric distress — increasing constipation, nausea, or heartburn
- Regular (weekly) weight logs either in clinic or that patient performs at home

### How do we get our patient clear for use?

- Record your patient’s height and weight into their chart (type into Internal Note section)
- Confirm the following to ensure the patient is a candidate 
    - No personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN 2)
    - No type 1 or type 2 diabetics who are insulin-dependent
    - No history of thyroid cancer
    - No history of pancreatitis
    - Not pregnant or intending to become pregnant in the next two months
    - At Portrait, patients already on a hypoglycemic agent (e.g. metformin) are not candidates and should be managed by their primary care provider
- Have your PCC notify that you need clearance for semaglutide
- Patient will be evlauated for clearance by the on-staff provider

### Dosing Recommendations

- 0.25 mg is injected under the skin once a week for 4 weeks
- Increase by 0.25 mg every 4 weeks, until goal achieved OR 
    - max dose of 2.5 mg once a week is reached

### Ongoing Monitoring/Documentation

For patients already on semaglutide, document the following at each visit:

Date Treatment Commenced:

Current dose (if taking):

Starting weight, current weight:

Any active gastrointestinal symptoms?

Any mood symptoms?

Any change in intent for pregnancy?

Please upload recent labs, if you have any

\*\*\* IF THE PATIENT REPORTS SIGNIFICANT SIDE EFFECTS, RN’S NEED TO CONTACT THE GFE TEAM FOR NEXT STEPS. DO NOT MANAGE DOSING AS YOU MAY BE OUT OF PRACTICE SCOPE \*\*\*

### Outcome Expectations

Most studies evaluated patients after week 68 of ongoing weekly use

- Average was 15-20% of body weight loss over that time period
- Study participants also enjoyed greater improvement in cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline

[https://drive.google.com/drive/folders/1RXQJf6Zhv3Wp6\_7XUHTbSJumwPEHT0V\_?usp=sharing](https://drive.google.com/drive/folders/1RXQJf6Zhv3Wp6_7XUHTbSJumwPEHT0V_?usp=sharing)

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