As a nutrition support pharmacist, you will hear buzz about Wegovy for weight loss. It’s injectable semaglutide, the same GLP-1 agonist as injectable Ozempic or oral Rybelsus for type 2 diabetes. READ OUR NOTE, "Weight LOSS medications don't always work".
Wegovy starts at the same 0.25 mg weekly dose as Ozempic, but titrates to 2.4 mg (see Table 1). Ozempic maxes out at 1 mg weekly. Using Wegovy 2.4 mg weekly for about a year leads to roughly 10% to 12% more weight loss than with placebo, or 9 kg (20 lb) for a 90 kg (200 lb) patient. This is about double the weight loss with daily Saxenda (liraglutide), the other GLP-1 agonist for obesity and similar to Qsymia (phentermine/topiramate ER). Other prescribed medications lead to less weight loss.
| Table (1). Wegovy™ Dosing Schedule | |||
|---|---|---|---|
| Initiate and adjust dose using the following schedule: In patients who do not tolerate a dosage increase, consider delaying the increase for an additional 4 weeks... | |||
| Semaglutide (Wegovy, U.S. only) |
Week 1 through week 4: 0.25 mg once weekly. | Note: For use as an adjunct to diet and exercise in patients with a BMI ≥ 30, or in patients with a BMI ≥ 27 and ≥ 1 weight-associated comorbidity (e.g., hypertension, dyslipidemia). | Discontinuation rate due to adverse effects: one out of every 28 patients. |
| Week 5 through week 8: 0.5 mg once weekly. | |||
| Week 9 through week 12: 1 mg once weekly. | |||
| Week 13 through week 16: 1.7 mg once weekly. | |||
| Week 17 and thereafter (maintenance dosage): 2.4 mg once weekly; if not tolerated, may temporarily decrease dosage to 1.7 mg once weekly for up to 4 additional weeks, then increase to 2.4 mg once weekly. | |||
| Missed dose: Missed dose should be administered as soon as possible within 5 days; resume usual schedule thereafter. If > 5 days have elapsed, skip the missed dose and resume administration at the next scheduled weekly dose. If more than 2 consecutive doses are missed, resume dosing as scheduled; alternatively, may reinitiate dosage adjustment schedule. | |||
Educate that GI side effects are common with Wegovy. But most patients can tolerate it if titrated appropriately over 16 weeks. Balance this against downsides of other weight loss medications. For example, Qsymia may cause kidney stones, since it contains topiramate. Keep in mind, the cost of Wegovy or Saxenda costs.
Continue to emphasize lifestyle changes BEFORE weight loss medications. And consider referral for bariatric surgery if BMI is 35 or more. Don’t jump to discussing medications unless patients have a BMI of 30 or more or 27 or more plus a weight-related condition (diabetes, etc).
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We prefer treatment with Wegovy (semaglutide) rather than Saxenda (liraglutide); administration of Wegovy is once weekly rather than once daily, and Wegovy has greater efficacy for weight loss than Saxenda.
Lean toward Wegovy if a GLP-1 agonist is preferred for weight loss, but it is still NOT available in Egypt. But stop the medication if 2.4 mg/week isn’t tolerated or patients don’t lose 5% of their body weight after 12 weeks at this dose. Consider long-term use for patients who are successful. Don’t combine Wegovy with other weight loss medications due to lack of evidence. And avoid combining it with other GLP-1 agonists or DPP-4 inhibitors (Januvia, etc), which work similarly.
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REFERENCES
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Wadden TA, Bailey TS, Billings LK, Davies M, Frias JP, Koroleva A, Lingvay I, O'Neil PM, Rubino DM, Skovgaard D, Wallenstein SOR, Garvey WT; STEP 3 Investigators. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial. JAMA. 2021 Apr 13;325(14):1403-1413. Available at: https://jamanetwork.com/journals/jama/fullarticle/2777025
Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, Lingvay I, Mosenzon O, Rosenstock J, Rubio MA, Rudofsky G, Tadayon S, Wadden TA, Dicker D; STEP 4 Investigators. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021 Apr 13;325(14):1414-1425. Available at: https://jamanetwork.com/journals/jama/fullarticle/2777886
Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989. Available at: https://www.nejm.org/doi/10.1056/NEJMoa2032183