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GLP-1 Receptor Agonist Pregnancy: D — discontinue 2 months before conception

Semaglutide

Brand names: Ozempic (SC), Rybelsus (oral), Wegovy (obesity)

Adult dose

Dose: SC: 0.25mg weekly × 4 weeks → 0.5mg weekly → 1mg weekly. Oral: 3mg OD × 4 weeks → 7mg OD → 14mg OD
Route: Subcutaneous or Oral
Frequency: Once weekly (SC) or once daily (oral)
Obesity (Wegovy): 0.25mg SC weekly, escalate every 4 weeks to 2.4mg. Take oral form 30min before food with ≤120mL water.

Clinical pearls

  • SUSTAIN-6 and PIONEER-6: significant CV event reduction in T2DM
  • SELECT trial: 20% reduction in MACE in obese/overweight adults WITHOUT diabetes
  • Significant weight loss — Wegovy approved for obesity management
  • Slow dose escalation critical to minimise GI side effects
  • Discontinue 5 weeks before surgery requiring anaesthesia (gastroparesis risk)

Contraindications

  • Personal/family history of MTC
  • MEN2 syndrome
  • Pancreatitis history (relative)

Side effects

  • Nausea
  • Vomiting
  • Diarrhoea
  • Constipation
  • Pancreatitis (rare)
  • Gallbladder disease
  • Injection site reactions

Interactions

  • Oral medications — delayed gastric emptying may reduce absorption (give 1h before semaglutide)

Monitoring

  • HbA1c
  • Body weight
  • Heart rate
  • Renal function (if GI side effects cause dehydration)

Reference: SUSTAIN-6; SELECT trial (NEJM 2023). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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