GLP-1 Receptor Agonist Pregnancy: Should not be used during pregnancy; discontinue at least 2 months before a planned pregnancy (long half-life). Women of childbearing potential should use contraception. Should not be used during breast-feeding (§4.6).

Semaglutide

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

Used in: Diabetes & DKA

Semaglutide is a GLP-1 receptor agonist used in type 2 diabetes and, at higher doses, for weight management; it lowers glucose with weight loss and has cardiovascular benefit.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Start 0.25 mg once weekly for 4 weeks, then increase to 0.5 mg once weekly; after at least 4 weeks may increase to 1 mg once weekly, then after at least a further 4 weeks to 2 mg once weekly to further improve glycaemic control

Route: Subcutaneous (abdomen, thigh or upper arm)

Frequency: Once weekly

Max: 2 mg once weekly (weekly doses higher than 2 mg are not recommended)

SPC (Ozempic solution for injection). 0.25 mg is not a maintenance dose. When added to a sulfonylurea or insulin, consider reducing the dose of that agent to lower the risk of hypoglycaemia. Missed dose: give within 5 days, otherwise skip. Not for type 1 diabetes or diabetic ketoacidosis. Paediatric: safety and efficacy in patients below 18 years not yet established — no data available.

Dose adjustments

Renal

No dose adjustment required for mild, moderate or severe renal impairment; experience in severe renal impairment is limited.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

• RYBELSUS and OZEMPIC tablets are not substitutable on a mg-to-mg basis. • Take RYBELSUS or OZEMPIC tablets orally once daily on an empty stomach in the morning with water (up to 4 ounces of water); do not take with other liquids besides water. ( 2.1 ) • Swallow tablets whole. Do not split, crush, chew or dissolve in any solution. ( 2.1 ) • After taking RYBELSUS or OZEMPIC tablets, wait at least 30 minutes before eating food, drinking beverages or taking other oral medications. ( 2.1 ) • See the Full Prescribing Information for instructions on switching between RYBELSUS and OZEMPIC tablets ( 2.3 ) and from OZEMPIC injections to RYBELSUS or OZEMPIC tablets. ( 2.4 ) Recommended Starting, …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-01-30. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Nausea (very common)
Diarrhoea (very common)
Vomiting (common)
Abdominal pain (common)
Constipation (common)

Interactions

Sulfonylurea or insulin — increased risk of hypoglycaemia; consider reducing the dose of the sulfonylurea or insulin (§4.2/§4.4)

Clinical monograph

How it works

It mimics GLP-1 — increasing glucose-dependent insulin secretion, suppressing glucagon, slowing gastric emptying and reducing appetite.

Prescribing in practice

Gastrointestinal effects (nausea, vomiting) are common, particularly during dose escalation — titrate slowly.
Delayed gastric emptying is relevant around general anaesthesia or sedation (aspiration risk) and can affect other oral drugs; rare pancreatitis.
Hypoglycaemia risk is low alone but higher with a sulfonylurea or insulin (reduce those); it is not a substitute for insulin in type 1 diabetes or DKA.

Monitoring

Monitor HbA1c and weight; review gastrointestinal tolerance and remain alert to features of pancreatitis.

Counselling the patient

Nausea is common at first and usually improves; the dose is increased gradually.
Tell anaesthetic or endoscopy teams you take it, as it slows stomach emptying.
Report severe, persistent abdominal pain.

Evidence & guidelines

GLP-1 receptor agonists are recommended in type 2 diabetes (especially with obesity or cardiovascular risk) per NICE NG28, with cardiovascular outcome benefit (e.g. SUSTAIN programme).

Reference: SUSTAIN-6; SELECT trial (NEJM 2023); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways