semaglutide: clinical use

Prescribing considerations

• Confirm the indication and use the product licensed for that indication; brands and formulations are not automatically interchangeable.
• Review pancreatitis history, gastrointestinal motility disorders, diabetic retinopathy, renal or hepatic impairment, and planned procedures involving anaesthesia or deep sedation.
• Avoid rapid insulin withdrawal or reduction; consider hypoglycaemia risk when combined with insulin or a sulfonylurea.
• Counsel about dehydration, pancreatitis, gallbladder disease, urgent visual symptoms and product-specific administration.
• Record the product name and batch number to support traceability.

Contraindications and cautions

• Hypersensitivity to semaglutide or any product excipient.
• Semaglutide is not a substitute for insulin and is not indicated for type 1 diabetes or diabetic ketoacidosis.
• Avoid during pregnancy and breastfeeding.
• Use caution with previous pancreatitis or gastroparesis; it is not recommended in severe gastroparesis.

Monitoring

• Clinical response appropriate to the licensed indication, including weight or glycaemic measures.
• Blood glucose and hypoglycaemia risk when used with insulin or a sulfonylurea.
• Renal function if significant vomiting, diarrhoea or dehydration occurs.
• Diabetic retinopathy and any new visual symptoms; arrange urgent ophthalmic assessment for sudden sight loss.
• Thyroid parameters with levothyroxine and INR with warfarin or another coumarin anticoagulant.
• Tolerance of gastrointestinal effects and symptoms suggesting pancreatitis or gallbladder disease.

Clinical pharmacology

A long-acting GLP-1 analogue with high albumin binding and resistance to enzymatic degradation. Receptor activation affects appetite pathways and produces glucose-dependent effects on insulin and glucagon; oral absorption is low and variable and relies on an absorption-enhancing excipient.

Formulation and product differences

• FlexTouch is a multi-use pre-filled subcutaneous pen supplied with disposable needles; it must not be shared and the needle should be removed after use.
• Oral products must be swallowed intact under strict fasting and water conditions; taking food, drink or other tablets too soon reduces absorption.
• Weight-management tablets, diabetes tablets and injection products have different licences and product-specific switching instructions; they should not be directly substituted without prescriber review.

Tablet

Route: Oral

Strengths: 1.5 mg, 4 mg, 9 mg, 25 mg

Injection

Route: Parenteral

Strengths: 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, 2 mg, 2.4 mg, 7.2 mg