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GLP-1 receptor agonist counselling — GPhC CRA MCQ

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HardEndocrine TherapeuticsGLP-1 receptor agonist counsellingGPhC CRA

A patient starts semaglutide 0.25 mg once weekly and, after two doses, asks to increase early because fasting glucose remains high. There are mild transient gastrointestinal effects only. What is the best advice?

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Correct answer: D — Complete four weeks at 0.25 mg weekly before scheduled dose escalation

Complete four weeks at 0.25 mg weekly before scheduled dose escalation: The 0.25-mg dose is used for treatment initiation and tolerability; shortening the titration increases gastrointestinal adverse effects and is not the licensed schedule. Increase to 1 mg weekly after the second initiation dose: The starting dose must not be skipped and 1 mg is not the next titration step. Inject 0.25 mg twice weekly during the remaining initiation period: Semaglutide is administered once weekly; splitting changes the licensed regimen. Stop semaglutide because mild transient nausea establishes acute pancreatitis: Mild transient nausea is common and, without pancreatic red flags, does not establish pancreatitis. Use 0.25 mg only when fasting glucose exceeds the agreed target: Semaglutide is scheduled weekly, not used as an as-needed glucose correction.

Reference: Ozempic UK summary of product characteristics: https://www.medicines.org.uk/emc/product/9750/smpc; BNF: semaglutide: https://bnf.nice.org.uk/drugs/semaglutide/