Wegovy, Rybelsus, or Ozempic? So many options to choose from! Scroll down and learn more about these GLP1 agonist medications.

What is Semaglutide?

Semaglutide, an FDA-approved compound, treats type 2 diabetes and obesity. Available in various formulations—subcutaneous injection (Ozempic, Wegovy) and oral tablet (Rybelsus)—it offers versatile treatment options. While Ozempic and Rybelsus are FDA-approved for type 2 diabetes management and can be used off-label for obesity, Wegovy is specifically FDA-approved for obesity management. The primary difference between Wegovy and Ozempic lies in dosage, but they are essentially the same medication.

How Does Semaglutide Work?

Semaglutide, a GLP-1 receptor agonist, mimics the effects of the hormone GLP-1 by increasing insulin secretion, slowing digestion, and reducing appetite, aiding in blood sugar control and weight loss. Additionally, it exhibits anti-inflammatory effects by decreasing pro-inflammatory receptors and increasing anti-inflammatory cells throughout the body. This anti-inflammatory action may potentially reduce the risk of atherosclerosis and improve cardiovascular health. Furthermore, it suggests potential applications for Semaglutide in treating inflammatory conditions like arthritis, polycystic ovarian syndrome, and psoriasis, although further research is necessary to confirm its efficacy in these areas.

Who Qualifies for Semaglutide?

If diagnosed with type 2 diabetes, Rybelsus and Ozempic are FDA-approved options. For obesity management, Wegovy is FDA-approved, while Rybelsus and Ozempic can be used off-label. Eligibility criteria include a BMI over 30 or over 27 with obesity-related conditions. Semaglutide, due to its weight loss and anti-inflammatory effects, may also benefit patients with Polycystic Ovarian Syndrome (PCOS). However, further clinical trials are required to confirm its role in PCOS management.

Effectiveness of Semaglutide for Weight Loss

Several studies have explored the weight loss benefits of semaglutide in both diabetic and non-diabetic individuals. It’s essential to supplement these medications with a calorie-restricted diet and regular exercise.

Ozempic has demonstrated significant weight reduction in diabetic patients. The SUSTAIN-6 trial showed participants on weekly Ozempic lost 3-5 kg (8-11 lbs) over two years. Incorporating diet and exercise may enhance this effect.

Rybelsus also effectively reduces body weight. In the PIONEER-1 trial, those on a 14 mg dose experienced a 2.6 kg (~5 lbs) difference after 26 weeks, despite not following a diet or exercise plan.

In the STEP 1 Trial, Wegovy effectively treated obesity in non-diabetic patients over 68 weeks. Participants experienced a significant 15% reduction in body weight when paired with diet and exercise.

Semaglutide vs Other GLP-1 Medications

Semaglutide vs Tirzepatide (Mounjaro)

Tirzepatide, marketed as Mounjaro, is a novel dual-action medication that targets both GLP-1 and GIP receptors. Unlike semaglutide, it also affects GIP receptors, enhancing the efficacy of GLP-1. Administered as a weekly injection, tirzepatide offers a convenient dosing schedule.

In comparisons with semaglutide for managing type 2 diabetes, tirzepatide demonstrated superior weight loss effects across all doses, with higher doses showing more significant changes in body weight and BMI. It’s important to note that these findings were observed without participants following a diet and exercise program, suggesting even greater weight loss potential when combined with a calorie-restricted diet and regular exercise (~150 minutes/week).

Semaglutide vs Liraglutide (Saxenda, Victoza)

Liraglutide, available as Saxenda or Victoza, is another GLP-1 agonist medication akin to semaglutide, offering weight loss benefits. Saxenda is FDA-approved for obesity treatment, while Victoza is approved for type 2 diabetes in patients aged ten and older. Both are administered via once-daily injections.

In comparison to semaglutide, liraglutide has shown a lesser weight loss effect. In the STEP-8 clinical trial, researchers compared the weight loss impact of semaglutide and liraglutide on non-diabetic patients with obesity. Over a 68-week period, those on semaglutide experienced a 15.8% change in body weight, whereas those on liraglutide observed a 6.4% change.

Semaglutide vs Dulaglutide (Trulicity)

Dulaglutide, marketed as Trulicity, is a GLP-1 agonist approved for treating type 2 diabetes and preventing associated heart issues. It can also be used off-label for obesity treatment, administered via once-weekly injections.

In the SUSTAIN-7 trial, comparing semaglutide to dulaglutide for type 2 diabetes treatment, participants on semaglutide lost approximately 4.6 kg (~10 lbs), while those on dulaglutide lost about 2.3 kg (~5 lbs) over 40 weeks. Larger doses of either medication showed greater changes in body weight. Notably, participants weren’t enrolled in a diet and exercise program, suggesting potential for additional weight loss with such supplementation.

Semaglutide Side Effects

The primary side effects of semaglutide are gastrointestinal, including abdominal pain, nausea, vomiting, and diarrhea. Frequencies of these symptoms vary between Ozempic, Wegovy, and Rybelsus, as well as with different dosages. In trials like SUSTAIN-6 and PIONEER-1, gastrointestinal side effects were less common with Rybelsus compared to Ozempic (5-16% vs. 50-52%). Rates were similar between Wegovy and Ozempic (44% vs. 50-52%). These side effects are typically mild to moderate and tend to diminish over time. Animal studies suggest potential fetal abnormalities and miscarriage risk, warranting caution in pregnant or planning-to-be-pregnant individuals. Consulting with a healthcare provider is advised to weigh the medication’s benefits against potential fetal risks.

Semaglutide Dosage and Administration

Ozempic, Rybelsus, and Wegovy all contain semaglutide as their active ingredient but differ in dosing and administration methods.

Wegovy is administered as a once-weekly pen injection, starting at 0.25 mg for four weeks, then increased to 0.5 mg, with subsequent increases up to a maximum of 2.4 mg.

Similarly, Ozempic is a once-weekly pen injection, starting at 0.25 mg for four weeks, then increased to 0.5 mg, with subsequent increases up to a maximum of 2 mg.

Both Wegovy and Ozempic are injected into the abdomen, thigh, or upper arm, and injection sites should be rotated. They can be taken with or without food, and missed doses should be taken within 2-5 days of the scheduled time.

In contrast, Rybelsus is a once-daily tablet, starting at 3 mg for 30 days, then potentially increased to 7 mg or a maximum of 14 mg. It should be taken 30 minutes before the first meal, beverage, or oral medication, with water, and should not be split, crushed, or chewed.

Semaglutide Contraindications and Warnings

Pancreatitis

Pancreatitis occurs when the pancreas becomes inflamed. This is an infrequent but potential side effect of semaglutide. If you have a history of pancreatitis, please inform your provider before starting semaglutide.

Hypoglycemia (Low Blood Sugar)

Since semaglutide increases insulin secretion, there is a risk that your blood sugar can be lowered to dangerous levels. This is known as hypoglycemia. If you have a history of hypoglycemia or are currently using insulin, you must inform your provider before starting semaglutide.

Serious Allergic Reaction

You may experience a severe allergic reaction to semaglutide when first taking it. Signs of a severe allergic reaction include swelling of your face, lips, tongue, or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat. Let your provider know immediately if you have experienced this with other GLP-1 medications or are currently experiencing this when taking semaglutide.

Kidney Disease

Though semaglutide is safe for people with kidney disease, the stomach problems associated with semaglutide may lead to fluid loss by vomiting, nausea, or vomiting. If you do have kidney problems, it is essential to stay hydrated while on semaglutide. If the gastrointestinal side effects of semaglutide are preventing you from adequately staying hydrated, then let your provider know immediately.

Severe Stomach Problems

The most common side effect of Semaglutide is gastrointestinal upset, which includes stomach ache, nausea, diarrhea, vomiting, and loss of appetite. If these symptoms become so severe that they significantly affect your daily life or ability to eat regularly, then let your provider know.

Changes in Vision

For patients with a history of diabetic retinopathy, there is a chance that your vision can worsen when taking semaglutide. If you do have a history of diabetic retinopathy, then let your provider know before starting semaglutide.

Gallbladder Disease

Semaglutide can also cause some gallbladder issues along with other gastrointestinal side effects. Since semaglutide can decrease food movement through the gastrointestinal system, it can also reduce the gallbladder’s function. This can lead to gallstone formation, which can block the release of bile, leading to the inflammation of the gallbladder.

If you have a history of gallstones or cholecystitis (inflammation of the gallbladder), then let your provider know before starting semaglutide. If you have had your gallbladder removed in the past, then you can still take semaglutide.

Thyroid Cancer or Family History of MEN-2

Though very rare, there is a risk of the development of a specific type of thyroid cancer when taking Semaglutide, called Medullary Thyroid Cancer. If you have a history of medullary thyroid cancer or a family history of Multiple Endocrine Neoplasia Cancer Syndrome Type 2 (MEN-2), let your provider know before starting semaglutide. MEN-2 is a genetic cancer syndrome that puts a patient at risk for the development of Medullary Thyroid Cancer, which is why patients with this syndrome should avoid taking semaglutide.

Pregnancy

The use of Semaglutide is not well studied. The current guidelines suggest that the weight loss effects of Wegovy may not benefit you during pregnancy and can potentially cause harm to the fetus. Therefore, you should avoid taking Semaglutide for weight loss alone if you are pregnant or are planning on becoming pregnant. For Ozempic and Rybelsus, you should discuss with your provider if the benefits of treatment for Type 2 diabetes out weigh the risks for the fetus.

Semaglutide Cost

$450/month

Where Can I Get Semaglutide?

Compounded and commercial pharmacies.

Omni Health NP is a virtual obesity medicine practice that connects you with medical providers, like nurse practitioners, to help you optimize your weight loss journey. We provide monthly video chats with actual medical providers to provide guidance about weight management and to get you started on prescription weight loss medications to supplement your weight loss plan.

References

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