What is Semaglutide?
Semaglutide is a medicine which is similar to a natural hormone called glucagon-like peptide-1 (GLP-1).
GLP-1 is a peptide hormone secreted by L-cells in the intestine and certain neurons in the brainstem after eating a meal. It has been shown to promote satiety and reduce food intake. It also increases insulin production in the pancreas in a dose dependent manner. See figure-1.
Normally the GLP-1 produced in the body is rapidly broken down by an enzyme. The discovery of the GLP-1 receptor and natural GLP-1 has allowed medicinal chemists to develop a longer acting GLP-1. Semaglutide used once weekly is bound to albumin in the blood allowing for a longer effect or once weekly dosing.
In the stomach it reduces gastric emptying time and promotes a feeling of fullness. Some patient’s experience nausea with the delayed gastric emptying. Slow titration (every 3 or 4 weeks) of the drug can reduce the nausea and other side effects of Semaglutide. It also promotes insulin secretion in the pancreas at higher doses.
A higher weekly dose appears to reduce the progression of chronic kidney disease and cardiovascular events seen in patients with Type-2 diabetes. Also at higher doses, it acts on centers in the brain and suppresses appetite. Semaglutide was associated with less hunger and food cravings, better control of eating and a lower preference for high‐fat foods. Resting metabolic rate, adjusted for lean body mass, did not differ between treatments, indicating Semaglutide does not increase metabolism.
How fast is weight loss on semaglutide?
Across all four STEP clinical trials, participants who received semaglutide lost an average of between 10% and 17% of their body weight. Overall, the drug performed much better than other anti-obesity medications that typically result in a 5% to 9% reduction in body weight (N Engl J Med 2021; 384:989-1002). You could see results as early as the first week when combined with a healthy nutrition plan and increased exercise. Healthy sustainable weight loss is 1 – 3 pounds a week. Generally, weight loss attributed to Semaglutide will start around week 5.
What is another name for semaglutide?
Semaglutide is a prescription medication used to treat Type 2 Diabetes Mellitus and for Weight Management. Semaglutide is available under the following different brand names: Ozempic, Wegovy (both injected once a week subcutaneous) or Rybelsus (oral tablet). Both injectables and oral tablet have also been shown to lower body weight. But the injectable has some additional benefits. In clinical studies, it was shown to lower the risk of heart attack, stroke, or death due to heart problems in certain people by 26%.
This benefit hasn’t been confirmed with Rybelsus. Ozempic and Rybelsus are FDA approved for people with Diabetes Type -2. Only Wegovy is FDA approved for weight loss.
What is the difference between Wegovy and Ozempic?
Semaglutide is the active ingredient in both Wegovy and Ozempic. Wegovy is approved by the FDA for weight loss in overweight and obese individuals whereas Ozempic is only approved to treat Type-2 diabetes. The dosage pen accompanying Wegovy is calibrated differently from Ozempic since weight loss starts to occur at a lower dosage of semaglutide. Generic Semaglutide manufactured by licensed compound pharmacies is supplied in a vial and dispensed with insulin syringes for once weekly dosing which requires the patient to draw the appropriate amount into the syringe, but allows for easier titration to minimize side effects.
How can specialty pharmacies compound and dispense Semaglutide Sodium?
Semaglutide is registered with the FDA while Semaglutide sodium is not, we do not promote the use of the sodium salt. Semaglutide is a biologic because it contains fewer than 40 amino acids. Additionally, the FDA maintains a medication shortage list, as long as the Semaglutide is listed a compounding pharmacy may compound semaglutide. Compounded semaglutide is governed by the regulations that restrict the compounding of commercially available drugs (Section 503A of the FD&C Act), which state that a pharmacy must only make a compounded medication on-demand and must not stockpile it.
What is the cost of a one month supply (4 injections) of Wegovy, and a compounded Semaglutide injectable?
Ozempic or Wegovy (US): $1250.00 (Source: Good Rx)
Semaglutide (compounded) $300.00 (approximate)
Physiologic effects of Glucagon Like Peptide (GLP-1)
Reference: Laurindo LF, Barbalho SM, Guiguer EL, da Silva Soares de Souza M, de Souza GA, Fidalgo TM, Araújo AC, de Souza Gonzaga HF, de Bortoli Teixeira D, de Oliveira Silva Ullmann T, Sloan KP, Sloan LA. GLP-1a: Going beyond Traditional Use. International Journal of Molecular Sciences. 2022; 23(2):739. https://doi.org/10.3390/ijms23020739
Most important traditional organ targets for GLP-1 and its actions on each target. GLP-1: Glucagon-like peptide; ↓: decrease; ↑: increase; +: plus. The red color represents the indirect effects of GLP-1 on the determined organ, and the blue color represents direct effects. The red–blue mixtures represent the determining effects in direct and indirect related GLP-1 activity. https://doi.org/10.3390/ijms23020739
