Ozempic

# Ozempic ## Overview - **Classification**: Glucagon-like peptide-1 (GLP-1) receptor agonist. - **Mechanism**: Mimics natural GLP-1, increasing glucose-dependent insulin secretion, decreasing glucagon secretion, and slowing gastric emptying. ## Primary Indications 1. **Type 2 Diabetes Mellitus**: To improve glycemic control in adults. 2. **Cardiovascular Risk Reduction**: To reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and established CV disease. ## Adult Dosing ### Standard Dosing **Type 2 Diabetes Mellitus / Cardiovascular Risk Reduction** - **Dose**: Initial **0.25 mg** subcutaneously once weekly for 4 weeks. - After 4 weeks, increase to **0.5 mg** once weekly. - After ≥4 weeks on **0.5 mg**, may increase to **1 mg** once weekly. - After ≥4 weeks on **1 mg**, may increase to **2 mg** once weekly. - **Frequency**: Once weekly - **Route**: Subcutaneous injection - **Maximum Dose**: **2 mg** once weekly. ### Dose Adjustments - **Renal Impairment**: No dose adjustment needed. - **Hepatic Impairment**: No dose adjustment needed. - **Elderly Patients**: No dose adjustment needed based on age. Closely monitor for adverse effects. ## Pediatric Dosing *Ozempic (semaglutide) is **not indicated** for use in pediatric patients (ages 0-18 years).* - **Special Notes**: Safety and efficacy have not been established in pediatric patients. ## Safety Information ### Contraindications - **Absolute**: Personal or family history of medullary thyroid carcinoma (MTC). - **Absolute**: Patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). - **Absolute**: Hypersensitivity to semaglutide or any excipients. - **Absolute**: Pregnancy (based on animal data showing fetal harm). - **Absolute**: Diabetic ketoacidosis (DKA). ### Common Adverse Effects - **Very Common (>10%)**: Nausea, vomiting, diarrhea, abdominal pain, constipation. - **Common (1-10%)**: Dyspepsia, fatigue, decreased appetite, flatulence, gastroesophageal reflux disease, cholelithiasis. - **Serious but Rare**: Pancreatitis, acute kidney injury, severe hypoglycemia (when used with insulin/sulfonylurea), thyroid C-cell tumors (rodent data), gallbladder disease, hypersensitivity reactions. ### Key Drug Interactions - **Insulin/Sulfonylureas**: Increased risk of hypoglycemia. - **Monitoring**: Close glucose monitoring required. - **Dose Adjustment**: Consider reducing insulin or sulfonylurea dose. - **Oral Medications**: Semaglutide slows gastric emptying. - **Effect**: May affect absorption of concomitantly administered oral medications. - **Clinical Significance**: Monitor for altered efficacy/toxicity of narrow therapeutic index drugs. - **Warfarin**: Potential for altered INR. - **Monitoring**: Close INR monitoring advised, especially when initiating/titrating Ozempic. ## Monitoring & Follow-up - **Before Treatment**: Baseline A1C, renal function (eGFR). - **During Treatment**: - **Glycemic Control**: A1C every 3-6 months. - **Renal Function**: Periodically, especially in patients with pre-existing renal impairment. - **Signs of Pancreatitis**: Persistent severe abdominal pain (with or without vomiting). - **Thyroid Nodules**: Routine physical examination. - **Gallbladder Disease**: Persistent symptoms like severe abdominal pain, nausea, vomiting. - **Clinical Signs**: Monitor for symptoms of hypoglycemia, acute kidney injury (dehydration), pancreatitis. ## Clinical Pearls - 💡 **Administration**: Administer once weekly on the same day each week, any time of day, with or without meals. - 💡 **Missed Dose**: If a dose is missed and there are >2 days (48 hours) until the next scheduled dose, administer it as soon as possible. If <2 days, skip the missed dose and resume on the next scheduled day. - 💡 **Storage**: Store new pens in the refrigerator. After first use, store at room temperature or in the refrigerator for up to 56 days. - 💡 **Injection Sites**: Inject subcutaneously into the abdomen, thigh, or upper arm. Rotate injection sites weekly. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.