Obesity Pharmacotherapy
2. Semaglutide( mean change in BMI: 17 %)
a. Patient Selection: i. FDA-approval:
1. Obesity indication( Wegovy): a. Youth ≥12 years( subQ) with BMI ≥95th percentile b. Adults ≥18 years( subQ and PO) with BMI ≥30 kg / m 2 or with BMI ≥27 kg / m 2 with weight related comorbidity
2. Type 2 diabetes indication: a. Ozempic: ≥18 years b. Rybelsus( oral semaglutide): ≥18 years.
3. Other Considerations a. Consider for patients with i. insulin resistance: acanthosis nigricans, elevated fasting blood glucose levels between 100 and 125 mg / dL, or hemoglobin A1c between 5.7 and 6.4 % ii. poor satiety, food cravings ii. iii. Fatty liver disease CONTRAINDICATIONS
1. personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
2. pregnancy or breastfeeding iii. USE CAUTION 1. thyroid c-cell tumors 2. acute gall bladder disease 3. renal impairment 4. suicidal ideation b. To Start Semaglutide: i. Check baseline basic metabolic panel to assess kidney function ii. Review warnings with patient and family: gallbladder disease, pancreatitis, nausea, diarrhea, constipation, vomiting, abdominal pain, dyspepsia, headache, dizziness, fatigue iii. Start semaglutide 0.25mg subcutaneously weekly x 4, then 0.5mg weekly x 4, then 1mg weekly x 4, then: 1. If using Wegovy: 1.7mg weekly x 4, then 2.4mg weekly thereafter 2. If using Ozempic: 2mg weekly thereafter iv. Wegovy pills: 1.5 mg daily for 30 days, then 4 mg daily for 30 days, then 9 mg daily for 30 days, then 25 mg daily thereafter v. Renown’ s 340b pharmacy offers Ozempic at a discounted price( currently about $ 300 / month). Wegovy is discounted through NovoCare. com and other discount programs like GoodRx.
c. |
Follow-up: |
i. |
See patient every 1-3 months initially to review side effects, efficacy |
ii. |
Expect BMI stabilization at a minimum |
d. |
Discontinue: |
i. |
If BMI continues to increase at full dose after 3-4 months or with side effects |
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