Semaglutide (Weight Management) (Wegovy)

1. Health Canada Product Monograph — Semaglutide (Weight Management)

• As an adjunct to a reduced-calorie diet and increased physical activity, for chronic weight management in adults with an initial BMI of 30 kg/m2 or greater (obesity), or 27 kg/m2 or greater (overweight) in the presence of at least 1 weight-related comorbidity such as hypertension, type 2 diabetes, dyslipidemia, or obstructive sleep apnea.
• To reduce the risk of non-fatal myocardial infarction in adults with established cardiovascular disease and a BMI of 27 kg/m2 or greater, independent of weight-loss goals.
• Do not substitute for Ozempic (semaglutide for type 2 diabetes, maximum dose 2 mg weekly) or use the two products interchangeably.

Contraindicated in pregnancy. Confirm pregnancy status and discuss alternative therapy with the prescriber before dispensing.

• Contraindicated. Discontinue at least 2 months before a planned pregnancy given the drug's long elimination half-life and the theoretical risk that treatment-related weight loss itself could harm the fetus.

• Not recommended. Semaglutide is a large protein molecule and would be expected to transfer into breast milk only in very small amounts, but no human lactation data are available to confirm safety.

• No specific dose adjustment is required based on age alone; monitor closely for gastrointestinal adverse effects and volume status.

• Not established for chronic weight management in patients under 18 years of age with this product; confirm current pediatric/adolescent labelling status before prescribing in this population.

• Initiate at 0.25 mg subcutaneously once weekly for 4 weeks.
• Increase every 4 weeks as follows: 0.5 mg weekly (weeks 5-8), 1 mg weekly (weeks 9-12), 1.7 mg weekly (weeks 13-16), then the 2.4 mg once-weekly maintenance dose from week 17 onward.
• If a dose increase is not tolerated, delay escalation to the next dose by an additional 4 weeks before trying again. If the 2.4 mg maintenance dose is not tolerated, a temporary reduction to 1.7 mg weekly is an option before re-attempting escalation.
• Evaluate response once the patient has been on the maintenance dose for approximately 12 weeks; inadequate weight loss despite confirmed adherence warrants reassessment of the treatment plan.
• Inject subcutaneously into the abdomen, thigh, or upper arm; rotate injection sites. May be administered at any time of day, on the same day each week, independent of meals.

If overdose is suspected, seek emergency medical attention immediately or contact your regional Poison Control Centre without delay.

• Overdose experience is limited; expect an increase in gastrointestinal adverse effects (nausea, vomiting) proportional to the excess dose. Manage with supportive care and monitoring for dehydration/hypoglycemia if the patient also uses insulin or a sulfonylurea.

• Nausea, vomiting, diarrhea, and constipation are most common, particularly during dose escalation, and are minimized by adhering to the recommended slow titration schedule.

Serious side effects require immediate discussion with the prescriber or emergency care.

• Acute pancreatitis — persistent severe abdominal pain, with or without radiation to the back, warrants immediate discontinuation and evaluation; do not restart if pancreatitis is confirmed.
• Cholelithiasis and cholecystitis.
• Gastroparesis and, rarely, bowel obstruction — evaluate promptly for severe abdominal distension, persistent vomiting, or absence of bowel movements/flatus.
• Acute kidney injury, usually secondary to dehydration from severe vomiting or diarrhea.
• Diabetic retinopathy complications may worsen in patients with pre-existing type 2 diabetes and retinopathy, related to the rate of glycemic improvement.

• History of gallbladder disease.
• Diabetic retinopathy.
• Renal impairment, or any condition predisposing to volume depletion given the gastrointestinal adverse-effect profile.
• Concurrent insulin or sulfonylurea therapy — hypoglycemia risk may require a dose reduction of the concurrent agent.

• Personal or family history of medullary thyroid carcinoma.
• Multiple endocrine neoplasia syndrome type 2 (MEN 2).
• Pregnancy and breastfeeding.
• Known hypersensitivity to semaglutide or any excipient.

• Delays gastric emptying, which can affect the rate of absorption of concurrently administered oral medications, including oral contraceptives — monitor efficacy of narrow-therapeutic-index oral drugs.
• Increased hypoglycemia risk when combined with insulin or a sulfonylurea; a dose reduction of the concurrent agent may be required.
• Monitor INR more closely when starting in a patient stabilized on warfarin, given the potential for altered absorption.

• None specific — unlike orlistat, efficacy does not depend on meal fat content or timing relative to meals.

• Any day of the week, at any time of day; keep the same weekly day for consistency. The day can be changed if at least 2 days have elapsed since the last dose.

• Store unused pens refrigerated at 2-8°C; do not freeze. An individual pen may be kept at room temperature (below 30°C) or refrigerated for up to a defined period per the product-specific pen type — confirm the exact in-use storage duration on the pen's own labelling before relying on room-temperature storage.

• This is a different product, at a different (higher) maximum dose, than the semaglutide used for diabetes (Ozempic) — the two must not be substituted for one another.
• Nausea is common when starting or increasing the dose and usually improves with time; report severe or persistent abdominal pain right away.
• This medication is intended for long-term, ongoing use — stopping it typically leads to weight regain.