Ro’s Body Program is here to help you meet your goal to lose weight, but we’re not a replacement for a primary care provider (PCP).

Your Ro-affiliated provider will manage your GLP-1 prescription and your weight management treatment. Meanwhile, your PCP is responsible for taking care of your overall health and wellness. 

Having a PCP is important for everyone, but especially for people who have overweight or obesity. Having overweight or obesity can increase your risk of developing or worsening chronic diseases, such as diabetes, high blood pressure, high cholesterol, or heart disease. These diseases can affect your quality of life and your life expectancy. A PCP can help you prevent or detect these diseases early, and provide you with the best treatment options.They can also provide you with regular check-ups, screenings, immunizations, and referrals to specialists when needed. 

It’s important to let your PCP know that you are taking a GLP-1 through Ro so that they can have a clear picture of all the medications you take and your overall health. 

If you do not have a PCP, you should find one as soon as possible. Here are some ways to find a PCP near you: 

• Ask your insurance company for a list of PCPs in your network. 

• Ask your friends or family for recommendations. 

• Use online tools, such as Healthgrades or Zocdoc, to search for PCPs and read reviews from other patients. 

Liraglutide comes in a prefilled injection pen. You (or someone in your household) will administer the injection of liraglutide under the skin of your stomach, thigh, or arm once a day.

Be sure to read the instructions that come with the pen before taking your first dose.

The instructions for Saxenda-branded liraglutide are below. Note that Saxenda comes in a “dial-a-dose” pen. Each pen contains multiple doses, and you’ll turn a dial to select the prescribed dose. You’ll need to attach a new needle per the instructions below each time you administer a dose—after which the needle should be disposed of safely (like in a sharps container purchased from your local pharmacy, or a heavy-duty plastic container with a screw-on lid).

You can watch a video showing how to use the injection pen here.

How to store your medication

• Before you use an injection pen for the first time, it should be stored in the refrigerator between 36–46ºF.

• After a pen is first used, it may be kept outside the refrigerator between 59–86ºF or in the refrigerator between 36–46ºF.

• Do not freeze Saxenda, and do not use Saxenda if it has been frozen.

• If your Saxenda pen has been used, it should be thrown away after 30 days even if there is still Saxenda left in it. Unused Saxenda may be used until the expiration date printed on the label, if kept in the refrigerator.

• Keep Saxenda away from heat and out of the light.

When to take your dose You’ll take Saxenda once a day, every day. You can take your Saxenda with or without food.

Steps

1. Wash your hands before handling your medication.

2. Preparing the medication

3. First, make sure the pen indicates the correct medication that you were prescribed and that the expiration date has not passed.

4. Next, pull the cap of the pen straight off.

5. Inspect the medication—it should look clear and colorless, with no debris or particles in it. If it’s not, don’t use the medication. In that instance, contact your pharmacy and your Ro-affiliated provider for further guidance, since you may need a new pen.

6. If the medication looks clear, colorless, and particle-free, you can attach a new needle.

7. Take a new needle and tear off the paper tab. Do not take the cap off the needle just yet.

8. Holding the pen in one hand, take the capped needle between the thumb and forefinger of your other hand. Push the needle straight onto the pen. Turn clockwise until the needle is on tight.

9. Pull off the outer needle cap. Do not throw the outer cap away.

10. Pull off the inner needle cap. You can throw the inner cap away.

Always use a new needle for each injection. Do not reuse a needle. Do not share needles with other people. Do not use a bent or damaged needle.

Check the Saxenda flow with each new pen.

• You should check the Saxenda flow each time you use a new pen. If you’ve previously used a pen, you should proceed to the “Select your dose” steps below.

• To check the flow: Turn the dose selector until the dose counter shows the flow check symbol, which looks like two dots and a dash: ••–.

• Hold the pen with the needle pointing up toward the sky.

• Press and hold in the dose button until the dose counter shows 0. The 0 must line up with the dose pointer.

• A drop of Saxenda will appear at the needle tip.

• If no drop appears, repeat Steps 1–3 up to six times. If this does not cause a drop to appear, replace the needle and repeat Steps 1–3 once more. If a drop of Saxenda still does not appear, contact your pharmacy or Ro-affiliated provider.

Select your dose

• Turn the dose selector until the dose counter shows your dose (0.6 mg, 1.2 mg, 1.8 mg, 2.4 mg, or 3 mg). Follow the dosing instructions from your Ro-affiliated provider to select the correct dose.

• You will hear a “click” every time you turn the dose selector. Do not set the dose by counting the number of clicks you hear. Only the dose counter and dose pointer will show how many mg you select for each dose.

Administering the injection

• Choose an injection site in either your stomach, thigh, or upper arm. You can use the same part of your body each day, but don’t inject it into the exact same spot in that body part each time.

• First, use an alcohol wipe to clean the injection site you’ve chosen.

• Insert the needle by pressing the pen firmly against your skin. Make sure you can see the dose counter.

• Hold the button down until the dose counter turns to 0. The 0 must line up with the dose pointer.

• After the dose counter turns to 0, wait six seconds. Remove the needle from your skin.

• After administering the dose, carefully remove the needle from the pen.

Dispose of the needle in a sharps container (your local pharmacy may be able to provide one) or a heavy-duty plastic container with a screw-on lid. Do not throw the needle into your regular trash.

Put the cap back onto your pen.

If your pen contains more medication, then store it in a safe location. If the pen contains no more medication, dispose of it in your sharps container or heavy-duty plastic container.

Additional Guidance: In addition to the medication, you should pursue a healthy diet as well as physical activity. We will work with you through our GLP-1 patient experience and coaching team to help guide you through these lifestyle changes.

What if I miss a dose? If you miss a dose, take it as soon as you remember. If it is within 3 days of your prior dose, you can take your next dose without changes to your dosing. If it is greater than 3 days from your prior dose, restart the medication at 0.6 mg and contact your Ro-affiliated provider for additional instructions.

What if I take more than I am prescribed? In the instance that you should take a more than prescribed dose, contact your Ro-affiliated provider and monitor your symptoms. The primary side effects of taking a more than prescribed dose are severe nausea, vomiting, and possibly low blood sugar. Should symptoms persist, worsen, or are very severe, contact your primary care provider and, if necessary, seek emergency medical attention.

Side effects of the injection: Patients occasionally note irritation of the skin or small raised areas near or at the injection site. By ensuring that the area of injection is cleaned with an alcohol swab prior to injection and injecting at a perpendicular angle to the skin, you can decrease the chance of these reactions occurring. These usually go away on their own within 4-8 weeks.  

Side effects of the medication: The side effects of GLP-1s are generally limited to gastrointestinal complaints, with the most common being nausea and diarrhea. Other side effects included vomiting, constipation, and abdominal pain, dyspepsia (or upset stomach), abdominal distension, and reflux. Non-gastrointestinal side effects included headache, fatigue, and dizziness. 

In patients with type 2 diabetes, there were also reports of low blood sugar. Complications of diabetic retinopathy, an eye condition that can cause vision changes and blindness in people with diabetes, was observed in clinical trials with a greater risk seen in people who had a history of diabetic retinopathy before starting GLP-1 treatment.   

Less common were serious side effects including inflammation of the pancreas (pancreatitis), gallbladder inflammation and stones, kidney injury, increases in heart rate, and complications related to diabetic retinopathy in patients with type 2 diabetes. Changes in mood have been reported with GLP-1s and you should report these to your Ro-affiliated practitioner. We will also monitor this while you’re undergoing treatment with us.  

Possible thyroid tumors, including cancer. You should alert your Ro-affiliated practitioner if you get a lump or swelling in your neck, develop a hoarse voice, have trouble swallowing, trouble breathing, or shortness of breath. While it is not certain if Wegovy, Ozempic, Saxenda, or compounded semaglutide could cause thyroid tumors or a type of thyroid cancer, Wegovy/Ozempic/Saxenda and medications like it have caused tumors in rodent studies.  Additionally, cases of medullary thyroid carcinoma (“MTC”) in patients treated with a different medication in the same class as semaglutide (liraglutide, another GLP-1 receptor agonist), have been reported, but the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans.

Medications such as semaglutide, Saxenda, Ozempic, Wegovy, and compounded semaglutide (GLP-1 receptor agonists) are associated with slower emptying of the stomach (slowed gastric emptying) and intestines.  This means that when you take the medication, food leaves your stomach and intestines more slowly, which helps you feel more full and for a longer period of time. This process is one of the ways the medication helps some people lose weight—and for most patients, it goes away when the medication is stopped. However, the FDA has received reports that in some people this effect may be more severe. This can sometimes cause stomach paralysis (also called gastroparesis) or intestinal blockage (also called an ileus). This effect may not resolve even after the medication has stopped and can create the risk of unwanted side effects. If you have abdominal pain, nausea, vomiting or severe constipation, please reach out to your Ro-affiliated provider so they can help determine the next steps in your care. 

Symptoms of hypersensitivity reactions (allergic reactions) may occur. Do not take it if you are allergic to the GLP-1 medication or any of its ingredients. Stop using the GLP-1 and seek in-person medical care right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.

If only 1 dose is missed, the once-daily regimen should be resumed as prescribed with the next scheduled dose. An extra dose or increase in dose should not be taken to make up for the missed dose.

• Example: If you forget to take your Monday dose, take your next dose on Tuesday as prescribed. Do not take an extra dose or higher dose on Tuesday to make up for missing Monday.

If more than 3 days have elapsed since the last dose, go back to taking 0.6 mg daily. Contact your Ro-affiliated provider to discuss how to start increasing your dose again.

• Example: If you forget to take your dose on Monday, Tuesday, Wednesday, and Thursday, take 0.6 mg on Friday—no matter what dose you were taking before that. Contact your Ro-affiliated provider to discuss how to begin increasing your dose again.

Despite the best intentions, accidents sometimes happen.

If you accidentally take more than the prescribed dose of your GLP-1, you may have a higher chance of experiencing side effects, and those side effects may be more severe than your experience with your regular dose. How severe the side effects may be will depend on the dose you took and how your body responds to it.

Daily medications, such as Saxenda reach their peak level within your body and are cleared from your system within a day. You may find that side effects from taking too much Saxenda will follow a similar pattern.

Weekly medications, such as Wegovy, Zepbound, Ozempic, and compounded semaglutide, can take up to a few days to reach their peak in your body and stay in your system for several days. As a result, it’s possible that side effects from taking too much of a weekly medication may take a few days to develop and may persist for several days.

Follow the steps below if you believe you have taken more than your prescribed GLP-1 dose:

If you have no symptoms:

• First, call Poison Control at 1-800-222-1222

• Next, notify your Ro-affiliated provider

• Monitor for any side effects that may develop over the next several days

If you develop mild symptoms:

• First, call Poison Control at 1-800-222-1222 if you haven’t already

• Next, notify your Ro-affiliated provider

• Use the tips in our article on managing side effects

• If your side effects aren’t manageable with the help of those tips, or if your side effects become more severe, seek treatment at an emergency care facility

If you develop severe symptoms:

• If you experience any of the following symptoms, seek treatment immediately at an emergency care facility:

  • Severe nausea and vomiting or inability to keep fluids down

  • Severe abdominal pain that won’t go away or keeps coming back

  • Severe headache

  • Lightheadedness or passing out

  • Seizure

  • Difficulty breathing or shortness of breath

  • Lip, tongue, or face swelling

  • Chest pain

  • Blood in vomit

  • Bloody stools

  • Black tarry stools

  • Thoughts of hurting yourself

• After you’ve received medical care for your symptoms, please contact your Ro-affililated provider to let them know what happened.

GLP-1s are prescription medications that are clinically-tested, stimulant-free, and non-habit forming. These medications work by mimicking the functions of a naturally occurring hormone in your body to slow down how fast your stomach empties after you eat and act on your brain to make you less hungry. This helps you feel fuller, causing less food intake without uncomfortable hunger. These medications are meant to be used with a reduced calorie diet and regular physical activity.

GLP-1s and GIP/GLP-1s aren’t for everyone. You shouldn’t take one if you have any of the following risk factors:

• Pregnant, possibly pregnant, or planning to get pregnant in the next 3 months; this applies to both men and women who are able to become pregnant

• Breastfeeding

• History of hypersensitivity to semaglutide, tirzepatide, or other GLP-1 medications

• Personal or family history of medullary thyroid carcinoma 

• History of multiple endocrine neoplasia syndrome type 2 (MEN2) 

• History of pancreatitis

• History of delayed gastric emptying or gastroparesis  

• History of gallbladder disease or bile duct disease

• History of suicidal ideation or history of suicide attempts 

• History of tachycardia or atrial fibrillation

• Type 1 diabetes

• History of impaired kidney function

• Diabetic retinopathy complications due to type 2 diabetes

GLP-1 medications can cause too low blood sugar in patients who take GLP-1s with another glucose control medication, including insulin. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.

Complications of diabetic retinopathy, an eye condition that can cause vision problems and blindness in people with diabetes, have been observed in clinical trials. The risk was higher for people who already had a history of diabetic retinopathy before starting GLP-1 treatment. If you have type 2 diabetes, tell your provider right away if you experience changes in vision.

GLP-1s can lower blood glucose and using them with other medications that lower blood glucose such as insulin or sulfonylureas can cause hypoglycemia or significantly low blood sugar. If you are currently taking one of these medications, you should mention these medications to your Ro-affiliated provider as well as consult with your prescribing provider regarding its use along with a GLP-1.

One of the effects of GLP-1s is decreasing the speed of gastric emptying or the speed that material moves through your gastrointestinal tract. Due to this it can change the absorption of medications taken by mouth.

If you are on thyroid medication, specifically levothyroxine, GLP-1s can increase the concentration of the levothyroxine in your blood. Please inform your Ro-affiliated provider that you are taking this medication as well as consult with your prescribing provider regarding its use along with a GLP-1.

Most people who take GLP-1s notice a decrease in hunger, feeling more full for longer or feeling more full after less food. Some people report side effects such as nausea or diarrhea. At lower doses, however, you may not feel any changes at all. That does not mean the medication is not working—you may start seeing small changes on the scale after several weeks, even at low doses—but some people may require higher doses before they notice changes in their appetite.  Ultimately, the goal of GLP-1 therapy is weight loss and this may occur without any noticeable differences in how you feel. If you still feel no different and haven’t noticed changes on the scale by the time you’ve been prescribed higher doses of the medication, discuss this with your Ro-affiliated provider.

Liraglutide was originally a medication developed for the treatment of diabetes. It is still used for the treatment of diabetes, and one form of it is the brand known as Victoza. Saxenda is the weight loss formulation of liraglutide. The difference between the two is that Saxenda has a higher dose per injection than Victoza, though both are the exact same medication (liraglutide). In a study of the use of Saxenda for weight loss, at about one year patients lost approximately 8% of their body weight.

(A) WARNING: RAPID WEIGHT LOSS MAY CAUSE SERIOUS HEALTH PROBLEMS. RAPID WEIGHT LOSS IS WEIGHT LOSS OF MORE THAN 1.5 POUNDS TO 2 POUNDS PER WEEK OR WEIGHT LOSS OF MORE THAN 1 PERCENT OF BODY WEIGHT PER WEEK AFTER THE SECOND WEEK OF PARTICIPATION IN A WEIGHT-LOSS PROGRAM.

(B) CONSULT YOUR PERSONAL PHYSICIAN BEFORE STARTING ANY WEIGHT-LOSS PROGRAM.

(C) ONLY PERMANENT LIFESTYLE CHANGES, SUCH AS MAKING HEALTHFUL FOOD CHOICES AND INCREASING PHYSICAL ACTIVITY, PROMOTE LONG-TERM WEIGHT LOSS.

(D) QUALIFICATIONS OF THIS PROVIDER ARE AVAILABLE UPON REQUEST.

(E) YOU HAVE A RIGHT TO:

1. ASK QUESTIONS ABOUT THE POTENTIAL HEALTH RISKS OF THIS PROGRAM AND ITS NUTRITIONAL CONTENT, PSYCHOLOGICAL SUPPORT, AND EDUCATIONAL COMPONENTS.

2. RECEIVE AN ITEMIZED STATEMENT OF THE ACTUAL OR ESTIMATED PRICE OF THE WEIGHT-LOSS PROGRAM, INCLUDING EXTRA PRODUCTS, SERVICES, SUPPLEMENTS, EXAMINATIONS, AND LABORATORY TESTS.

3. KNOW THE ACTUAL OR ESTIMATED DURATION OF THE PROGRAM.

4. KNOW THE NAME, ADDRESS, AND QUALIFICATIONS OF THE DIETITIAN OR NUTRITIONIST WHO HAS REVIEWED AND APPROVED THE WEIGHT-LOSS PROGRAM ACCORDING TO s. 468.505(1)(j), FLORIDA STATUTES.