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.

Semaglutide and liraglutide come in a prefilled injection pen. You (or someone in your household) will administer the injection of semaglutide or liraglutide under the skin of your stomach, thigh, or arm once a week.

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

Wegovy-branded semaglutide comes in single-use pens. You should receive a pack of four pens, each with the same dose.

Each prefilled pen has a tiny needle at the tip. The needle is covered, so it’s okay if you don’t see it. Each pen is meant to be used only once—after which it 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).

How to store your medication

The injection pens should be stored in the refrigerator at 36–46º F, but they may be kept between 46–86º F for up to 28 days.

When to take your dose

You’ll use one pen each week.

Take your Wegovy-branded semaglutide on the same day each week (for example, every Monday), with or without food.

Steps

Wash your hands before handling your medication.

Preparing the medication

1. When you use a new pen, make sure the pen indicates the correct medication and dose that you were prescribed. Make sure that the expiration date has not passed.

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

3. 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.

4. If the medication looks clear, colorless, and particle-free, you can choose an injection site in either your stomach, thigh, or upper arm. You can use the same part of your body each week, but don’t inject it into the exact same spot in that body part each time.

5. Once you’ve selected a spot, it’s time to administer your medication!

Administering the injection

1. First, use an alcohol wipe to clean the area on the abdomen, thigh, or upper arm you’ve selected.

2. Press the pen firmly against your skin and hold the button down.

3. Injection should take about 10 seconds. You will hear two clicks during this process:

• The first click means the injection has started. You should see the yellow bar on the pen start moving now.

• The second click means the injection is still going. Once you hear the second click, keep holding the button down until the yellow bar has stopped moving and you’ve reached 10 seconds. Don’t remove the pen until the yellow bar has stopped moving.

4. The yellow bar will stop right before the end of the window. Once the yellow bar has stopped moving, remove the pen from your skin.

5. After you’ve administered the dose, dispose of the used pen in a sharps container (your local pharmacy may be able to provide one) or a heavy-duty plastic container with a screw-on lid. Because the semaglutide pen contains a needle, do not throw it into your regular trash.

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.

If you forget to take your shot, but it’s more than 48 hours before the next one is scheduled, you should take the missed shot right away. Then, take the next shot on its regularly scheduled day.

• Example: You usually inject on Saturdays, but one time you forget and don’t realize that you’ve forgotten until Wednesday. The next Saturday’s shot is more than 48 hours away, so you should take that missed shot on the day you’ve remembered to take it (Wednesday), then take the next shot on schedule (Saturday). 

If the next shot is less than two days away, don’t take the missed one. Instead, wait for the next scheduled shot and take that one on time. If you’re not sure what to do, contact your Ro-affiliated provider for advice.

• Example: You usually take your shot on Saturdays, but one time you forget and don’t realize you’ve forgotten until Friday. The next Saturday’s shot is less than 48 hours away, so you should not take the missed shot. Instead, wait for the next scheduled shot (Saturday).

If you’ve missed more than two weeks of shots, don’t take your next one. Contact your Ro-affiliated provider for the next steps.

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 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 2 months; this applies to both men and women

• Breastfeeding

• History of hypersensitivity to semaglutide 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 patients 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 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.

GLP-1s are just one mechanism of weight management.

All medications, devices, and procedures are just one part of the weight management journey. It is also important to ensure that you are pursuing a healthy diet and engaging in healthy practices such as physical activity, getting enough sleep, and managing stress. Your Ro-affiliated provider and coaching team can help you with these and other changes that are important for weight management.

For Wegovy: The research for semaglutide for weight management is quite strong. Semaglutide for weight management, also known as “Wegovy,” is a higher dose of semaglutide than the dosing used for the treatment of type 2 Diabetes. In a study of patients with a history of overweight or obesity, patients on a 68-week regimen that combined Wegovy with diet and exercise lost approximately 16% of their body weight versus about 6% weight loss for patients who used diet and exercise alone. Other studies show similar weight loss of greater than 10% in patients who achieve the highest stable dose of Wegovy and pursue a healthy diet along with exercise for 68 weeks.

(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.