Semaglutide

ATC code

A10BJ06

Therapeutic class

Glucagon-like peptide-1 (GLP-1) analog · Drugs used in diabetes, blood glucose lowering drugs, excl. insulins

Forms

injectable solution, oral tablet

Brand names

Ozempic (EU) · Wegovy (EU) · Rybelsus (EU) · Ozempic (US) · Wegovy (US) · Rybelsus (US)

Overall confidence

high

Regulatory sources consulted

Approved indications

Treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise: as monotherapy when metformin is considered inappropriate due to intolerance or contraindications; in addition to other medicinal products for the treatment of diabetes.
Chronic weight management, as an adjunct to a reduced-calorie diet and increased physical activity, in adults with an initial BMI of ≥30 kg/m² (obesity), or ≥27 kg/m² (overweight) in the presence of at least one weight-related comorbid condition.

Contraindications

Absolute

Hypersensitivity to the active substance or to any of the excipients.
Personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Clinical warnings

Boxed warning · Risk of Thyroid C-Cell Tumors. In rodents, semaglutide causes thyroid C-cell tumors. It is unknown whether it causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans. Contraindicated in patients with a personal or family history of MTC or MEN 2. — FDA
Major warning · Acute pancreatitis has been reported. Patients should be informed of the characteristic symptoms (severe, persistent abdominal pain). If pancreatitis is suspected, semaglutide should be discontinued and not restarted if confirmed. — EMA SPC

Drug interactions

HighInsulin or sulfonylureasA10A, A10BB
Mechanism: Increased risk of hypoglycemia due to the insulinotropic effect of semaglutide.
Recommendation: Consider a dose reduction of the insulin or sulfonylurea to reduce the risk of hypoglycemia when initiating semaglutide treatment.
EMA SPC
ModerateOral medicationsN/A
Mechanism: Delayed gastric emptying induced by semaglutide, which may alter the rate and/or extent of absorption of oral drugs.
Recommendation: Carefully monitor effects or concentrations of drugs with a narrow therapeutic index (e.g., levothyroxine). Administer oral semaglutide on an empty stomach, 30 minutes before other oral medications.
EMA SPC

Adverse events

Common (≥1%)

nausea · diarrhea · vomiting · constipation · abdominal pain · decreased appetite · fatigue · hypoglycemia

Rare but serious

acute pancreatitis · intestinal obstruction · anaphylactic reaction · acute kidney injury · gastroparesis

Pregnancy and lactation

FDA category: X

Contraindicated during pregnancy and lactation. Treatment should be discontinued at least 2 months before a planned pregnancy due to its long half-life.

Recent literature (PubMed)

Acute pancreatitis due to different semaglutide regimens: An updated meta-analysis.
Masson W, et al. · Endocrinol Diabetes Nutr (Engl Ed) · 2024 · Relevance 5/5
Metaanálisis actualizado de 21 ensayos (34,721 pacientes) que concluye que el tratamiento con semaglutida (oral o subcutánea, a dosis bajas o altas) no se asocia con un aumento del riesgo de pancreatitis aguda en comparación con placebo (OR 0.7; 95% CI 0.5-1.2).
GLP-1-based medications: Mechanisms involved in obesity treatment.
Salvador J · Med Clin (Barc) · 2025 · Relevance 4/5
Revisión que describe cómo los agonistas de GLP-1, como la semaglutida, actúan sobre múltiples vías fisiopatológicas de la obesidad (regulación del apetito, función adipocitaria, resistencia a la insulina) para lograr una pérdida de peso significativa y mejorar comorbilidades.
Weight management treatment in obesity.
Rubio-Herrera MA, et al. · Med Clin (Barc) · 2025 · Relevance 4/5
Revisión sobre el arsenal terapéutico para la obesidad, destacando que los agonistas del receptor de GLP-1 como la semaglutida logran pérdidas de peso del 15-17%. Menciona la sinergia con otros péptidos (GIP, glucagón) para potenciar los resultados.
[Translated article] Glucagon-Like Peptide-1 Agonists for Treating Obesity in Patients With Immune-Mediated Skin Diseases.
Vilarrasa E, et al. · Actas Dermosifiliogr · 2024 · Relevance 3/5
Revisión que explora el uso de agonistas de GLP-1 para tratar la obesidad en pacientes con psoriasis e hidradenitis supurativa, sugiriendo que la pérdida de peso inducida puede ser una herramienta útil para manejar estas condiciones dermatológicas inflamatorias.