What is semaglutide and how does it work?
Semaglutide mimics the body’s own hormone glucagon-like peptide (GLP-1) and binds to its docking sites (receptors). The active ingredient therefore belongs to the group of GLP-1 receptor agonists, or GLP-1-RA for short.
Semaglutide causes the pancreas to produce and release more insulin. As a result of the insulin, the body’s cells absorb more sugar (glucose) from the blood and blood glucose levels drop. Semaglutide also delays the emptying of the stomach. In this way, the carbohydrate (“sugar”) contained in the food enters the bloodstream more slowly.
During weight loss, effects in the brain play a particularly important role. Semaglutide acts there in the hypothalamus and brainstem, where food intake is controlled. It increases the feeling of satiety and at the same time reduces the feeling of hunger.
Heart and kidney protection
Studies show that semaglutide and other GLP-1 receptor agonists are beneficial for the heart and kidneys. They reduce the risk of sudden cardiovascular disease (e.g., heart attack, stroke) and protect the kidneys and blood vessels.
Uptake, degradation and excretion
When is semaglutide used?
Semaglutide is used in adults with type 2 diabetes to lower blood sugar. This can be done either alone (monotherapy) or in combination with other antidiabetic drugs.
Semaglutide is also used in (severely) overweight patients to support weight loss. The active ingredient is approved for this from a body mass index (BMI) of 30. In the case of existing risk factors (including diabetes or coronary heart disease), semaglutide can be used from a BMI of 27.
Important: The health insurance company covers the treatment costs for diabetes. However, if semaglutide is to be used for weight loss, the doctor may only issue a private prescription. The costs must therefore be paid by the patient himself, unless his private health insurance covers it.
How to obtain medication with semaglutide
Preparations containing semaglutide require a prescription in Germany, Austria and Switzerland. You can obtain the medication with a valid prescription at a pharmacy.
Semaglutide for overweight and obesity has already been approved by the European Medicines Agency (EMA). However, the corresponding preparation is not yet on the market in any of the three countries.
What are the side effects of semaglutide?
Side effects of semaglutide mainly affect the gastrointestinal tract. More than one in ten people report complaints such as abdominal pain, nausea, diarrhea or constipation and other digestive problems in the first one to two weeks. Inflamed stomach lining and heartburn are also possible.
Gastrointestinal complaints occur mainly at the beginning of treatment or after dose increases. These side effects usually disappear by themselves after some time.
Semaglutide also promotes gallstones. As a result, the gallbladder can become inflamed in some individuals. In addition, people taking semaglutide injections occasionally suffer from acute pancreatitis. This side effect was less common with the tablet form. Talk to a doctor if you experience sudden upper abdominal pain.
In the studies on the side effects of semaglutide, treated individuals also complained very frequently of headaches. They also often felt exhausted. Dizziness can also occur frequently with semaglutide.
Another side effect is hair loss. However, hair loss was mostly mild in studies and improved over the course of treatment. When someone injects themselves with semaglutide, reactions occasionally occur at the injection site (e.g., redness). Some patients also have allergic reactions to semaglutide. Rarely, these reactions are severe (anaphylaxis).
If diabetes has damaged the retina (diabetic retinopathy), complications are more likely under semaglutide (e.g., bleeding into the vitreous). This has been observed at least in patients who injected insulin at the same time. Patients with retinal diseases who use insulin and semaglutide should therefore urgently go for regular ophthalmological check-ups.
For other adverse reactions, see the package insert of your semaglutide medication. Talk to your doctor or pharmacist if you notice or suspect any side effects.
How semaglutide is used
As an injection, semaglutide is injected under the skin (subcutaneously) by the patients themselves once a week. The injection can be administered into the abdomen, upper arm or thigh independently of meals. Treatment usually begins with a weekly dose of 0.25 milligrams. The dose then gradually increases at intervals of at least one month each. This reduces unwanted gastrointestinal symptoms. The target dose in diabetes therapy is a maximum of two milligrams; for semaglutide for weight loss, 2.4 milligrams.
Semaglutide is the first GLP-1 receptor agonist also approved in tablet form. Patients swallow the tablets fasting with a sip of water. Finally, they should wait at least half an hour before drinking or eating anything. The dose of the tablets is also gradually increased each month from three to seven milligrams daily and to 14 milligrams if needed.
Semaglutide in tablet form is not yet on the market in all countries (e.g. Germany and Austria). In tablet form, it is also not approved for weight reduction.
When should semaglutide not be used?
- if you are hypersensitive or allergic to the active substance or other components of the semaglutide medication,
- @ during pregnancy and breastfeeding,
- @ in children and adolescents under 18 years of age, as no study data are available for them.
Patients who have current problems due to diabetic retinal disease are also better not to take semaglutide. Otherwise, there is a risk of serious complications. Semaglutide is also not suitable for patients with severe renal impairment.
Drug interactions
Patients who are taking anticoagulants at the same time are best to watch their blood clotting when using semaglutide as an injection. If necessary, patients should first have their coagulation values checked in the laboratory.
If semaglutide is taken in tablet form and thyroid hormones are taken at the same time, regular monitoring of thyroid levels is advisable.
Semaglutide delays gastric emptying. This could affect the absorption of medications taken at the same time. Therefore, always inform your doctor about all medications you are taking. This will allow him to pay special attention to the effect of each medication.
Pregnancy and breastfeeding
Pregnant women should not use semaglutide. If you become pregnant, you must stop semaglutide. This also applies if you wish to have children. Since it takes some time for the body to break down the active substance, there should be at least two months between discontinuation and planned pregnancy.
Important: Contact your doctor if you are using semaglutide and want to become pregnant. He/she will discuss a new therapy with you. As long as you are using semaglutide, it is advisable to use safe contraception. And it is best to do this for at least two months after you have stopped taking it in consultation with your doctor.
Semaglutide should also not be used while breastfeeding. Studies on rats show that the active ingredient passes into breast milk. Experts cannot rule out the possibility of this having a negative effect on the child.
