What Is Wegovy?

  • Salma Tarabeih Pharm.D. Clinical Pharmacist | Pharmacy Preceptor, Beirut Arab University
  • Kajal Madhavani MSc in Biomedical Science(Cancer Biology), University of Westminster
  • Regina Lopes Senior Nursing Assistant, Health and Social Care, The Open University

Introduction

Obesity is the abnormal accumulation of fat in the body, associated with health risks such as diabetes, cardiovascular disease, hypertension, and hyperlipidemia. It has become a remarkable public health epidemic over the past 50 years, with healthcare expenditures exceeding $700 billion annually. Obesity is defined using the body mass index (BMI), calculated as weight (kg)/height(m). It is a complex, multifactorial disease and is the second most frequent preventable cause of death after smoking. Treatment requires multi-faceted strategies and maybe a lifelong endeavour.1

In June 2021, the U.S. Food and Drug Administration approved Wegovy (semaglutide) injection, administered once weekly at a dosage of 2.4 mg. This approval was for chronic weight management in adults suffering from obesity or overweight who also have at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol. The medication is intended to complement a reduced-calorie diet and enhanced physical activity. Notably, this under-the-skin injection marks the first approved treatment for chronic weight management in adults with general obesity or overweight since 2014.2

In this article, we'll explore Wegovy, delving into its functionality, usage, and potential side effects and identifying who should avoid taking it. Stay tuned to discover more fascinating details!

What is wegovy used for?

Wegovy is used in addition to diet and physical activity to help people lose weight and keep their weight under control. It is prescribed for adults under the following conditions:3

  • Individuals with a body mass index (BMI) of 30 kg/m² or higher, indicating obesity or
  • Individuals with a BMI of at least 27 kg/m² but less than 30 kg/m², indicating overweight, and who suffer from weight-related health issues such as diabetes, hypertension, and abnormal lipid levels

Additionally, it is recommended for adolescents aged 12 and above whose BMI is at or above the 95th percentile for their age and gender, indicating obesity, and who weigh more than 60 kg. A BMI at the 95th percentile denotes a value greater than that of 95% of individuals of the same age and gender.3

How is wegovy used?

Wegovy is a medication that contains the active substance semaglutide and is available in pre-filled pens containing a solution for injection. The injection is administered once weekly beneath the skin, typically in the abdomen, thigh, or upper arm. The dosage is incrementally raised over 16 weeks to mitigate potential gastrointestinal symptoms. The medicine can be self-administered by patients at home, but it can only be obtained with a prescription from a doctor.3

How does wegovy work?

Semaglutide is a type of medication that falls into a group called glucagon-like peptide-1 (GLP-1) receptor agonists. What it does is act like a hormone called GLP-1, which the body releases in response to eating. GLP-1 prompts the body to produce more insulin, which in turn lowers blood sugar. Additionally, GLP-1 interacts with the parts of the brain that reduce appetite and signal a feeling of fullness.4

When should wegovy be avoided?

Wegovy should be avoided in the following conditions:5

  • Individuals with a personal or family history of Medullary thyroid cancer (MTC), or those diagnosed with MEN 2
  • Patients who have experienced a severe allergic reaction to semaglutide or any of the ingredients in Wegovy. 

Warnings and precautions!

Risk of thyroid c-cell tumours

In studies conducted on mice and rats, it was found that semaglutide led to a higher occurrence of thyroid C-cell tumours (adenomas and carcinomas) in a manner that depended on the dosage and duration of treatment. However, it's uncertain whether Wegovy causes thyroid C-cell tumours, including MTC, in humans.5

Patients should be counselled on the potential risk for MTC with the use of Wegovy and should be informed of symptoms of thyroid tumours (e.g. a mass in the neck, difficulty swallowing, shortness of breath, persistent hoarseness). Regularly monitoring serum calcitonin levels or utilising thyroid ultrasound for early detection of MTC in Wegovy-treated patients remains uncertain. However, if serum calcitonin levels are found to be elevated, further evaluation of the patient is warranted. Patients who are found to have thyroid nodules during a physical exam or neck imaging should undergo additional evaluation.5

Acute pancreatitis

Acute pancreatitis was observed in patients treated with Wegovy in clinical trials. After initiation of Wegovy, monitor patients carefully for signs and symptoms of acute pancreatitis (including persistent severe abdominal pain radiating to the back at times, which may or may not be coupled with vomiting). If acute pancreatitis is suspected, Wegovy should be stopped immediately, and appropriate management should be initiated. If acute pancreatitis is confirmed, Wegovy should not be restarted.5

Acute gallbladder disease

Treatment with Wegovy has been linked to a higher likelihood of developing cholelithiasis and cholecystitis. This risk seems to be more pronounced in children aged 12 years and older who are treated with Wegovy compared to adults receiving the same treatment. If cholelithiasis is suspected, gallbladder studies and appropriate clinical follow-up should be considered.5

Hypoglycemia

Wegovy lowers blood glucose and can cause hypoglycemia. Patients with type 2 diabetes mellitus who are using Wegovy alongside medications that boost insulin secretion (like sulfonylureas or insulin itself might face a higher chance of experiencing low blood sugar, including severe cases. Patients should be informed of the risk of hypoglycemia and counselled on the signs and symptoms of hypoglycemia. In patients with type 2 diabetes, blood glucose should be monitored before starting Wegovy and during Wegovy treatment. When starting Wegovy, it's important to consider lowering the dose of insulin boosters (like sulfonylureas) or insulin to decrease the risk of hypoglycemia.5

Acute kidney injury

There have been postmarketing reports of acute kidney injury and exacerbation of chronic kidney failure, which have, in some cases, required hemodialysis in patients treated with semaglutide. A majority of the reported events occurred in patients who had encountered nausea, vomiting, or diarrhoea, leading to volume depletion.5
Kidney function monitoring is crucial when initiating or increasing Wegovy doses, especially in patients experiencing severe gastrointestinal adverse reactions. Additionally, it's important to monitor kidney function in patients with kidney impairment who report any adverse reactions potentially leading to volume depletion.5

Hypersensitivity

Serious hypersensitivity reactions such as anaphylaxis and angioedema have been reported with Wegovy. If hypersensitivity reactions occur, Wegovy should be discontinued, and the patient should be treated promptly per standard of care.5
Patients who have previously experienced anaphylaxis or angioedema with another GLP-1 receptor agonist should exercise caution when using Wegovy, as it remains uncertain whether these individuals may be predisposed to similar reactions with this medication.5

Diabetic retinopathy complications in patients with type 2 diabetes

In a study among adult patients with type 2 diabetes and a BMI of 27 kg/m2 or higher, the occurrence of diabetic retinopathy was slightly higher in those treated with Wegovy compared to those who received a . Another trial involving semaglutide injections for adults with type 2 diabetes and high cardiovascular risk found a greater occurrence of diabetic retinopathy complications in patients treated with semaglutide versus placebo. This risk was particularly notable among patients with a history of diabetic retinopathy at baseline. Therefore, individuals with such a history should undergo careful monitoring for the progression of the condition.5

Heart rate increases

Increases in resting heart rate were associated with treatment using Wegovy. Heart rate should be checked regularly, as is typically done in clinical practice. Patients should be instructed to inform their healthcare providers of palpitations or feelings of a racing heartbeat while at rest during Wegovy treatment. If a sustained increase in resting heart rate is experienced by patients, Wegovy should be discontinued.5

Suicidal behaviour and ideation

Suicidal behaviour and ideation have been noted in clinical trials involving other weight management products. Patients receiving treatment with Wegovy should undergo regular monitoring for the onset or exacerbation of depression, suicidal ideation or actions, and/or any atypical alterations in mood or behaviour. Wegovy should be discontinued in patients who experience suicidal thoughts or behaviours.5

What are the possible side effects of using Wegovy?

The most common side effects of Wegovy are headache, nausea (feeling sick), vomiting, diarrhoea, constipation, and abdominal (belly) pain.3

How should one respond in the event of an overdose?

Overdoses have been reported with other GLP-1 receptor agonists, manifesting in severe nausea, severe vomiting, and severe hypoglycemia. In the case of an overdose, it is crucial to administer suitable supportive treatment based on the patient’s clinical presentation. Due to Wegovy’s long half-life of about one week, a prolonged period of observation and treatment for these symptoms may be necessary.6

What should be done if a dose is missed?

  • If one dose is missed and the next scheduled dose is more than 2 days away (48 hours), Wegovy should be administered as soon as possible. If one dose is missed and the next scheduled dose is less than 2 days away (48 hours), the dose should not be administered. Dosing should be resumed on the regularly scheduled day of the week.6
  • If 2 or more consecutive doses are missed, dosing should be resumed as scheduled or, if necessary, Wegovy should be reinitiated, and the dose escalation schedule should be followed, which may reduce the occurrence of gastrointestinal symptoms associated with the re-initiation of treatment.6

How should wegovy be stored?

The Wegovy single-dose pen should be stored in the refrigerator from 2°C to 8°C (36°F to 46°F). If necessary, before cap removal, the pen can be kept from 8°C to 30°C (46°F to 86°F) for up to 28 days. Freezing should be avoided. Wegovy should be protected from light. It must be kept in the original carton until the time of administration. The Wegovy pen should be discarded after use.6

Summary

  • Wegovy (semaglutide) injection is a significant advancement in chronic weight management, particularly for individuals suffering from obesity or overweight with associated health conditions.
  • Wegovy acts as a complement to a reduced-calorie diet and increased physical activity, providing a comprehensive approach to weight management.
  • Patients should adhere strictly to the recommended dosage and administration schedule, gradually increasing the dosage over 16 weeks to minimise gastrointestinal symptoms.
  • While Wegovy presents promising benefits, individuals with certain medical conditions should avoid its use.
  • Patients and healthcare providers should closely monitor for any adverse reactions and promptly address them according to established guidelines.
  • In the event of a missed dose, patients should adhere to specific instructions to maintain consistency in treatment.
  • Proper storage of Wegovy is crucial to ensuring its effectiveness and safety, including refrigeration between 2°C to 8°C and protection from light.

References

  1. Panuganti KK, Nguyen M, Kshirsagar RK. Obesity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Feb 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK459357/
  2. Commissioner O of the. FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. FDA [Internet]. 2021 [cited 2024 Feb 13]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014.
  3. https://www.ema.europa.eu/en/documents/overview/wegovy-epar-medicine-overview_en.pdf
  4. Research C for DE and. Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss. FDA [Internet]. 2024 [cited 2024 Feb 13]. Available from: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss.
  5. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/215256s007lbl.pdf
  6. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/215256s005lbl.pdf
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Salma Tarabeih

Pharm.D. Clinical Pharmacist | Pharmacy Preceptor

Salma is a Doctor of Pharmacy with several years of experience in Pharmacy Management and Patient Consultation. She has a track record of delivering remarkable patient care and optimizing drug therapy outcomes. Her expertise includes guiding students, collaborating with healthcare professionals, and ensuring quality standards. She is passionate about Clinical Research and Pharmacy Practice Education, and she is dedicated to making a positive impact in these areas.

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