On average, it takes patients 2-3 months to reach their ideal dose. We consider the ideal dose to be when a patient is feeling well without side effects, reports appropriate appetite suppression with both decreased cravings and daily caloric intake, and is losing weight. Sustainable weight loss goals target 1.5-2.5 pounds per week.

With medication compliance and lifestyle modifications, most patients start losing weight within the first month. The medication is started at the lowest dose and is titrated up slowly to reduce the likelihood of developing side effects.

The injection is relatively painless. We use a thin needle that is only inserted under the skin, not into the muscle (like more painful shots or vaccines). Often patients do not even realize they are getting the injection if they don’t look!

Nausea, constipation, diarrhea, and fatigue are common after the injection. These side effects are usually harmless and pass quickly. Semaglutide can also suppress the craving for alcohol.

Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. Compounding includes the combining of two or more drugs. Compounded drugs are not FDA-approved, and the agency does not verify the safety or effectiveness of compounded drugs.

When a drug is in shortage, compounders may be able to prepare a compounded version of that drug if they meet certain requirements in the Federal Food, Drug, and Cosmetic (FD&C) Act. As of May 2023, the brand names of semaglutide from Novo Nordisk are both listed on FDA’s Drug Shortages list.

FDA has received adverse event reports after patients used compounded semaglutide. Patients should not use a compounded drug if an approved drug is available to treat a patient. Patients and health care professionals should understand that the agency does not review compounded versions of these drugs for safety, effectiveness, or quality.

Additionally, FDA has received reports that in some cases, compounders may be using salt forms of semaglutide, including semaglutide sodium and semaglutide acetate. The salt forms are different active ingredients than is used the approved drugs, which contain the base form of semaglutide. The agency is not aware of any basis for compounding using the salt forms that would meet the FD&C requirements for types of active ingredients that can be compounded. On April 27, 2023, FDA wrote to the National Association of Boards of Pharmacy expressing the agency’s concerns with use of the salt forms in compounded products.

Patients should be aware that some products sold as ‘semaglutide’ may not contain the same active ingredient as FDA-approved semaglutide products and may be the salt formulations. Products containing these salts, such as semaglutide sodium and semaglutide acetate, have not been shown to be safe and effective.

Patients should only obtain drugs containing semaglutide with a prescription from a licensed health care provider, and only obtain medicines from state-licensed pharmacies or outsourcing facilities registered with FDA.