Semaglutide (Ozempic)

FDA Approved

GLP-1 Receptor Agonist | Weight Loss & Diabetes

Weight: 4,113.64 Da
Half-life: ~7 days (168 hours)
Chain: 31 amino acids
9 studies
2025 latest
3 recent
FDA Approved
Dose 0.25mg starting, titrate to 1-2.4mg weekly
Frequency Once weekly (same day each week)
Cycle Ongoing therapy as prescribed
Storage Pen: 2-8°C before first use, room temp up to 56 days after. Compounded: 2-8°C
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Long-acting GLP-1 receptor agonist approved for type 2 diabetes and chronic weight management. Over 17,000 trial participants have demonstrated significant efficacy through appetite suppression and glycemic control. The 7-day half-life enables convenient weekly dosing.

Mechanism of Action

Mimics native GLP-1, binding to receptors to stimulate glucose-dependent insulin secretion, suppress glucagon, slow gastric emptying, and reduce appetite via hypothalamic pathways.

01 15-20% average body weight reduction
02 Established cardiovascular protection
03 Convenient once-weekly dosing options
04 Comprehensive safety data from extensive trials
05 Flexible injectable and oral formulations

Molecular Data

Molecular Weight
4,113.64 Da
Chain Length
31 amino acids
Type
GLP-1 receptor agonist
Amino Acid Sequence
One-letter: HUEGTFTSDVSSYLEGQAAKEFIAWLVRGRG
H₂N
H 1
O ‖ C
N
U 2
O ‖ C
N
E 3
O ‖ C
N
H
G 4
O ‖ C
N
T 5
O ‖ C
N
F 6
O ‖ C
N
T 7
O ‖ C
N
S 8
O ‖ C
N
D 9
O ‖ C
N
V 10
O ‖ C
N
S 11
O ‖ C
N
S 12
O ‖ C
N
Y 13
O ‖ C
N
L 14
O ‖ C
N
E 15
O ‖ C
N
H
G 16
O ‖ C
N
Q 17
O ‖ C
N
A 18
O ‖ C
N
A 19
O ‖ C
N
K 20
O ‖ C
N
E 21
O ‖ C
N
F 22
O ‖ C
N
I 23
O ‖ C
N
A 24
O ‖ C
N
W 25
O ‖ C
N
L 26
O ‖ C
N
V 27
O ‖ C
N
R 28
O ‖ C
N
H
G 29
O ‖ C
N
R 30
O ‖ C
N
H
G 31
COOH
His
1

Histidine

Position 1

Aib
2

Aminoisobutyric Acid

Position 2

Glu
3

Glutamic Acid

Position 3

Gly
4

Glycine

Position 4

Thr
5

Threonine

Position 5

Phe
6

Phenylalanine

Position 6

Thr
7

Threonine

Position 7

Ser
8

Serine

Position 8

Asp
9

Aspartic Acid

Position 9

Val
10

Valine

Position 10

Ser
11

Serine

Position 11

Ser
12

Serine

Position 12

Tyr
13

Tyrosine

Position 13

Leu
14

Leucine

Position 14

Glu
15

Glutamic Acid

Position 15

Gly
16

Glycine

Position 16

Gln
17

Glutamine

Position 17

Ala
18

Alanine

Position 18

Ala
19

Alanine

Position 19

Lys
20

Lysine

Position 20

Glu
21

Glutamic Acid

Position 21

Phe
22

Phenylalanine

Position 22

Ile
23

Isoleucine

Position 23

Ala
24

Alanine

Position 24

Trp
25

Tryptophan

Position 25

Leu
26

Leucine

Position 26

Val
27

Valine

Position 27

Arg
28

Arginine

Position 28

Gly
29

Glycine

Position 29

Arg
30

Arginine

Position 30

Gly
31

Glycine

Position 31

N-terminus C-terminus
Hydrophobic
Polar
Positive (+)
Negative (-)
Modified
Peak 0.0 mcg
Trough 0.0 mcg
SS Peak 0.0 mcg
SS Trough 0.0 mcg

Research Indications

Weight Loss
Clinically Significant Weight Reduction most effective

FDA-approved for chronic weight management with average 15-20% body weight loss in clinical trials.

Appetite and Craving Control most effective

Reduces hunger and food cravings through central nervous system GLP-1 receptor activation.

Sustained Weight Maintenance effective

Long-term studies show maintained weight loss with continued treatment over 2+ years.

Diabetes
Glycemic Control most effective

FDA-approved for type 2 diabetes with HbA1c reductions of 1.5-2% in clinical trials.

Cardiovascular Protection most effective

Proven 26% reduction in cardiovascular death, MI, or stroke in high-risk diabetes patients.

Beta Cell Preservation effective

Improves insulin secretion and may preserve pancreatic beta cell function.

Metabolic
Metabolic Syndrome Improvement effective

Addresses multiple components: weight, glucose, blood pressure, and lipids.

NASH/Fatty Liver moderate

Emerging evidence for improvements in non-alcoholic fatty liver disease.

Inflammation Reduction moderate

Decreases systemic inflammation markers independent of weight loss.

Dosing Protocols

Pre-filled pen devices for once-weekly subcutaneous injection. Brands include Ozempic (diabetes) and Wegovy (weight loss).

GoalDoseFrequencyRoute
Weight Loss Initiation0.25mgWeekly x 4 weeks, then increaseSubcutaneous
Weight Loss Maintenance2.4mgWeekly (after 16-week titration)Subcutaneous
Diabetes Management0.5-1mgWeeklySubcutaneous
Cardiovascular Protection0.5-1mgWeeklySubcutaneous
Tolerability-Based0.25-2.4mgWeekly (individualized)Subcutaneous

Reconstitution Instructions

Materials Needed:
  • Semaglutide pre-filled pen or vial
  • Pen needles (if using pen device)
  • Alcohol swabs
  • Sharps disposal container
  • Injection site rotation chart
  1. 1 If using pre-filled pen, attach new needle and prime per instructions
  2. 2 If using vial, draw prescribed dose with appropriate syringe
  3. 3 Clean injection site with alcohol swab and let dry
  4. 4 Inject subcutaneously at 90-degree angle (45-degree if lean)
  5. 5 Hold for 6 seconds after injection to ensure full dose delivery
  6. 6 Dispose of needle safely and rotate injection sites weekly

Interactions

~
Insulin
May increase hypoglycemia risk when combined; requires blood glucose monitoring.
monitor
!
Tirzepatide
Both are incretin mimetics with overlapping mechanisms; concurrent use increases side effects.
avoid
++
Cagrilintide
Combined as CagriSema in clinical trials for enhanced weight loss efficacy.
synergistic
+
Metformin
Commonly used together for diabetes management with good safety profile.
compatible
+
BPC-157
No contraindications; may help with GI side effects.
compatible
~
Sulfonylureas
Increased hypoglycemia risk; may require sulfonylurea dose reduction.
monitor
%
Oral Medications
Delayed gastric emptying may affect absorption of oral medications.
requires timing

What to Expect

Week 1-4
Mild appetite reduction, possible nausea during initial dose
Month 2-3
Noticeable weight loss (5-10% typical), improved satiety
Month 4-6
Continued weight loss (10-15% common), stable glucose levels
Month 6+
Weight loss plateau possible, focus on maintenance
Diabetes
Blood sugar improvements within 1-2 weeks

Side Effects & Safety

Common Side Effects

  • Nausea
  • Diarrhea
  • Vomiting
  • Constipation
  • Abdominal pain

Stop Signs - Discontinue if:

  • Severe persistent abdominal pain (possible pancreatitis)
  • Persistent vomiting preventing fluid intake
  • Signs of thyroid tumor (neck lump, hoarseness, trouble swallowing)
  • Severe allergic reaction (rash, itching, difficulty breathing)
  • Vision changes (possible diabetic retinopathy progression)
  • Severe hypoglycemia (if combined with insulin/sulfonylureas)
  • Kidney problems (decreased urination, swelling)

Contraindications

  • Personal or family history of medullary thyroid cancer
  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Pregnancy or breastfeeding
  • History of pancreatitis

Quality Checklist

Good Signs

  • FDA-approved branded products (Ozempic, Wegovy, Rybelsus)
  • Proper refrigeration verified and not expired
  • Clear, colorless to slightly yellow solution in pen/vial

Warning Signs

  • Compounded versions - FDA warns about untested compounded semaglutide

Bad Signs

  • Cloudy or discolored solution
  • Particles or precipitation visible
  • Non-pharmacy sources or unverified online sellers

References

  • Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1)
    Wilding, J.P.H., et al.
    New England Journal of Medicine (2021)

    14.9% average weight loss vs 2.4% placebo over 68 weeks with 2.4mg weekly. 86% achieved ≥5% weight loss; 51-64% achieved ≥15% weight loss.

  • Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT)
    Lincoff, A.M., et al.
    New England Journal of Medicine (2023)

    20% reduction in MACE (CV death, MI, or stroke) with semaglutide 2.4mg vs placebo over mean 40 months. First GLP-1 RA to demonstrate cardiovascular benefit in non-diabetic population.

  • Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (SUSTAIN-6)
    Marso, S.P., et al.
    New England Journal of Medicine (2016)

    26% reduction in MACE (HR 0.74) with semaglutide vs placebo. Established cardiovascular safety and benefit profile for semaglutide in type 2 diabetes.

  • Two-year effects of semaglutide in adults with overweight or obesity (STEP 5)
    Garvey, W.T., et al.
    Nature Medicine (2022)

    Sustained weight loss of 15.2% at week 104 vs 2.6% placebo. 77.1% achieved ≥5% weight loss at 2 years, demonstrating long-term efficacy.

  • Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (PIONEER 6)
    Husain, M., et al.
    New England Journal of Medicine (2019)

    Oral semaglutide was noninferior to placebo for cardiovascular safety. Numerically fewer CV deaths in oral semaglutide group (0.9% vs 1.9%).

  • Once-Weekly Semaglutide in Adolescents with Obesity (STEP TEENS)
    Weghuber, D., et al.
    New England Journal of Medicine (2022)

    16.1% BMI reduction with semaglutide vs 0.6% increase with placebo over 68 weeks. 44.9% of semaglutide recipients reclassified to normal-weight or overweight BMI category.

  • Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (STEP-HFpEF)
    Kosiborod, M.N., et al.
    New England Journal of Medicine (2023)

    Semaglutide 2.4mg reduced symptoms, physical limitations, and improved exercise function in obesity-related HFpEF. Reduced inflammation and appeared to improve adverse cardiac remodeling.

  • Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes (FLOW)
    Perkovic, V., et al.
    New England Journal of Medicine (2024)

    24% lower risk of primary kidney outcome (kidney failure, sustained eGFR decline, or renal/CV death) with semaglutide vs placebo. 29% reduction in CV death. Trial stopped early for efficacy.

  • Phase 3 Trial of Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis (ESSENCE)
    Sanyal, A.J., et al.
    New England Journal of Medicine (2025)

    62.9% achieved MASH resolution without fibrosis worsening vs 34.3% placebo at 72 weeks. Combined resolution and fibrosis improvement in 32.7% vs 16.1% placebo. Mean weight loss of 10.5%.

Related Peptides

Cagrilintide synergistic

Combined as CagriSema in clinical trials for enhanced weight loss efficacy.

BPC-157 compatible

No contraindications; may help with GI side effects.

Disclaimer

This information is for educational and research purposes only. Consult a healthcare professional before use.