Semaglutide Drug Interactions
Also known as: Ozempic, Wegovy, Rybelsus
Semaglutide is a once-weekly (or once-daily oral) GLP-1 receptor agonist that lowers blood sugar and reduces body weight by mimicking the natural gut hormone GLP-1. It is sold under three brand names — Ozempic (injectable, type 2 diabetes), Wegovy (injectable, weight management), and Rybelsus (oral tablet, type 2 diabetes) — all manufactured by Novo Nordisk. Clinical trials show it reduces HbA1c by up to 2.0 percentage points and body weight by up to 15% at the highest injectable dose.Semaglutide has 2 documented drug interactions in our database, including 0 contraindicated, 0 major, 2 moderate, and 0 minor interactions.
0
Contraindicated
0
Major
2
Moderate
0
Minor
Combining semaglutide and liraglutide, both GLP-1 receptor agonists, is generally not recommended. This combination is unlikely to provide additional glycemic control or weight loss benefits beyond monotherapy, but significantly increases the risk of dose-dependent adverse effects.
Mechanism
Both semaglutide and liraglutide act as glucagon-like peptide-1 (GLP-1) receptor agonists, stimulating insulin secretion, suppressing glucagon release, slowing gastric emptying, and promoting satiety. Concomitant use leads to additive pharmacological effects on the GLP-1 receptor.
Clinical Management
Concomitant use of semaglutide and liraglutide should be avoided. If a patient is not achieving desired outcomes on one GLP-1 agonist, consider optimizing the dose, switching to a different class of antidiabetic medication, or adding another agent from a different class, rather than combining two GLP-1 agonists. Monitor for increased gastrointestinal side effects if inadvertently co-administered.
Semaglutide can potentially increase the effect of warfarin, leading to a higher risk of bleeding. This interaction is generally not considered severe but requires careful monitoring, especially when semaglutide is initiated or its dose is changed.
Mechanism
While a direct pharmacokinetic interaction is not well-established, semaglutide can cause gastrointestinal side effects (e.g., nausea, vomiting, diarrhea) which may alter the absorption of warfarin or affect vitamin K intake, thereby impacting INR levels. Additionally, significant weight loss induced by semaglutide could potentially alter warfarin pharmacokinetics or pharmacodynamics.
Clinical Management
Patients on stable warfarin therapy should have their International Normalized Ratio (INR) closely monitored, especially when initiating semaglutide or during dose escalation. Warfarin dose adjustments may be necessary to maintain the INR within the therapeutic range. Educate patients on bleeding signs and symptoms.
For complete prescribing information:
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