GLP-1 receptor agonists
ATC code: A10BJ06 (Semaglutide)
Brand names
Ozempic, Wegovy, Rybelsus
Selective GLP-1 receptor agonist. Stimulates glucose-dependent insulin secretion, suppresses inappropriate glucagon, slows gastric emptying, and enhances satiety centrally. Reduces by 1.5–1.8 % and body weight by 5–15 % depending on dose and indication. Improves cardiovascular outcomes in T2D with established CVD. In obesity without diabetes (Wegovy 2.4 mg weekly), weight loss reaches 15 % over 68 weeks.
First line
Per 2023 and / 2024, in T2D patients with established atherosclerotic CVD, GLP-1 agonists (semaglutide, liraglutide, dulaglutide) and SGLT2 inhibitors are first-choice regardless of . MACE reduction is established in large RCTs (SUSTAIN-6, REWIND, LEADER).
In T2D patients with established atherosclerotic CVD.
First line
Semaglutide 2.4 mg weekly (Wegovy in the US and EU) is approved for obesity in adults with BMI ≥ 30, or ≥ 27 with comorbidities. STEP-1 (1,961 patients) showed 14.9 % weight loss over 68 weeks vs 2.4 % on placebo. Wegovy is not registered in Russia; obesity treatment uses Ozempic off-label or Saxenda (liraglutide). Approved in adolescents 12–17 years with obesity per STEP-Teens. Benefits persist only with continued therapy — two thirds of weight returns within a year after discontinuation.
First line
Per 2024 and 2022, semaglutide is first-line in T2D with established CVD, HF, or CKD, especially when weight loss is needed. Subcutaneous start: 0.25 mg weekly for 4 weeks, then 0.5 mg, escalating to 1.0 or 2.0 mg if needed. SUSTAIN-6 (3,297 patients) showed a 26 % reduction in MACE in T2D patients at high CV risk.
Individual decision
Use of semaglutide in patients without obesity (BMI under 27) or metabolic comorbidities for cosmetic weight loss is not supported by international guidelines. The drug has real side effects (nausea, vomiting, acute pancreatitis risk, euglycemic ketoacidosis) and financial burden. Effects are short-lived — weight returns without continued therapy. In this group, lifestyle change is the foundation.
In patients without obesity or metabolic comorbidities.
Boxed warning
FDA boxed warning: increased risk of thyroid C-cell tumors (medullary cancer) in rodents. Causal link in humans is unconfirmed, but the drug is contraindicated in personal or family history of medullary thyroid cancer and MEN 2.
Contraindicated in pregnancy. Discontinue at least 2 months before planned conception. In pregnant T2D, the standard is insulin, occasionally metformin in consultation with the endocrinologist.
Contraindicated during breastfeeding per manufacturer label.
semaglutide is evaluated for the following indications with varying evidence strength: Obesity (evidence tier A), Type 2 diabetes mellitus (evidence tier A), Established ASCVD, secondary prevention (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of semaglutide (≥ 1 in 100): Nausea (15–20 % of patients, especially in early weeks), Vomiting, diarrhea, Constipation, Decreased appetite, Abdominal pain, Eructation. See the Safety section for uncommon and serious reactions.
Contraindicated in pregnancy. Discontinue at least 2 months before planned conception. In pregnant T2D, the standard is insulin, occasionally metformin in consultation with the endocrinologist.
Contraindicated during breastfeeding per manufacturer label.
semaglutide is contraindicated in: Personal or family history of medullary thyroid cancer; Multiple endocrine neoplasia type 2 (MEN 2); Type 1 diabetes; History of acute pancreatitis; Pregnancy and breastfeeding. Full list in the Safety section.
FDA boxed warning: increased risk of thyroid C-cell tumors (medullary cancer) in rodents. Causal link in humans is unconfirmed, but the drug is contraindicated in personal or family history of medullary thyroid cancer and MEN 2.
semaglutide is registered for T2D and obesity (BMI ≥ 30, or ≥ 27 with comorbidities). Without these indications, benefit does not outweigh risk.
real side effects include nausea, vomiting, theoretical medullary thyroid cancer risk (rodent data, not confirmed in humans), acute pancreatitis, euglycemic ketoacidosis, and Fournier gangrene. Therapy requires medical supervision.
studies show two thirds of lost weight returns within a year after discontinuation. Effective long-term obesity care requires continued therapy or sustained lifestyle change.