Rybelsus Disease Interactions

The use of semaglutide (Wegovy) for weight loss should be avoided in patients with a history of suicidal attempts or active suicidal ideation. Suicidal behavior and ideation have been reported in clinical trials with other weight management products. If used, monitor patients for the emergence or worsening of depression, suicidal thoughts or behaviors, and/or any unusual changes in mood or behavior. Discontinue use in patients who experience suicidal thoughts or behaviors.

The use semaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Patients with elevated serum calcitonin or thyroid nodules noted on physical examination or neck imaging should be further evaluated. Counsel patients regarding the potential risk for MTC with the use of semaglutide and inform them of symptoms of thyroid tumors.

There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which may sometimes require hemodialysis, in patients treated with GLP-1 receptor agonists, such as semaglutide. Some events occurred without underlying renal disease, and the majority of events occurred in patients experiencing gastrointestinal reactions (nausea, vomiting, dehydration). It is recommended to monitor renal function when initiating or escalating doses of semaglutide in patients reporting severe adverse gastrointestinal reactions. No dose adjustment is recommended for patients with renal impairment.

The concomitant use of semaglutide with insulin and insulin secretagogues (e.g., sulfonylurea) may increase the risk of hypoglycemia. It is recommended to use caution and a lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when these agents are used in combination with semaglutide.

Pancreatitis has been reported with the use of semaglutide. It is recommended to carefully observe patients for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting) after therapy initiation. Discontinue treatment if pancreatitis is suspected and manage as appropriate; if confirmed, do not restart treatment with semaglutide and reevaluate for appropriate treatment.

Semaglutide should be used with caution in patients with a history of diabetic retinopathy. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. It is recommended to monitor closely for progression of diabetic retinopathy.