A recently-approved weight loss drug from Novo Nordisk has taken the pharmaceutical world by storm. Wegovy was released earlier this summer, and patients are so eager to get their hands on it that there is currently a supply shortage that isn’t expected to clear up until next year.
How does Wegovy work?
Clinical trials showed that over a year, obese patients reduced their average body weight by 15 percent. That’s a significantly bigger drop than other prescription weight loss drugs currently on the market, and patients would only see a bigger impact if they committed to invasive bariatric surgery.
Wegovy’s active ingredient is semaglutide, which is also used in diabetes drugs. It’s a synthetic version of a hormone called GLP-1, which regulates hunger and metabolism, and it’s administered as a weekly subcutaneous injection.
How is Wegovy administered?
Wegovy is administered subcutaneously. Patients will likely need instruction on how to administer the drug safely and effectively.
The first time you dispense it, ask them if they would like a demonstration. The drug should be injected under the skin of the patient’s stomach, thigh, or upper arm, and should not be injected into a muscle or vein.
The injection should be given weekly on the same day each week at any time of day, and patients should change the injection site every week.
Doses of the drug will start at .25 mg a week and increase every month until patients reach the full dose of 2.4 mg. If patients miss a dose for more than 2 weeks, they should reach out to their doctor to determine how to restart their therapy.
Potential side effects of Wegovy
Though uncommon, some serious side effects were reported during clinical trials for Wegovy, and nearly 7 percent of patients in the clinical trials discontinued use because of negative side effects. When dispensing, make sure your patients are aware of the potential risks.
Risk of thyroid cancer
Wegovy comes with a boxed warning that it may cause thyroid cancer, which is the most serious kind of warning the FDA hands out. Rats given Wegovy in animal studies had an increased risk of thyroid cancer, but animal studies aren’t necessarily predictive of what will happen in human patients.
Right now, clinical trials don’t demonstrate if Wegovy increases the risk of thyroid cancer in humans, but if your patient has a family history of medullary thyroid carcinoma or the genetic condition MEN2, they should not take the drug.
Pancreatitis
In clinical trials for Wegovy, four patients experienced acute pancreatitis while taking the drug, compared to one patient in the placebo group. The drug has not been studied in people with a history of pancreatitis, so it’s not known if they are at higher risk if they take Wegovy.
Patients who are prescribed Wegovy should be aware of the symptoms of acute pancreatitis, which include:
- Persistent, severe abdominal pain that may spread to the back
- Vomiting
- Diarrhea
- Loss of appetite
- Jaundice
Gallbladder problems
Acute gallbladder disease was reported in clinical trials for Wegovy, including gallstones. Counsel patients about the common symptoms of gallbladder disease, including:
- Abdominal pain
- Jaundice
- Loss of appetite
- Vomiting
- Dark urine
If patients start having these symptoms, they should consult with their doctor to find out if they should keep taking the drug.
Other side effects
Patients should be aware of other potentially serious side effects they could experience while taking Wegovy, which include:
- Hypoglycemia when used with insulin
- Acute kidney injury
- Anaphylactic reaction
- Diabetic retinopathy complications in patients with Type 2 diabetes
- Heart rate increase
- Suicidal behavior and ideation
Mild side effects reported during critical trials included:
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Abdominal pain
- Headache
- Fatigue
- Dyspepsia
- Dizziness
- Abdominal distention
- Burping
- Flatulence
- Gastroenteritis
- GERD
Other considerations for patients using Wegovy
In addition to side effects, there are other factors patients should be aware of while taking Wegovy.
Drug interactions
Wegovy has the potential to interact with certain medications. Patients who use an insulin secretagogue or insulin should be monitored closely because semaglutide lowers blood glucose and can cause hypoglycemia.
The drug hasn’t been studied in patients who take insulin, and it is recommended to reduce the dose of insulin when initiating Wegoby in order to reduce the risk of hypoglycemia.
Because Wegovy causes a delay in gastric emptying, it also has the potential to impact how oral medications are absorbed. Clinical trials didn’t show that absorption of oral medications was affected, but pharmacists should monitor the effects of oral medications in patients who are taking Wegovy.
Pregnant and lactating patients
Wegovy had negative effects on fetuses during animal reproduction studies, and since weight loss doesn’t offer benefits to pregnant patients, they should not take Wegovy.
Patients who are planning to get pregnant should discontinue the drug at least two months before attempting to conceive because semaglutide has a long half-life.
There’s no information on how the drug affects lactating human patients or breastfeeding infants, but animal studies showed that the drug was present in the milk of lactating rats, which means it will likely be present in human breastmilk.
Cost
Wegovy will probably sound appealing to many patients, but the cost could put a damper on their enthusiasm.
Right now, Medicare doesn’t cover Wegovy, and neither do many commercial insurance plans. Without insurance coverage, the drug can cost up to $1,700 per month, putting it out of reach for most patients.
To help reduce the costs, Novo Nordisk has issued six-month waivers to insured patients that limit the out-of-pocket price to $25 per month, but long-term affordability is still in question.
Long-term effects
There’s still a question mark about the long-term effects Wegovy could have on patients. Studies have demonstrated that people who stop taking the drug often regain most of the weight they lost within a year.
If patients want to maintain their weight loss, they may have to commit to taking the drug for the long term. If that’s something they can’t afford or are otherwise unwilling to do, some researchers worry it could cause cycles of weight gain and loss.
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