Semaglutide
B 6.8/10
aka Ozempic, Wegovy, Rybelsus
- Evidence
- Strong (8/10)
- Benefit
- High (8/10)
- Risk
- Med (GI effects; gallbladder/pancreatitis; altered skin sensation more common at Wegovy HD 7.2 mg; separately, compounded semaglutide carries pharmacy-quality risk the branded product does not — see Notes) (5/10 safety)
- Legality
- Rx
- Dose / route context
- Wegovy obesity label: titration to 2.4 mg SC weekly; Wegovy HD: 7.2 mg SC weekly in selected adults; Ozempic (T2DM): 0.25-2 mg SC weekly
- Class
- Prescription
- Last reviewed
- Aug 29, 2026
Read Off Label grades Semaglutide as B (6.8/10) based on strong evidence, high benefit magnitude, and a med-risk safety profile.
STEP 1: ~15% body weight loss over 68 weeks.
Studied, labeled, or reported-use context: Wegovy obesity label: titration to 2. — Rx; not individualized guidance.
What it is
STEP 1: ~15% body weight loss over 68 weeks. SELECT 2023: 20% reduction in MACE in obese patients with CVD but no diabetes. FDA approved Wegovy HD 7.2 mg on March 19, 2026 after data showed additional average weight reduction vs lower approved doses with a broadly consistent GLP-1 safety profile; altered skin sensation (sensitivity, pain, burning) was more common at the higher dose and is under further FDA investigation. GI side effects common; rare pancreatitis/gallbladder. Weight regain on cessation. Delayed gastric emptying raises peri-operative aspiration risk — anesthesia guidance now recommends holding GLP-1 agonists before elective surgery. Oral Wegovy (semaglutide tablets) is FDA-approved for chronic weight management; Phase 3 OASIS-4 (n=307, 64 wk): ~13.6% weight loss vs 2.4% placebo (treatment-policy estimand). A Jul 2026 BMJ network meta-analysis (262 RCTs, n=99,791) of approved anti-obesity drugs found subcutaneous semaglutide was the only agent in the comparison showing reduced all-cause mortality (RR 0.81) and MI (RR 0.72) -- an independent confirmation of the SELECT mortality signal. **Compounded-product safety, Aug 2026.** A nationwide Class II recall covering roughly **127,000 vials** of compounded semaglutide was initiated on 29 Jul 2026 by Apollo Care, LLC and is still ongoing, across eight strengths of sterile multi-dose vial. The reason given is particulate matter in the vials, identified as nylon/polyamide and silk/proteinaceous material — that is, visible foreign material in a product injected subcutaneously. Class II means exposure may cause temporary or medically reversible harm. **This is a compounding-pharmacy quality failure, not a property of semaglutide**, and it does not touch Novo Nordisk's Ozempic or Wegovy; the ratings on this row are unchanged. It is recorded because compounded multi-dose vials are how a large share of readers actually obtain this drug, usually to avoid brand pricing, and that route carries a manufacturing risk profile the branded pen does not. Anyone holding compounded vials can check lot numbers against the FDA enforcement report.
Mechanism
GLP-1 receptor agonist: slows gastric emptying; suppresses glucagon; enhances glucose-dependent insulin secretion; central appetite suppression via hypothalamic GLP-1R