Semaglutide Treatment Plan

This treatment plan reviews the risks and benefits of the treatment we recommend. Please make sure to read this as well as the manufacturer’s pamphlet that comes with the medicine. The manufacturer’s pamphlet contains the full information on interactions, side effects, and other information you should know about the medicine before you start.

GLP-1s (glucagon-like peptide-1 receptor agonists) are a class of medications used primarily for the treatment of type 2 diabetes and, more recently, for weight management. These drugs mimic the effects of a natural hormone called GLP-1, which is released in the gut after eating.

These medications work by:

• Increasing insulin secretion to help lower blood glucose after meals
• Suppress glucagon release to limit glucose release by the liver
• Works on receptors in the brain to increase fullness and reduce hunger
• Slow gastric emptying to allow a more gradual absorption of glucose to reduce post-meal blood sugar spikes and to help you feel full longer

DOSAGE:

Once-daily pill

IMPORTANT NOTES:

Take your once-daily pill on an empty stomach, with 4 to 8 ounces of plain water. Also  be sure to wait at least 30 Minutes before eating and drinking anything else, or taking any other prescription medications.

DOSAGE:

Once-weekly injection

IMPORTANT NOTES:

Your Semaglutide vials must be stored in the prescription bottle it comes in and placed in your refrigerator as soon as you receive it.

Keep your Semaglutide vial in your refrigerator at 36-46 degrees Fahrenheit.

Administer one dose each week, on the same day each week, any time of day, with or without food.

Do not share your medication or needles with anyone.

Due to the size and dosage of the vials provided, you may have leftover medication in your vial after your prescribed treatment. Do not use the vial after 28 days from the first use. Using it longer can affect effectiveness and increase the risk of contamination. Always store as directed and discard any unused medication after 28 days.

PREPARE:

• Your vial of Semaglutide medication
• One sterile syringe with a needle
• Alcohol wipes or alcohol and a swab
• A sharps container or a heavy-duty plastic container with a screw on lid

FILLING YOUR SYRINGE:

1. Double check the information on the vial including your dose, expiration date, and that the medication is clear and colorless. If you note that the medication is not free of debris or not colorless, reach out to your Wisp provider for further guidance.
2. Gently shake the vial. If it’s a new vial, remove the plastic cap. Clean the top of the vial with an alcohol wipe.
3. On the syringe, remove the caps from the plunger and needle. It’s important that you keep the needle sterile so don’t let anything touch the needle.
4. While holding the syringe with the needle pointed up, pull the plunger down to the correct dosage based on your prescription from your Wisp provider.
5. Insert the needle into the rubber part of the vial top and press fully down on the plunger to inject all of the air from the syringe into the vial. Injecting the air into the medical vial makes the next step easier!
6. While the needle is still in the vial, turn the vial upside down. Make sure your needle is surrounded by liquid. Pull back the plunger just past your dosage amount.
7. Use the remaining amount to remove any air bubbles by tapping the syringe with your finger.
8. Push the plunger to the prescribed dose level after removing the air bubbles
9. Turn the vial upright and remove the needle
10. Do NOT put the needle cap back on the needle

ADMINISTERING YOUR INJECTION:

1. Choose an injection site. Good areas include your stomach, upper arm, or thigh. You can use the same area each week, but don’t inject at the same site each week. Your injection site should be 1-2 inches away from the previous injection site used.
2. Clean your prepared injection site with alcohol
3. Push the plunger slightly until a drop of liquid forms at the end of the needle
4. Pinch and hold the site you will inject. Holding the syringe pointing directly at the pinched skin, quickly push the needle through the skin into the fat tissue, making sure to insert the entire length of the needle. Then, slowly push the plunger to inject all of the medication.
5. Pull the needle out and clean the skin with an alcohol wipe or tissue. It’s normal to see a drop of blood at the injection spot. Press gently on the site for a few seconds for the bleeding to stop.
6. Dispose of the used syringe and needle in a sharps container (your local pharmacy may be able to provide one) or a heavy-duty plastic container with a screw on lid. Do not throw in the regular trash.

If you administer too much medication:

• Call Poison Control at 1-800-222-1222
• Seek in person care immediately

DOSAGE:

Once-weekly injection

IMPORTANT NOTES:

Store your pens in the refrigerator between 36°F to 46°F (2°C to 8°C).

The pen you are using should be disposed of (thrown away) after 56 days, even if it still has medicine left in it. Write the disposal date on your calendar.

Do not freeze your pens. Do not use your pen if it has been frozen.

When stored in the refrigerator, do not store your pens directly next to the cooling element.

Keep your pens away from heat and out of the light

Your pen is a prefilled, single-patient-use, dial-a-dose pen.

It contains 2 mg of semaglutide, and you can select doses of 0.25 mg or 0.5 mg.

Each prefilled pen contains 4 doses of 0.25 mg and 2 doses of 0.5 mg or contains 4 doses of 0.5 mg

ADMINISTERING YOUR INJECTION:

1. Wash your hands with soap and water.
2. Pull off the pen cap,
3. Look through the pen window. If the liquid looks cloudy or contains
   particles, do not use the pen.
4. Take a new needle cap, and tear off the paper tab. Do not attach a new needle to your pen until you are ready to give your injection.
5. Push the needle cap straight onto the pen. Turn until it is on tight.
6. The needle is covered by 2 caps. You must remove both caps.
7. First Time Use for Each New Pen: Turn the dose selector (pen top) until the dose counter shows the flow check symbol. Hold the pen with the needle pointing up. Press and hold in the dose button until the dose counter shows ZERO. The ZERO must line up with the dose pointer. A drop of semaglutide will appear at the needle tip. If it does not, repeat this step up to 6 times. If it still does not, change the needle and repeat the step. Do not use the pen if a drop of medicine does not form at the end of the needle.
8. Select your dose by turning the dose selector (pen top) until the dose counter stops and shows your dose (0.25 mg or 0.5 mg) in the view window. (If you select the wrong dose, you can turn the dose selector forward or backwards to the correct dose.)
9. Choose your injection site and wipe the skin with an alcohol swab. Let the injection site dry before you inject your dose. The injection site should be under the skin of your abdomen, thigh, or upper arm. Do not inject into a muscle or vein.
10. Insert the needle into your skin and press and hold down
    the dose button (pen top) until the dose counter shows ZERO. You may
    then hear or feel a click. Continue pressing the dose button while keeping the needle in your skin and count 6 seconds while keeping the dose button pressed.
11. Remove the needle from your skin. You can then release the dose button. If blood appears at the injection site, press lightly with a gauze pad or cotton ball. Do not rub the area.
12. After your injection, carefully remove the needle from the pen and discard it safely.
13. Put the pen cap on your pen after each use and return it back to your refrigerator

If a dose is missed within 5 days from your last dose, administer your dose as soon as possible and resume the usual schedule from that date.

If more than 5 days have passed since your missed dosage, skip the missed dose and resume your scheduling administration the following week at your normal scheduled dosing time.

This medicine may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following, please stop the medicine and see your doctor in person:

• Ozempic
• Wegovy
• Rybelsus
• Semaglutide
• Hypersensitivity to GLP-1 Receptor Agonists in the past

We evaluate your health history and the specific health information you provide us; however, if anything changes and you develop or discover that one of these conditions applies to you, please stop taking this medicine and seek care in person:

• Pregnancy
• Breastfeeding
• BMI less than 27
• Personal or Family History of Medullary Thyroid Carcinoma
• Personal or Family History of Multiple Endocrine Neoplasia Type 2
• History or Active Renal disease
• Type I Diabetes
• Poorly controlled Type II Diabetes
• History of Pancreatitis
• Elevated Triglycerides
• Significant Alcohol Use
• Gallbladder disease without surgical removal
• History of Retinopathy
• History of a bowel obstruction
• History of eating disorders
• History of gastroparesis
• History of Suicidal Ideation in the past
• Recent bariatric surgery

Medications for weight loss therapy are not recommended during pregnancy.

If you become pregnant while taking Semaglutide you should discontinue your treatment.

Due to the protein binding of this medication the amount of Semaglutide in breastmilk is likely to be low. However, breastfeeding during therapy with oral semaglutide is not recommended as you should be eating an additional 340-400 calories to support your breastmilk production.

This medicine can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you, please stop taking the medicine and call 911 or seek immediate medical help in person:

• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Blurred or changes in vision
• Severe diarrhea with or without blood
• Severe vomiting
• Palpable mass in your neck
• Trouble swallowing
• Shortness of breath
• Persistent voice hoarseness
• Decreased urine output
• Pain in the right upper stomach with or without fever
• Yellowing of the skin or eyes
• Persistent gastroparesis

This medicine can also cause other side effects. If any of the other side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and see your doctor in person:

• Abdominal discomfort
• Constipation
• Diarrhea
• Nausea
• Vomiting
• Decreased appetite
• Altered sensation of taste
• Fatigue
• Headache
• Belching
• Gas
• Heartburn
• Discomfort, irritation, or redness at the injection site

We evaluate your health history and the specific health information you provide us; however, if anything changes and you start or discover that you are taking any of the medicines, foods, or supplements listed below, consult with your physician or local care before you take the medicine.

• Sulfonylureas
• Insulin

We evaluate the specific health information you provide and make our recommendations based on it. If you incorrectly provide that information, we may misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment.

This treatment is not 100% effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If it is an emergency, call 911 or seek immediate medical help in person.

There is also a risk that we will misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. This risk exists with a doctor in person as well but they may have additional signs and symptoms to aid their evaluation. We use an evidence-based practice and guidelines as well as clinical decision support to try to minimize these risks.

We recommend this treatment because the potential benefits of treatment outweigh the risks. You should evaluate this information as well as the manufacturer’s pamphlet, and any input from your in-person healthcare team, or other information to decide if this treatment plan is appropriate for you. You are free to decline our treatment recommendations although, doing so may prolong symptoms and be associated with negative outcomes.

We have based our recommendation on your specific case and medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can’t provide.

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.