Novo Nordisk, Inc
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Semaglutide is typically initiated at 0.25 mg weekly , gradually increasing to 2.4 mg (Wegovy) or 1 mg-2 mg (Ozempic)
severe gastroparesis [3][5][9][32] GI side effects are dose-dependent, so consider slower dose escalation or drug holidays (temporary cessation of incretin therapy) for those who are struggling with GI side effects in the early weeks of therapy [22][32][33] a lower maintenance dose can be considered for individuals unable to tolerate the usual maintenance dose [22][32][33] Advise patients reporting GI side effects to adopt the following mitigating strategies: [22][32][33] eat slowly, stop eating as soon as you start to feel full, and avoid eating when not feeling hungry eat smaller portion sizes and eat more frequently during the day, but avoid eating late in the day maintain good hydration, aiming for 23 litres of fluids daily (not including alcohol) limit intake of alcohol and fizzy drinks, especially if experiencing nausea or dyspepsia avoid eating high-fat, ultra-processed, and spicy foods increase fibre and water intake if experiencing constipation consider short-term use of PPIs, antiemetics, laxatives, and antidiarrhoeal medications for those with disabling side effects Consider alternative causes of GI symptoms if persistent despite mitigation strategies, or if red-flag features are present
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