Weight loss is a long-term journey that often requires the right tools and support to improve your health. GLP-1 agonist medications such as Wegovy® (semaglutide) have gained popularity as effective medications for weight management. The national Wegovy® shortage of 0.25 mg, 0.5 mg, and 1 mg (starter dosages) is predicted now through 2024, leaving many individuals seeking alternatives to continue their weight loss journey. We explain what the Wegovy® shortage means for individuals starting this medication and those already prescribed Wegovy® and suggest alternatives for weight loss medication you can discuss with our weight management healthcare team.
About Wegovy®
Wegovy® (semaglutide) is an injectable prescription medication known for its high effectiveness in weight loss when combined with exercise and a reduced-calorie diet. Wegovy® helps individuals with obesity and weight-related medical conditions achieve significant weight loss, averaging 12% of body weight within 18 months and, in some individuals achieving much more substantial weight loss over extended periods.
How GLP-1 Medications like Wegovy® Work
GLP-1 medications such as Wegovy® work in three main parts of your body to help you lose weight.
In your brain, As a GLP-1 receptor agonist, suppress your food cravings.
In your stomach, GLP-1 medications slow down your gut and make you feel full for longer.
In your pancreas, GLP-1 medications help lower your blood sugar.
GLP-1 medications are not effective on their own. These combined effects help individuals consume less food, and when combined with healthy low-calorie diets and exercise, can lead to successful weight loss.
Prescription Eligibility
GLP-1 weight loss medications are typically prescribed to individuals with obesity (BMI of 30 or higher) or overweight (BMI of 27 or higher) and have weight-related health conditions, including type 2 diabetes, high blood pressure, or high cholesterol.
Dosage and Administration
Wegovy® is administered once a week using a pen-like device, which delivers a single dose of the medication. The injections are given under the skin of the abdomen, thigh, or upper arm. The dosage is gradually increased under the guidance of a healthcare provider. The starting dose is 0.25 milligrams (mg) dose per week. The dosage is adjusted every four weeks as needed. The maximum dosage of Wegovy® is 2.4 mg per week.
Safety and Side Effects
GLP-1 medications are generally safe and well-tolerated by most individuals. However, it is essential to note that it may not suit everyone. Pregnant, nursing, or planning to become pregnant should not take GLP-1 medications; patients with type 1 diabetes, medullary thyroid cancer, or MEN2 should not take GLP-1 medications. Specific individuals, such as those with pancreatitis, or kidney or gallbladder problems, may be more prone to experiencing side effects. The most common side effects of all GLP-1 medications are nausea, constipation, headache, and heartburn.
Understanding the Wegovy® Shortage
The Wegovy® shortage has created a temporary challenge for individuals relying on this medication to aid their weight management journey. According to Novo Nordisk, the manufacturer of Wegovy®, the shortage is expected to continue through 2024 and affects the following dose strengths:
0.25 mg (taken during month one)
0.5 mg (taken during month two)
1.0 mg (taken during month three)
On the other hand, it is anticipated that the 1.7-milligram and 2.4-milligram strengths, taken during months four and five, respectively, are likely to be unaffected.
Please visit the FDA website for the most up-to-date information on the Wegovy shortage
Your specific circumstances will determine the impact of the Wegovy® shortage on you. If you are considering starting Wegovy®, obtaining the initial and subsequent medication dosages may be more challenging or impossible due to the shortage affecting the initial dosage strengths prescribed at the beginning of treatment. During the shortage, we recommend starting your weight loss journey with Saxenda®. (which we’ll discuss further in detail below) and transitioning to Wegovy® when it becomes available for additional weight loss. For those already taking Wegovy® and have progressed to the higher dosage strengths of 1.7 mg or 2.4 mg, getting their prescription may be less problematic as these strengths are expected to be less affected by the shortage. However, to ensure uninterrupted supply, Novo Nordisk advises contacting your pharmacy for a refill at least 1-2 weeks earlier than your usual refill time as a precautionary measure.
Alternative Option 1: Compounded Semaglutide
Semaglutide is the active ingredient in Ozempic® and Wegovy®, administered via injection pens. Compounded semaglutide usually comes in a vial with syringes, often combined with a small amount of vitamin B12, with or without glycine.
Our preferred compounding pharmacy ensures that compounded semaglutide* is an exact molecular copy of the semaglutide base. Its authenticity and potency are also verified by an external lab. The compounded semaglutide from our preferred pharmacy is not a salt form of semaglutide, as cautioned bythe FDA regarding the safety and effiicacy concerns associated withsalt formulations.
Availability of compounded semaglutide in certain doses will only remain available as an alternative to branded Wegovy® as long as it remains on the FDA drug shortages list. Upon resolution of the shortage, you can ask your doctor about Wegovy® or other alternative medications for weight loss. Compounded semaglutide is not covered by insurance.
For more information and pricing information, please visit PlushCare's compounded semaglutide.
* Prescriptions for compounded semaglutide are currently restricted to residents in the following states: type: embedded-entry-inline id: 1Af4BTJFTsCNpEXnDwp6tF It is important to note that compounded semaglutide is only available as an alternative to branded Ozempic® and Wegovy® as long as they remain on the FDA drug shortages list. If those branded medications are no longer on the FDA shortage list, compounded semaglutide will no longer be available. Although compounded semaglutide is not FDA-approved, our pharmacy provider complies with pertinent federal and state laws and FDA regulations.
Alternative Option 2: Contrave® (naltrexone/bupropion)
Contrave® is an FDA-approved prescription medication that helps change brain signaling pathways to reduce appetite and control cravings. It combines two ingredients, bupropion and naltrexone. Bupropion is the same ingredient in the antidepressant and smoking addiction medication known as Wellbutrin. Naltrexone is traditionally used to treat opioid and alcohol dependence and can help control food cravings. Contrave® is FDA-approved for weight loss. It has an average weight reduction of about 5.4% of your body weight when combined with calorie-reduced diets and regular moderate exercise routines. It can also help with smoking cessation. It suits those struggling with emotional eating, cravings, low-energy depression, or fatigue. It is relatively inexpensive if prescribed as the two generic meds separately. Potential side effects may include nausea, headache, constipation, and elevated blood pressure. Consult our healthcare team to determine if Contrave® is right for you.
Alternative Option 3: Saxenda® (Liraglutide)
Currently, there is also a national shortage of liraglutide, but there is a possibility for increased availability later this year.
Saxenda® (Liraglutide) belongs to the same class of medications as Wegovy (semaglutide). Since it is a GLP-1 medication, like Wegovy, it works in the brain, gut, and pancreas in the same way to decrease food cravings, slow digestion, reduce blood sugar and help treat insulin resistance.
Clinical trials have shown that liraglutide can lead to an average of 9% weight loss when combined with a low-calorie diet and moderate daily exercise.
Saxenda is administered once daily via a pen to deliver adjustable doses of medications. The injections are given under the skin. The doses are gradually increased each week with the guidance of your doctor, starting at 0.6mg and reaching a maximum dosage of 3.0mg.
While liraglutide has proven effective for weight management, it is essential to note that it may not suit everyone. As with any medication, it is important to consult with our weight management healthcare team to determine if liraglutide is the right choice for you.
Alternative Option 4: Off Label Medications:
Besides the FDA-approved weight loss medications, other drugs can be considered on an “off label” basis. These drugs may have a particularly helpful role where other therapeutic options may be limited due to shortages or contraindications. Off-label options to consider include:
Metformin
Topiramate
Buproprion
Please speak with your doctor if any of these medications may be helpful for you in your weight loss journey.
Conclusion
Weight loss is a long-term journey to achieve better health. The popularity and success of GLP-1 medications have led to waves of shortages in the past year. Short-term disruptions in medication availability do not need to alter your long-term weight loss success. Liraglutide, Contrave®, and physician-guided diet and exercise provide evidence-based tools to continue working towards your overall weight loss and health goals. These medications can assist patients in their weight loss journey when combined with lifestyle modifications. Talking to our doctors and weight management team is essential to determine the most appropriate medication option based on your goals, medical history, medication costs, and availability. We can guide, monitor progress, and evaluate for safety throughout treatment. Remember, weight management is a complex process and a comprehensive approach that includes physician-directed treatment and daily lifestyle changes to help you become healthier and happier!
Sources
Novo Nordisk. (2023, June). Wegovy® (semaglutide) injection for subcutaneous use [Prescribing Information]. Retrieved from https://www.novo-pi.com/wegovy.pdf
Apovian, C. M., Aronne, L. J., Bessesen, D. H., McDonnell, M. E., Murad, M. H., Pagotto, U., ... & Still, C. D. (2021). Pharmacological management of obesity: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 106(9), 2970-3023.
FDA. (2020, January). Saxenda (liraglutide) injection for subcutaneous use [Prescribing Information]. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/206321s010lbl.pdf
Chang, S. H., Stoll, C. R., Song, J., Varela, J. E., & Eagon, C. J. (2015). The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surgery, 150(8), 819-830.
Novo Nordisk. (n.d.). Significant Weight Loss. Saxenda. Retrieved from https://www.novomedlink.com/obesity/products/treatments/saxenda/efficacy-safety/significant-weight-loss.html
