SemaglutideNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6][7][8]

Blood glucose

Why

Hypoglycemia with insulin or a sulfonylurea

When

When starting and with dose changes

Act on

Consider lowering the insulin or sulfonylurea dose

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2][3]

Hemoglobin A1c

Why

Glycemic response

When

After dose changes; escalate after at least 4 weeks on a dose

Act on

If more glycemic control is needed, step up the dose

Normal

Below 5.7% is normal and 6.5% or higher indicates diabetes. Many people with diabetes aim for below 7%.

Sources: [1][2]

Serum creatinine

Why

Acute kidney injury from volume depletion

When

When GI effects could cause dehydration, especially during initiation and escalation

Normal

0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2]

High-alert status

Semaglutide is not on the ISMP acute care high-alert list. Insulin and oral sulfonylureas are.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

Risk of thyroid C-cell tumors. Semaglutide causes these tumors in rodents; whether it causes medullary thyroid carcinoma in humans is unknown. Contraindicated with a personal or family history of MTC or with MEN 2. Teach patients to report a neck mass, trouble swallowing, shortness of breath, or lasting hoarseness.

Sources: [1]

Antidote or reversal

No specific antidote. Give supportive care based on symptoms, such as nausea, vomiting, and hypoglycemia. Observation may need to be prolonged because the half-life is about 1 week.

Sources: [1]

Patient teaching

• Missed dose: take it within 5 days; if more than 5 days have passed, skip it and take the next dose on the usual day
• Report a neck lump, hoarseness, or trouble swallowing or breathing
• Stop and call the prescriber for severe abdominal pain that may spread to the back
• Drink enough fluids; report nausea, vomiting, or diarrhea that will not stop
• Learn the signs of low blood sugar, especially if you also use insulin or a sulfonylurea
• Report changes in vision
• Tell the care team about any planned surgery or procedure
• Never share your pen with anyone

Sources: [1]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Adult dose

Start (all indications)

0.25 mg subcutaneously once weekly for 4 weeks to limit GI effects, then 0.5 mg once weekly.

Glycemic control

Maintenance 0.5 mg, 1 mg, or 2 mg once weekly. If more control is needed, increase to 1 mg after at least 4 weeks on 0.5 mg, then to 2 mg after at least 4 weeks on 1 mg. Maximum 2 mg once weekly.

Type 2 diabetes with chronic kidney disease

Increase to the 1 mg once-weekly maintenance dose after at least 4 weeks on 0.5 mg.

Sources: [1]

Renal adjustment

None, including kidney failure. Monitor renal function when GI effects could cause volume depletion, especially during initiation and escalation.

Sources: [1][2]

Hepatic adjustment

None. Hepatic impairment did not change exposure in a clinically relevant way.

Sources: [1]

Mechanism

A GLP-1 receptor agonist. When glucose is high it boosts insulin release and suppresses glucagon, so it lowers glucose in a glucose-dependent way. It also slows gastric emptying slightly after meals. Albumin binding and resistance to DPP-4 give it a half-life of about 1 week.

Sources: [1][2]