Ozempic vs. Wegovy(Semaglutides) for Weight Loss
Ozempic and Wegovy, the newest weight loss drugs, are in the family of Glucagon-like peptide 1 receptor agonists. GLP-1RAs are medications that were first developed for the treatment of diabetes. When treating diabetics there was not only reductions in blood sugar but significant weight loss. This led to the discovery of several GLP-1 medications including most recently liraglutide and semaglutide that possessed significantly greater weight loss effects that most anti-obesity medications. The first of these GLP1’s to be evaluated for its weight loss properties was liraglutide. Once daily injections of liraglutide resulted in 37% of patients experiencing a 20% weight loss or more from starting weight vs. 7% for placebo. This is far above the average FDA requirement of 5% or more weight loss from baseline. Numerous studies have been done to find the mechanisms for the weight loss that often equals the weight reduction observed after bariatric surgery. These mechanisms include:
- Reduction in appetite
- Reduction in cravings
- Increase in satiety
- Changes in food preferences- away from fatty foods and carbohydrates
- Reduced energy intake
The drawback of daily injections of liraglutide led to the search for other GLP-1 RA’s that could be administered by once a week injection and even taken orally. This led to the discovery of Ozempic for diabetes and the same drug, re-labelled Wegovy for weight loss.
Semaglutides(Wegovy and Ozempic)- How They Work:
Semaglutide is a long‐acting glucagon (glucagon is hormone made in the pancreas that increases blood sugar the opposite of insulin) like molecule that mimics the effects of GLP‐1, which promotes weight loss by reducing energy intake, increasing satiety and satiation, and reducing hunger. Many GLP‐1s have been approved for the treatment of type 2 Diabetes- first liraglutide 3.0 mg daily and latter semaglutide. Ozempic, the first semaglutides, was the first to be marketed at doses levels of up to a 1 mg injection once a week or in the oral tablet form at a dosage of up to 14 mg a day. Over the past 6 years extensive studies have proven the safety and effectiveness of Ozempic not only for diabetic control, but for weight loss as a secondary effect.
The higher doses of semaglutide(marketed as Wegovy) from 1.7 to 2.4 mg a week as a subcutaneous injection were evaluated found to have equal safety and greater weight loss that he lower doses seen with Ozempic. Some increase GI side effects weere found.
Taking Ozempic and Wegovy for Weight Loss
Ozempic and Wegovy are the same chemical, the only differences being the dosage. Ozempic can replace Wegovy, especially for the lower doses of 0.25, 0.5 and 1 mg per week. Ozempic, introduced for diabetes, has a maximal approved dose of 1.0mg and Wegovy for obesity a maximun dose of 2.4 mg per week. Each dose is given as a subcutaneous injection with a pen injector once a week. To prevent GI side effects, starting and intermediate doses of 0.25 & 0 .5 mg are used to titrate up to these doses. Weight loss increases as dose is increased beginning at 1 mg/week after 3-4 weeks when the “steady state is achieved.”
Ozempic is supplied in 2 different injection pens:
- 1 mg pen—with injection points of 0.25 mg and 0.5mg. To save money, we use the 4mg pens since the price is the same.
- 4 mg pen—injection points at 1 mg intervals. You can lower doses by micro dialing
- Micro dialing by counting clicks lets you administer 0.25 mg(20 clicks) and 0.5mg( 40 clicks). The 4 mg pen is the top dose which supplies 1 mg/week for a month.
Wegovy is supplied in 5 different pens strengths: from 0.25 mg to 2.4 mg/pen. Each pen is used for the once-a-week injection and discarded. They are supplied in boxes of 4 pens, each box is enough for a month.
The cost of all the pens, both Wegovy and Ozempic are the same.
There is a 1:1 relation between dose and weight loss, with the 2.4 mg dose being the highest currently approved dose. I have seen significant weight loss at 1 mg/week. We have used Wegovy and Ozempic interchangeably in the low doses, depending upon which pen is available. We have even taken 2 injections on the same day –one after another to arrive at our desired dose of 2.4mg when only the Ozempic pen was available.
Why Substitute Ozempic for Wegovy? It’s The Cost and the Lack of Insurance Coverage
The purpose of using Ozempic instead of Wegovy is simply the cost The discounted cash price of Wegovy thru Goodrx.com is $1300/month. Each month’s supply contains 4 pens starting at 0.25 mg/pen and going to four 2.4 mg pens per box. The price of Ozempic in the US is $849 (for a single multi-dose pen of 4 mg pen). The price of Ozempic in Canada is $299 for the 4mg pen (enough for 1 month and a week.) Since the first month or two of Ozempic requires only 0.25 and 0.5 mg, the cost for the first 10 weeks 0f therapy is the cost of 2- 4mg pens.
The greatest weight loss is seen at 2.4 mg injection once a week. However, significant weight loss is also seen at 1 mg per week. Insurance covers Wegovy for only a minority of obese people (usually depends on the insurance contract, not on the BMI or weight.) Ozempic is covered more often but only in uncontrolled diabetics.
How We Substitute Ozempic for Wegovy
We purchase a Ozempic pen with 4 mg/3cc, this is a single pen meant to inject a dose of Ozempic of 1 mg a week for a month. This pen has set points at 1 mg as you click around the wheel. The lower doses are not marked, but can be achieved by counting clicks: 20 clicks on this pen delivers 0.25 mg, 40 clicks 0.50 mg—these are the intermediate doses used to start and to titrate up to 1 mg or the full 2.4 mg dose if using the Wegovy pens. When 2.4 mg doses are needed using Ozempic, it might be cheaper to use the 2.4 mg Wegovy pen instead of multiple doses of Ozempic.
Standard Dosing of Ozempic to Titrate up to Wegovy Levels of 2.4 mg/week for Maximal Weight Loss
Following the protocols of the manufacturer, we start with 0.25 mg once a week for 4 weeks, then 0.5mg x 4 weeks, 1 mg x4—this is top dose for Ozempic. Each dose is once a week on same day. To achieve doses levels seen with Wegovy, you would simple click beyond 1 mg to the desired dose by counting clicks when using the 4 mg pen.
For Wegovy in comparison its: 0.25 x4 weeks, 0.5mg x4, 1mg x4, 1.7 mgx4, then 2.4 mg x4 weeks. Again, each dose is injected once a week. You can stop anywhere in this titration with either drug because of side effects or because you are losing weight at an acceptable rate. The Wegovy is supplied as box of 4 pens a month, each with the specific dose. The high dose Ozempic is supplied as a single 4mg delivering 1 mg increments for a month. The top dose in studies so far is 2.4 mg/week.
Ozempic/Wegovy: Side Effects and Weight Loss
The side effects appear much less than one would think. Only 5% of patients withdrew from studies. Most occur early and during the first few days after the injection, especially when escalating the dose. The most common side effects reported in ≥5% of patients treated are:
Stomach side effects are most common when starting treatment but decrease over time in most patients.
Zofran 4 mg or 8 mg is a inexpensive treatment for nausea. It is a little tablet placed under your tongue. It’s used for chemotherapy nausea.
Despite being a drug for diabetes, low blood sugars are not seen from the drug.
Significant weight loss is seen at doses less than 2.4 mg/week as would be encountered with Ozempic at standard doses, i.e. up to 1 mg/week.
Weight Loss with Semaglutide: Ozempic and Wegovy
Very variable, some weight loss with the 0.5mg, much more at 1.0 mg and still increasing with dose titration. See a graph showing weekly % weight loss on standard protocol. Note these are % of weight loss, not the actual weight loss. The first 8 weeks were the o.25/0.5 mg dose. Notice the weight loss at 10-12 weeks accounted for about 2/3 of total weight loss.
How to Increase Weight Loss with Wegovy/Ozempic without Increasing doses
1. Take the injections Saturday AM, these meds are more effective just after you take them, and many people eat more on the weekends.
2. Most individuals taking the drug find sweet and fatty foods very unpleasant. So why not simply avoid these. Exercise beginning in the 3rd week is always helpful.
See video for more help on using the pen: https://www.youtube.com/watch?v=BX1e3Y0MQ0Q