Combining Hormone Replacement Therapy and Semaglutide

No Documented Drug Interactions

The American College of Cardiology states that semaglutide has few clinically significant drug interactions, and HRT is not listed among the contraindications or cautions for GLP-1 receptor agonists 1, 2
Absolute contraindications for semaglutide are limited to: personal or family history of medullary thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2 (MEN2), and severe hypersensitivity reactions to the drug 1, 2

The American College of Cardiology recommends monitoring blood pressure and heart rate periodically, particularly if the patient is on HRT formulations that may affect cardiovascular parameters 2, 3
Monitor home glucose levels during the first 4-8 weeks, especially if the patient is on insulin or sulfonylureas, as both medications can affect glucose metabolism 4
Assess efficacy and safety at least monthly for the first 3 months, then quarterly 2

The Gastroenterology society recommends starting semaglutide at the lowest dose with gradual titration, beginning at 0.25 mg subcutaneously weekly for the first 4 weeks 3, 4
Increase to 0.5 mg, then 1.0 mg, then 1.7 mg weekly every 4 weeks at each dose until reaching maintenance dose of 2.4 mg after 16 weeks 3, 4

The American College of Cardiology recommends a comprehensive ophthalmologic examination to document retinopathy status, particularly in patients over 60 or with pre-existing diabetic retinopathy 4
Assessment for personal or family history of medullary thyroid cancer or MEN2 is required before initiating semaglutide 4
Do not co-administer semaglutide with other GLP-1 receptor agonists or DPP-4 inhibitors, and reduce doses of insulin or insulin secretagogues when initiating semaglutide to prevent hypoglycemia 3, 1, 2