Pre-Initiation Requirements for Semaglutide

Mandatory Contraindication Screening

• The FDA warns of thyroid C-cell tumor risk observed in rodent studies, though human relevance remains undetermined, and patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2 should not be initiated on Ozempic 1
• Pregnancy is an absolute contraindication to Ozempic therapy, and reliable contraception should be in place during treatment 2

Required Baseline Laboratory Assessments

• Obtain baseline eGFR or creatinine clearance before starting therapy, as no dose adjustment is required for any degree of renal impairment, but baseline assessment is necessary to monitor for potential acute kidney injury from GI-related dehydration 1, 2
• Assess baseline liver function tests before initiation, as no dose adjustment is required for hepatic impairment, but baseline values are needed for future monitoring 1, 2

Clinical History Assessment

• Screen for history of pancreatitis or current risk factors, and do not initiate Ozempic in patients at high risk for pancreatitis, as recommended by the American Diabetes Association 3
• Evaluate for history of cholelithiasis or cholecystitis, and avoid use in patients with active biliary disease or those at high risk 3

Medication Review and Adjustment Planning

• If the patient is on insulin or insulin secretagogues, plan to reduce these doses when initiating Ozempic to minimize hypoglycemia risk, as recommended by the American Association of Clinical Endocrinologists 3, 2

Patient Education Before Initiation

• Counsel patients about common gastrointestinal side effects including nausea, vomiting, diarrhea, and constipation, and advise on dietary modifications to mitigate GI effects 3, 1

Special Population Considerations

• No special pre-initiation requirements exist for patients with cardiovascular disease, as semaglutide provides cardiovascular benefits, according to the American College of Cardiology 1
• Patients with pre-existing hypertension require no additional screening beyond standard blood pressure measurement, but plan for weekly blood pressure monitoring by the patient during the first month of treatment 4

Evidence‑Based Baseline Assessments and Management for Semaglutide Initiation

Renal Function

• Semaglutide does not require dose adjustment in patients with chronic kidney disease, even when estimated glomerular filtration rate is below 30 mL/min/1.73 m². [Mayo Clinic Proceedings, 2022] 5

Cardiovascular Risk Stratification

• A fasting lipid panel (total cholesterol, LDL‑C, HDL‑C, triglycerides) should be obtained before starting semaglutide to establish baseline cardiovascular risk. [Mayo Clinic Proceedings, 2022] 5

Contraindications & Cautions

• A documented history of pancreatitis constitutes a relative caution for initiating semaglutide. [American College of Cardiology, 2018] 6

Medication Management

• When semaglutide is added to a regimen that includes insulin or sulfonylureas, the doses of those agents should be reduced by 20–50 % to lower the risk of hypoglycemia. [American College of Cardiology, 2018] 6

Ophthalmologic Evaluation

• Semaglutide has been associated with an increased incidence of diabetic retinopathy complications (as demonstrated in the SUSTAIN‑6 trial); therefore, a comprehensive eye examination should be performed if one has not been done within the prior 12 months, especially in patients with diabetes or a history of uveitis. [American College of Cardiology, 2018] 6