semaglutide (Ozempic)

General Information

Ozempic is a once-weekly injectable form of semaglutide, a GLP-1 receptor agonist indicated for type 2 diabetes and cardiovascular risk reduction in adults with type 2 diabetes and established cardiovascular disease (label).

It is not a psychiatric medication. In psychiatric practice, GLP-1 therapies are most often discussed when metabolic disease (obesity, prediabetes/diabetes) complicates care or when weight-gain–promoting psychotropics create cardiometabolic risk (clinical).

Evidence for GLP-1 therapy in antipsychotic-associated metabolic dysfunction is strongest for the class overall (including a randomized trial with liraglutide in clozapine/olanzapine-treated schizophrenia spectrum patients) rather than for any single product, and care is often coordinated with primary care/endocrinology (JAMA/clinical).

The compare view, evidence feed, and print page help track dosing/titration and key safety monitoring themes.

Access is frequently shaped by insurance coverage and by whether diabetes and cardiovascular indications are present. In psychiatric populations, the operational work (coordination, prior authorizations, education, and follow-up) often determines feasibility as much as efficacy (clinical).

Mechanism of Action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Semaglutide is a GLP-1 receptor agonist. GLP-1 activity increases glucose-dependent insulin secretion, suppresses inappropriate glucagon, and slows gastric emptying; clinically it also reduces appetite and supports weight loss (label/clinical).

In mental health care, the most common rationale is metabolic: reducing obesity/diabetes burden that increases cardiovascular risk and can limit psychotropic options (clinical).

• GLP-1 receptor agonism (incretin-based metabolic signaling).
• Appetite and satiety effects (clinical framing).

Metabolism and Pharmacokinetics

• Long half-life supports once-weekly dosing (approximately 7 days per label framing).
• As a peptide-based therapy, semaglutide is not primarily handled by CYP metabolism; major CYP-mediated interactions are not expected (label).

Dosing and Administration

• Typical: 0.5–2 mg subcutaneously once weekly after titration (start 0.25 mg once weekly for 4 weeks, then 0.5 mg; increase to 1 mg and up to 2 mg once weekly if needed) (label).
• Choose a consistent weekly dosing day. If a dose is missed, administer as soon as possible within 5 days; otherwise skip the missed dose and resume the regular schedule (label).
• Injection sites include abdomen, thigh, or upper arm; rotate sites to reduce local reactions (label).
• GI tolerability often improves with slower escalation, smaller meal sizes, and attention to hydration; abrupt discontinuation is not usually required for mild nausea (clinical).

Monitoring & Labs

• Weight/BMI and waist circumference trend; document baseline and track response over time (clinical).
• Glycemic control (HbA1c/fasting glucose) when diabetes or prediabetes is present; avoid overly rapid de-escalation of other diabetes medications that could destabilize control (clinical).
• Screen for symptoms of pancreatitis and gallbladder disease (persistent severe abdominal pain, vomiting) (label).
• Monitor for dehydration and renal function concerns when significant GI losses occur (label/clinical).
• For patients with diabetes and known retinopathy, monitor for progression during large glycemic shifts (label).

Consider coordination with primary care/endocrinology for diabetes regimen changes, cardiovascular risk management, and screening frequency decisions (clinical).

Adverse Effects

Interactions

• Delayed gastric emptying can affect absorption of some oral medications during titration; review narrow-therapeutic-index agents and time-sensitive regimens (clinical).
• Hypoglycemia risk increases when combined with insulin or sulfonylureas; coordinate dose adjustments with the diabetes prescriber (label/clinical).

Other Useful Information

• In serious mental illness care, the question is often “metabolic benefit vs feasibility.” The practical work (coverage, follow-up, injection teaching, tolerability) frequently drives whether GLP-1 therapy is sustainable (clinical).
• When used to address antipsychotic-associated weight gain, coordinate with the psychiatric plan (sleep, activity, substance use, and medication selection) rather than treating weight in isolation (clinical).

References

1. OZEMPIC (semaglutide) injection prescribing information — DailyMed (2026)
2. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes — New England Journal of Medicine (2016)
3. Effect OF Liraglutide Treatment ON Prediabetes AND Overweight OR Obesity IN Clozapine OR Olanzapine Treated Patients With Schizophrenia Spectrum Disorder: A Randomized Clinical Trial — JAMA Psychiatry (2017)
4. Therapeutic Management OF Atypical Antipsychotic Related Metabolic Dysfunctions Using GLP 1 Receptor Agonists: A Systematic Review — Experimental and Therapeutic Medicine (2023)