Losing Weight with Migraines; a word about semaglutide shots

Aug 06, 2023
Semaglutide (AKA Wegovy, Ozempic, Rybelsus) Am I a good candidate for semaglutide injections?

Semaglutide was developed over 10 years ago to lower A1C in type 2 diabetics, and received FDA approval in 2019.

A 'side effect' of the medication is weight loss, and this has been so prominent, that now semaglutide is now FDA approved for weight loss.

If you have been overweight for any length of time, I'm sure you are aware of just how difficult it can be to lose unwanted pounds.

This is evidenced further by the fact that gastric procedures to lose weight have soared in popularity, over the past decade.

For some individuals, semaglutide shots may be a option to consider, instead of surgery.

The following is not exhaustive, but it is a 'tip sheet' I put together for my patients who are interested in these weekly injections.

Semaglutide Tip Sheet 

NOTE:  Semaglutide does NOT cause weight loss.  CALORIE RESTRICTION causes weight loss.  Semaglutide DOES amplify your will power so that you can avoid eating. 

Contraindications:  Personal history of thyroid cancer (medullary thyroid carcinoma).  Family history of Multiple Endocrine Neoplasia type 2.  High dose exposure for long periods of time caused thyroid C cell tumors in rodents.  No known human relevance. 


Common side effects:  nausea, acid reflux, constipation. (There are others: these are just the most common.  For fuller list see https://en.wikipedia.org/wiki/Semaglutide)  Treat side effects as they come up.  (E.g., ondansetron for nausea, Nexium/Prilosec/Tums for acid reflux, Miralax/magnesium for constipation.  If these occur, they usually fade with time.  They may also temporarily worsen as you increase the dose of semaglutide. 


Injection schedule:  Start with 1/2mg SC injection weekly.  If side effects occur and are severe, consider starting with 1/4mg. 

Inject weekly x 4 weeks, then increase to 1mg SC injection weekly. 

Inject weekly x 4 weeks, then increase to 2mg SC injection weekly. 

Continue at 2mg/week until you reach your goal weight. 


Tapering off.  DO NOT STOP ABRUPTLY.  This will cause you to be ravenous.  Assuming you are at 2mg/week when you reach your goal weight, go to 1mg/week for 3 – 6 months, keeping an eye on the scale.  If your weight creeps up, get more aggressive with calorie restriction, or consider going back up to 2mg, or even 1.5mg/week. 

After 3 – 6 months of 1mg/week, then go to ½ mg/week x another 3 – 6 months.  If weight remains stable, then stop. 


As always, discuss this medication with your provider before starting.