Wegovy or Ozempic – does it matter?
Wegovy and Ozempic both contain semaglutide but are authorised for different indications. They are also presented in slightly different concentrations and dose schedules, explains Deborah Evans, Superintendent Pharmacist and Clinic Director at Remedi Health.
Both Wegovy and Ozempic are brand names for semaglutide – the difference is that Ozempic is licensed for treatment of type 2 diabetes whereas Wegovy is licensed for weight management. “They’re presented at slightly different concentrations and dose schedules, so there is a difference there, but for many people the question will be, ‘so what?’ and actually in clinical practice if a prescriber is prepared to prescribe Ozempic instead of Wegovy …… they will be prescribing off-label, so in other words outwith the license.”, explains Ms Evans. This situation can arise because at present (June 2023) Wegovy is not yet available in the UK.
There is a considerable demand for semaglutide for weight loss and this has led to shortages in the supply of Ozempic. “It is a real problem. We’re finding now that you can’t get the lower entry doses of Ozempic and in fact I tried today and I couldn’t get the high dose either. So, it is in short supply and the company have informed us that it’s likely to be in short supply throughout the whole of this year. What that means is that for people that have been prescribed it for type 2 diabetes they’re not going to be able to get their medicine and potentially an alternative is going to have to be found”, says Ms Evans. In these circumstances it is important for prescribers and pharmacists to make patients aware that the drug is being used off-label (for weight loss) and that they themselves are have adequate professional indemnity cover in place in case anything goes wrong.
In the landmark STEP1 trial semaglutide was given at a dose of 2.4 mg but Ozempic is not available in this dose. “If I go to the dosing of Wegovy, you start at 0.25 then you go up to 0.5 then you do one milligram then you do 1.7 milligram and then you do 2.4 milligram and you only reach 2.4 milligram by month five where whereas with Ozempic we do 0.25 for a month, 0.5 for a month then you probably stick around that for months three and four but you could go up to one milligram in the third month and then it stops”, says Ms Evans. Higher doses can then be prescribed if required.
Prescription or PGD?
Semaglutide products are prescription only medicines (POMs) so they should be prescribed by a licensed prescriber who has enough expertise to be competent to prescribe in this area. POMs can sometimes be supplied under an alternative mechanism – under a patient group direction (PGD). Currently, Saxenda (liraglutide), which was the first of the GLP-1s to be available, can be supplied under a PGD and there are a number of community pharmacies that have this type of protocol in place. “Essentially, a patient group direction is what it says – it’s a protocol that, provided the individual in front of you ….. meets the requirements, and there are no reasons why they can’t have the medicine, then they can be supplied it. …..In that instance the supplying pharmacist does not have to be a prescribing pharmacist”, Ms Evans explains. However, there are no PGDs at present for semaglutide because the only available product is Ozempic and it would be inappropriate to have a PGD for off-label Ozempic. “We’ll have to wait to see if anyone develops a commercial Patient Group Direction for Wegovy but for the moment it needs to be prescribed by an appropriately qualified and licensed prescriber who’s prescribing within their scope of practice”, she adds.