Semaglutide

What is SEMAGLUTIDE for?

    • SEMAGLUTIDE is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with a BMI >30 or a BMI>27 with comorbidities (high blood pressure, diabetes, high cholesterol).

    • Unlike other weight loss medications, you do not have to stop taking it after a short time. You may continue as long as you think it’s helpful.

    • For patients with or without diabetes mellitus, SEMAGLUTIDE is a preferred first-line pharmacotherapy for the treatment of obesity.

    • We obtain semaglutide from Magnum Compounding Pharmacy. If prescribed, it will be shipped to your home along with supplies (sharps container, syringes, and alcohol pads).

How does SEMAGLUTIDE work?

    • SEMAGLUTIDE is a glucagon-like peptide-1 receptor agonist (GLP-1) that stimulates glucose-dependent insulin secretion.GLP-1 also inhibits glucagon release and gastric emptying.

    • GLP-1 receptor agonists bind to the GLP-1 receptor and stimulate glucose-dependent insulin release from the pancreatic islets.

    • GLP-1 receptor agonists were initially approved for the treatment of type 2 diabetes. One of the mechanisms by which GLP-1 receptor agonists improve glycemia in diabetes is due to their ability to induce weight loss.

Does SEMAGLUTIDE work?

    • Once-weekly subcutaneous SEMAGLUTIDE has been shown to induce weight loss in individuals considered overweight or with obesity, with or without diabetes.

    • In studies of people taking SEMAGLUTIDE, there was a 15% weight loss at 16 months.

    • Studies show that shorter duration of treatment is associated with weight regain, so we encourage you to continue this medication long term. Individuals continuing SEMAGLUTIDE after 20 weeks continued to lose weight, while those switched to placebo regained weight over the subsequent 48 weeks.

    • SEMAGLUTIDE has been shown to reduce major cardiovascular disease events in adults with type 2 diabetes and established cardiovascular disease or chronic kidney disease.

    • At your 16 week follow up visit, we will evaluate if this medication works for you by looking for at least a 5% weight loss.

How do I take SEMAGLUTIDE?

    • Administer it subcutaneously in the abdomen, thigh, or upper arm once weekly.

    • The dose is increased as tolerated to the maximum effective dose (not more than 2.5mg).

    • If dose escalation is not tolerated due to side effects (eg, nausea, vomiting), the increase in dose can be delayed by another four weeks. We will continue the maximum tolerated dose if goal weight loss is achieved.

What are the cautions and contraindications?

    • You may not take SEMAGLUTIDE if you are pregnant, have a personal history of pancreatitis, or a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B.

    • If you take semaglutide with insulin or an insulin secretagogue (eg, a sulfonylurea), blood glucose should be monitored, and a dose reduction in the insulin or the sulfonylurea may be necessary to avoid hypoglycemia.

    • Rare cases of angioedema and anaphylaxis have been reported with semaglutide.

    • Patients with diabetic retinopathy should be monitored for complications

What are possible Side Effects?

    • It’s common to experience nausea, vomiting, or diarrhea. These are generally mild to moderate and improve over time.

    • Gastrointestinal symptoms could occur upon starting the medication and when increasing the dose each month.

    • If you experience nausea upon starting the medication, contact us if you don’t feel better after a few days and we can prescribe a temporary medication for nausea (ondansetron/Zofran).

    • Please read the “Up to Date” patient education handout for a complete list of possible side effects. (We will give to you at your visit)

We Encourage You to:

    • Eat nutritious food throughout the day to avoid hypoglycemia (low blood sugar), lightheadedness, or weakness. If you are diabetic and take insulin, check your blood sugars more often so you can prevent hypoglycemia.

    • Move your body once a week or more as you are able. Muscle growth with resistance training will increase your resting calorie burn, and cardiovascular exercise will improve your heart health, win win!

    • Avoid high calorie beverages like juice, soda, and alcohol.

We are in this with you!                                 

We wish you the best success on this journey,                                                       

Dr. Courtney Holmes, DNP, APRN, Diana Greenia, APRN, Dr. Logan Stern, DNP, APRN, Anika Nelson, RN, & Dr. Ellen Makar, DNP, RN

Treatment packages and pricing

Med delivery questions: Please call your compounding pharmacy: Empower 877-562-8577 or Magnum (855) 403-6028

FAQ

  • How do I start the semaglutide medical weight loss program?
      • Click the “Get An Appointment” button above and choose “Medical Weight Loss First Visit.” You will pay a $150 Non-Refundable Deposit that is applied toward the first visit. In the case of late cancellation (less than 48 hours) or no show, you forfeit the deposit. There are no refunds. You will pay the balance at the office during your visit with cash or card (HSA accepted). 
  • What happens at the first visit?
      • You will meet with one of our nurse practitioners for a full medical evaluation to determine if semaglutide is a safe treatment option for you. If so, a prescription will be sent to Magnum Pharmacy to be shipped to your home. The nurse practitioner will teach you how to self-inject at this visit. If you are not prescribed semaglutide, we will consider our other medical weight loss option, prescription Contrave.  In rare cases, neither option will be a safe fit, so you may not be prescribed anything. 
  • Can I start the semaglutide weight loss program if I am out of state?
      • Yes, HOWEVER, you must be in CT in person for the initial visit with our nurse practitioner. Our compounding pharmacy is then able to ship to CT, RI, NJ, NY, ME, PA, FL, MN, WI, IL, MO, WY, CO, UT, or AZ thereafter. 
  • Do I need labs/bloodwork before starting semaglutide?
      • Yes, labs are required to help determine safety. You may upload labs completed in the past year to our client portal. We need the following labs to assess kidney, liver, and thyroid function: BUN, creatinine, alk phos, AST, ALT, and TSH. 
      • If you do not have labs from the past year, please text us 203-701-6161 to request that we send an order to Quest to obtain before your visit. You do not need to be fasting, unless you request that we check your cholesterol levels as well. We are happy to add these to your lab order if you ask. When you book your appointment at Quest, choose “All other tests.” Please be sure to upload a copy of your health insurance card, so we can order labs at Quest. 
  • How much is the semaglutide weight loss program?
      • $333 per month.  You will pay the balance minus the non-refundable $150 deposit on the day of your first visit. If we determine at your FIRST visit that you are not a candidate for semaglutide or that you will begin Contrave instead, then your visit is 100% paid for by your non-refundable $150 deposit. 
  • Do you accept insurance for the semaglutide weight loss program?
      • No we do not. You are expected to pay, in full, for all visits and charges incurred at each visit. These charges may or may not be covered by your insurance.  Milford Med Spa does not provide or fill out claim forms for insurance purposes.  It is your responsibility to save receipts needed for any purpose (such as HSA’s). 
  • Will I be updated when my package ships from the pharmacy?
      • No you will not be updated. It will be sent overnight on ice, please place in the fridge upon receipt. 
  • Can I provide special delivery instructions for the package?
      • We are not able to do this. 
  • Do I have to sign for the package when it’s delivered?
      • No
  • How long does it take to receive the medication from the pharmacy?
      • Approximately 2 weeks due to high demand. If you have not received it by then, please contact us at 203-701-6161. 
  • How much medication do I inject?
      •  This is determined at your first visit with the nurse practitioner who provides the prescription and instructs you on how to inject. Our general dosing guidelines are provided to you at your first visit; you may view that below.  At subsequent visits you are instructed on how to safely increase your dose. If you are still unclear about the dose, text us at 203-701-6161.
  • When will the medicaiton start to work?
      • This varies for each person, but generally speaking most people don’t notice a change in appetite or weight during the first 2 weeks. This allows your body to adjust to the new medication with minimal or no side effects. Then, as we increase the dose, you will notice changes in appetite, feelings of fullness, and eventually weight loss. Others experiece weight loss the first week or month. Stay the full course of at least 4 months to evaluate if this medication is working for you or not. 
  • How do I get refills?
      • Schedule a nurse check-in visit either virtual or in person, to obtain refills. At the visit, together we decide to continue semaglutide or not. If you continue, you will pay the program fee in our mobile app or via invoice and then our nurse practitioner sends in a 90 day supply that will ship to you in one package. You will need to follow up with our nurse every 3 months to continue in the program and get refills. Medication is NOT refilled without the nurse visit every 3 months for your safety.
  • How do I pay to continue in the weight loss program?
      • In our mobile app, pick “Wellness” from the scrolling menu at the top, then pick Continue Semaglutide Medical Weight Loss.  Or you may pay in the office with cash or card, HSA is accepted. 
  • I’m afraid to self-inject, can you help me?
      • We assure you, these needles are so tiny, you’ll barely feel a thing. Our nurse practitioner will teach you how to self-inject and show you exactly what to do.  We use the tiniest needle possible of 31 gauge (same as an insulin or botox injection).  The injection is done in the subcutaneous level of the skin (not deep), so the needle is short. It’s barely felt when done on the abdomen.  If you are still not comfortable self-injecting after the first visit, you may schedule an appointment with our nurses for support injecting yourself once you receive your medication (virtual or in person). We will help you with this! 
  • Are the compounding pharmacies that you use legit?
    • Yes, you may view their National Provider ID here: Magnum, Empower.  
  • I have a question that isn’t covered in this FAQ, who can I talk to?

Dosing Guidelines

+1 (203) 701-6161

hello@hhp.sprucecare.com

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