Semaglutide (Ozempic, Rybelsus & Wegovy) and other GLP-1 RAs in Singapore
Semaglutide (Ozempic, Rybelsus & Wegovy) and other GLP-1 RAs in Singapore
Although healthy lifestyle changes are an important part of the treatment plan for people with diabetes, medications can also be useful for many people. There are several different medication options available that can be helpful in gaining better control of blood sugar. Among these are a class of medications known as GLP-1 receptor agonists, or GLP-1 RAs. Besides helping to control blood sugar, these medications can also lead to weight loss, and some of them are specifically approved for this purpose.
Ozempic, Rybelsus, and Wegovy are all different forms of a drug called Semaglutide, which is a GLP-1 RA. Other medications in this group include liraglutide and dulaglutide.
What is Ozempic?
Ozempic is a form of Semaglutide which is approved for use in treating diabetes. It’s taken by injection once per week. Ozempic comes in a pre-filled “pen” that’s used for self-injection of the medication. Each pen may contain one or a few doses of the medication.
Ozempic is usually started at a low dose of 0.25mg per week. This is continued for four weeks in order to get the body used to the medication, which helps to reduce side effects. Afterward, the dose is increased to 0.5mg per week. Some people continue at this dose, while others increase to 1 or 2mg per week. The dose is usually increased as needed to achieve good blood sugar control, and then maintained at that level.
What is Rybelsus?
Rybelsus is also a form of Semaglutide that’s approved for treating diabetes. However, instead of being injected weekly, it’s taken daily in the form of a tablet.
Rybelsus is generally taken at a dose of 3mg per day for the first 30 days. This is then increased to 7mg per day. The tablet needs to be taken at least 30 minutes before the first meal of the day. It’s recommended to keep Rybelsus and a small glass of water on your nightstand, and to take Rybelsus when first waking up.
What is Wegovy?
Wegovy is another form of Semaglutide, but it’s approved for weight loss. Similarly to Ozempic, Wegovy is taken by injection once per week. It also comes in a pre-filled pen, each of which may contain one or a few doses.
Wegovy is started at a low dose of 0.25mg per week. This is increased every four weeks, to 0.5mg, 1mg, and then 1.7mg per week. Some people remain on a dose of 1.7mg for the long term, while in others, the dose is further increased to 2.4mg per week.
How do GLP-1 RAs such as Semaglutide (Ozempic, Rybelsus, and Wegovy) work?
GLP-1 receptor agonists act on the receptor for a certain hormone produced in the gut. They help to control blood sugar and weight in several ways:
Increases production of the hormone that lowers blood sugar level, especially after taking food.
Reduces production of the hormone that increases fasting sugar, optimising fasting sugar levels.
Slows gastric emptying and decreases appetite, which makes you eat less, feel full longer, lose weight and also slows the release of glucose from your food.
Overhauls “hunger and craving hormones”, working on the reward centre of the brain, reducing cravings.
Which GLP-1 RAs are available in Singapore?
Certain GLP-1 RAs are approved specifically to promote weight loss, but others are approved only for treating diabetes. In Singapore, until recently, only liraglutide (sold under the brand name Saxenda) is currently approved for weight loss. There is also a form of semaglutide called Wegovy that has been recently approved for weight loss in Singapore.
For treating diabetes, there are more options. There are two different forms of semaglutide that are currently approved for use in Singapore – Ozempic, which is given by injection once a week, and Rybelsus, which is a tablet. Dulaglutide (Trulicity) and liraglutide (Victoza) are also approved for treating diabetes in Singapore. Although all of these medications have the potential to cause weight loss as a side effect, they’re primarily intended for helping to control blood sugar, and they’re generally only prescribed for this purpose.
Benefits of Semaglutide (Ozempic/Rybelsus/Wegovy), Liraglutide (Saxenda/Victoza), and other GLP-1 RAs
Blood sugar control
Diabetes is a condition in which a person's blood sugar levels are higher than usual. Keeping blood sugar under control is crucial for reducing the risk of the long-term complications of diabetes, such as vision loss, kidney disease, and nerve damage. Diabetes is usually diagnosed when a person has a fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher, or a hemoglobin A1c (HbA1c) level of 6.5% or higher.
GLP-1 RAs have been shown to control blood sugar effectively, making them an attractive option for many diabetes patients. For example, in a clinical trial in patients with type 2 diabetes (known as the Sustain 7 Study), Ozempic (the injectable form of semaglutide) was shown to lead to a reduction in hemoglobin A1c (HbA1c, a measure of average blood sugar) of up to 1.8% over 40 weeks.
GLP-1 RAs such as Semaglutide, Liraglutide, and Dulaglutide can be used on their own, in conjunction with lifestyle changes like exercise and taking a healthy diet. If needed, they can also be combined with other diabetes medications (such as metformin).
Weight loss
These medications have also been shown to result in weight loss, which may in turn help to reduce the risk of diabetes complications. Please note that only Saxenda and Wegovy are approved specifically for weight loss at this time. While other GLP-1 RAs may have weight loss as a side effect, they are not intended to be used for the purpose of controlling weight.
In order to be considered to be a candidate for receiving a GLP-1 RA for weight loss, a person must have a body mass index (BMI) indicating obesity. This means that body weight is high enough to cause a significant risk of health complications. Alternatively, they may have a slightly lower body weight, but are already experiencing complications due to their body weight (such as type 2 diabetes, high blood pressure, or high cholesterol).
Based on the available scientific research, the World Health Organization recommends slightly different cutoffs in body weight targets for Asian and non-Asian populations. To be a candidate for receiving a GLP-1 RA for weight loss, a person needs to meet one of the following criteria:
For non-Asians, a BMI of 30 or greater (indicating obesity), or a BMI of 27 or greater along with health complications of being overweight.
For Asians, a BMI of 27.5 or greater (indicating obesity), or a BMI of 23 or greater along with health complications of being overweight.
In multiple clinical studies of Saxenda, using the medication consistently resulted in weight loss of 4 to 6 kg. Nearly two-thirds of patients lost at least 5% of their body weight, and nearly one-third lost at least 10%. Meanwhile, with Wegovy, patients achieved 5%–20% or greater weight loss.
Reduction in risk of heart disease and kidney failure
GLP-1 RAs have been shown to have benefits for both the heart and kidneys. Semaglutide has been shown to reduce the risk of heart attack by more than 25% and to reduce the risk of stroke by 40% over the course of two years.
In addition, these medications reduce the risk of kidney failure. In one large study, people with diabetes who took semaglutide experienced a 15-20% improvement in kidney function over about a year and three months, while those taking a placebo experienced an 18% decline in their kidney function.
Different forms of GLP-1 RAs
For patients who are on injectable medication, Ozempic, Wegovy, and Trulicity may be attractive options because these are administered through once-weekly injections. Victoza and Saxenda are also injectable, but these forms are taken once per day. Note that Wegovy and Saxenda are the only versions that are approved specifically for weight loss, while the other forms are approved for diabetes treatment.
While most GLP-1 receptor agonists medications need to be taken through injections. Rybelsus is the first in this class of medication to be taken as a tablet. This makes it an attractive option for those who prefer to avoid injections. However, it does need to be taken daily, which some people consider to be more of a hassle than a weekly injection.
How to get the most benefit from Semaglutide (Wegovy, Ozempic & Rybelsus), Liraglutide (Saxenda), or Dulaglutide
To maximize the effectiveness of GLP-1 RAs, it is recommended to work on optimizing your diet and physical activity levels together with taking the medication.
Improving your nutrition and physical fitness will help with glucose control, make you feel more energetic, and help you get the most out of your day. It will also help to sustain the weight loss you experience.
Potential side effects of Semaglutide (Ozempic/Rybelsus/Wegovy), Liraglutide (Saxenda/Victoza), and other GLP-1 RAs
Like all medications, GLP-1 RAs can have side effects. Some of the most common side effects include:
Nausea and Vomiting
Constipation or Bloating
Headache
Heartburn
Abdominal Pain
Burping or Indigestion
Allergic Reaction (such as hives, swelling, or rash)
These side effects may be uncomfortable, but are usually not dangerous. However, an allergic reaction can be serious and should be reported to your doctor immediately. This is rare, but it can occur with any medication.
If you experience any of these side effects, you should consult your doctor to review your treatment plan. In many cases, lifestyle changes can help to manage the side effects. It’s also possible that your dose may need to be adjusted. Starting at a lower dose and gradually increasing it helps to give the body time to get used to the medication, which tends to reduce the side effects.
Where can I buy Semaglutide (Wegovy, Ozempic & Rybelsus), Liraglutide (Saxenda), and other GLP-1 RAs in Singapore?
These medications are not available over the counter. They can only be obtained by prescription, so you will need to consult a doctor in order to get them. Not all clinics in Singapore carry GLP-1 RAs such as Wegovy and Saxenda, so if this is an option that you’d like to explore, you should call the clinic to check before making an appointment. When it comes to the pricing, cost of a GLP-1 RA depends on the specific medication.
Medication alone isn’t enough. GLP-1 RAs, whether for weight loss or diabetes management, are most effective when paired with sustainable, healthy lifestyle habits that support long-term well-being.
As featured in CNA
“Medications containing semaglutide like Ozempic and Wegovy can play a crucial role in fighting the rise in obesity, but they must be seen as part of a toolkit alongside diet, exercise and behavioural support.” [5]
Meet our doctors
NOVI Health’s Optimum Plus Program, as featured on the Straits Times:
“Dr Sue-Anne Toh, co-founder of technology-enabled healthcare provider Novi Health, said the specialist clinic has received more requests from people for Ozempic, given the hype around the drug.
Patients will first have to consult a doctor to assess their suitability for the medication. If prescribed Ozempic, they will get consultations and digital coaching by Novi Health’s dietitian and health coach.
This ensures that patients are better supported to manage potential side effects, and get the most sustainable and optimal results with the medication.”