What semaglutide is

Semaglutide is a synthetic analogue of the human hormone GLP-1, developed by Novo Nordisk and approved across more than 80 countries. It is the most studied GLP-1 receptor agonist in clinical medicine today.

The same molecule is sold under three brand names for three different indications:

Following the expiry of Novo Nordisk's compound patent on semaglutide in India on 20 March 2026, multiple licensed Indian pharmaceutical companies have launched generic semaglutide preparations under various brand names. The active molecule is the same; the difference lies in manufacturing source, device, and supply reliability.

How semaglutide works

Semaglutide binds to GLP-1 receptors expressed in the pancreas, gut, brain, heart, and kidney. It:

Its long half-life (~7 days) is achieved through fatty-acid acylation that lets it bind albumin in the bloodstream, allowing once-weekly dosing.

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The evidence, briefly

STEP-1 — the obesity registration trial

STEP-1 (Wilding et al., New England Journal of Medicine, 2021). 1,961 adults with overweight or obesity, no diabetes, randomised 2:1 to semaglutide 2.4 mg or placebo for 68 weeks. Mean weight loss: 14.9% vs 2.4%. 86.4% achieved ≥5% weight loss; 50.5% achieved ≥15%.

STEP-2 — semaglutide in T2D + obesity

STEP-2 (Davies et al., Lancet, 2021). In adults with T2D and obesity, mean weight loss with semaglutide 2.4 mg was 9.6% versus 3.4% on placebo; HbA1c fell by approximately 1.6 percentage points. See our diabetes guide for the broader T2D context.

SUSTAIN-6 — cardiovascular outcomes in diabetes

SUSTAIN-6 (Marso et al., NEJM, 2016). 26% relative reduction in major adverse cardiovascular events in patients with T2D over ~2 years.

SELECT — cardiovascular benefit without diabetes

SELECT (Lincoff et al., NEJM, 2023). In 17,604 patients with cardiovascular disease and obesity but no diabetes, semaglutide 2.4 mg cut MACE by 20% — extending cardiovascular protection beyond the diabetic population.

STEP-HFpEF — heart failure with preserved ejection fraction

STEP-HFpEF (Kosiborod et al., NEJM, 2023). In patients with obesity-related heart failure with preserved ejection fraction, semaglutide 2.4 mg significantly improved Kansas City Cardiomyopathy Questionnaire scores and six-minute walk distance.

FLOW — kidney disease outcomes

FLOW (Perkovic et al., NEJM, 2024). 24% reduction in the composite of major kidney disease events, cardiovascular death and all-cause mortality in patients with T2D and CKD.

Dosing and titration

For chronic weight management (Wegovy or equivalent), the standard escalation is:

This stepwise increase is not a marketing artefact — it is how the GI side effects are minimised. Some patients tolerate faster titration; others need to remain on a lower dose for longer. Your Kaivo doctor will personalise it.

Side effect profile

The dominant side effects are gastrointestinal: nausea (most common, usually mild), diarrhoea, constipation, occasional vomiting, reflux, and burping. In STEP-1, ~4.5% discontinued semaglutide for GI reasons vs 0.8% for placebo. Less commonly: gallstones (linked to rapid weight loss in general, not unique to semaglutide), pancreatitis (rare; stop the drug and seek evaluation if you develop severe persistent abdominal pain radiating to the back), and injection-site reactions.

Real-world adherence studies suggest 30–50% of patients discontinue within 12 months — usually because of GI tolerability or because they perceive they have achieved their goal. The latter is a problem: stopping leads to weight regain unless lifestyle is firmly entrenched.

Pregnancy and breastfeeding

Semaglutide is contraindicated in pregnancy and breastfeeding, and women of childbearing potential should use effective contraception. Because of the drug's long half-life, it should ideally be stopped at least 2 months before attempting conception.

Storage, injection, and the Indian context

Semaglutide pens require refrigeration at 2–8°C before first use. Once started, most formulations can be kept at room temperature (below 30°C) for up to 4–6 weeks depending on the specific product label. In Indian conditions — particularly during May–June heat and monsoon humidity — cold-chain integrity from pharmacy to your home matters. Use cool packs for transport, store at the back of the refrigerator (not the door), and never freeze the pen.

Inject subcutaneously into the abdomen, thigh, or upper arm. Rotate sites. Pinch a fold of skin, insert at 90 degrees, count to six after delivery before withdrawing. Same day each week — pick a day you'll remember (many patients pick Sunday).

Wegovy and generics in India

Wegovy (semaglutide 2.4 mg) was launched in India by Novo Nordisk in June 2025, including via the Poviztra brand through their partnership with Emcure Pharmaceuticals. Following patent expiry in March 2026, licensed Indian manufacturers — including Sun Pharma, Dr Reddy's, Cipla, Natco, Alkem and others — have introduced approved generic semaglutide products in both vial and pen formats.

What to expect, week by week

This is a chronic therapy. Treating it as a six-month course is a common and costly mistake. Compare with the deeper-response alternative — tirzepatide — in our tirzepatide guide, or read about Mounjaro, the Indian brand of tirzepatide.

  1. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP-1). N Engl J Med. 2021;384(11):989–1002.
  2. Marso SP, Bain SC, Consoli A, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (SUSTAIN-6). N Engl J Med. 2016;375(19):1834–1844.
  3. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). N Engl J Med. 2023;389(24):2221–2232.
  4. Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (STEP-HFpEF). N Engl J Med. 2023;389(12):1069–1084.
  5. Perkovic V, Tuttle KR, Rossing P, et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes (FLOW). N Engl J Med. 2024;391(2):109–121.