A GLP-1 receptor agonist used for weight management and type 2 diabetes. Effective, and not a decision to take lightly.
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Semaglutide is a GLP-1 receptor agonist. It mimics a gut hormone released after eating, which slows stomach emptying, increases the sense of fullness, and reduces appetite — including the background preoccupation with food that many people describe as food noise.
It is given as a weekly injection, or daily as a tablet in one preparation. Different brand names correspond to different licensed indications and dose ranges: some are licensed for type 2 diabetes, others for weight management.
Eligibility is defined by licensed criteria — typically a BMI threshold, adjusted downward where weight-related health conditions are present, and adjusted for some ethnic groups in whom risk occurs at lower BMI.
Injected under the skin of the abdomen, thigh or upper arm, once weekly on the same day. Rotate the site.
The dose is increased gradually over months, starting low. This is deliberate and not a delaying tactic — escalating too quickly is the main cause of intolerable nausea and of people abandoning treatment.
The oral preparation has strict instructions: on waking, with a small sip of water, at least 30 minutes before anything else.
If a weekly dose is missed, it can usually be taken within a few days; beyond that, skip it. Check with your prescriber.
Gastrointestinal effects are very common, particularly when starting or increasing the dose: nausea, vomiting, diarrhoea, constipation, burping and reflux. Most ease with time and slower dose escalation.
Other recognised effects include fatigue, headache, dizziness and injection site reactions.
The ones that matter more:
What happens when you stop is part of the honest picture. Appetite returns, and weight regain after stopping is well documented and substantial in trials. This is a long-term treatment, not a course.
Caution with diabetic retinopathy, where rapid glucose improvement can temporarily worsen it.
Slowed stomach emptying affects the absorption of other oral medicines, including some antibiotics and, importantly, the combined oral contraceptive pill — relevant given the pregnancy warnings.
Insulin and sulfonylureas combined with a GLP-1 raise hypoglycaemia risk; doses often need reducing.
Before starting: HbA1c, kidney function, liver function, thyroid function and a lipid profile.
During treatment: regular weight and blood pressure, repeat bloods, and review of tolerance and effect. Anyone not achieving a meaningful response by a defined point should stop rather than continue indefinitely.
Where clinically appropriate and where licensed criteria are met, yes — but this is a medicine we assess carefully rather than supply on request, and it is worth being direct about what that means.
What we do first: establish why the weight is where it is. Thyroid disease, PCOS, insulin resistance, Cushing's and a long list of ordinary prescriptions all cause weight gain, and several are reversible. A BMI number alone does not exclude any of them.
What we require: baseline bloods, a full history including eating patterns and any history of disordered eating, and a discussion about what happens when treatment stops.
What we will not do: prescribe below licensed BMI criteria, prescribe for cosmetic weight loss in someone of healthy weight, prescribe without bloods, or prescribe where an eating disorder is present or suspected.
We would also point out honestly that a dedicated weight-management provider may serve you better for the ongoing programme — structured coaching and weekly support materially improve outcomes on these drugs, and a periodic GP appointment is not a substitute. See our comparison of the two models.
This page is information, not an offer to supply.
This is the expensive one, and we would rather be straight about it than let you find out later.
Semaglutide for weight loss is not available on the NHS for most people. NHS access is restricted to specialist weight management services with strict criteria and, in most areas, a long wait. Privately, you pay the full cost of the drug every month.
Expect a monthly drug cost in the low hundreds of pounds, varying by dose — the higher maintenance doses cost more than the starting ones. Pharmacy prices differ, and it is entirely reasonable to ring more than one. We do not sell the medication, so we have no interest in where you buy it.
Never buy semaglutide from a seller that does not require a consultation, or from a social media account. Counterfeit pens containing insulin have caused hospital admissions in the UK. There is no legitimate cheap source.
The honest position: appetite returns, and for most people so does the weight. Trial data shows the majority of lost weight is regained within a year or so of stopping.
That is not a reason not to take it — it is a reason to understand what you are starting. Semaglutide treats the biology of appetite while you take it; it does not permanently reset it.
The habits built while the medication is quieting appetite are what carry over. Protein intake, resistance training to protect muscle, and a food pattern you could sustain without the drug.
Weight lost on a GLP-1 includes meaningful muscle, and if it is regained as fat the body composition ends up worse than at the start. Strength training is not optional advice here.
No taper is required medically, though stepping down often makes the return of appetite less abrupt.
Stop immediately and seek advice if you become pregnant, and stop for severe persistent abdominal pain, which needs urgent assessment for pancreatitis.
Switching between semaglutide and tirzepatide is done at an equivalent starting dose rather than dose-for-dose, and needs re-titrating. It is not a swap to improvise, and supply shortages are a poor reason to do it unsupervised.
Most people do, and we would rather say so plainly. Trials show the majority of lost weight returns within about a year of stopping.
Treat it as a long-term medication rather than a course, and use the time to build habits that survive without it.
Only through specialist weight management services, with strict criteria and long waits in most areas.
For the great majority of people it is a self-pay medicine, and the cost is ongoing.
Because going faster causes nausea and vomiting, not because it works better slowly. Four weeks at each step is the licensed schedule.
Rushing the titration is the commonest reason people stop.
Nausea, constipation, reflux and burping are common, particularly after each dose increase. They usually settle within a week or two at each step.
Smaller meals, less fatty food and stopping when full make a substantial difference.
No, and this is genuinely dangerous. Counterfeit pens sold as semaglutide have contained insulin and caused hospital admissions in the UK.
Any seller that does not assess you is not a pharmacy.
Some, yes — rapid weight loss always includes lean tissue.
Resistance training two or three times a week and adequate protein substantially reduce it. This matters more than most providers mention.
Vomiting can reduce absorption of an oral contraceptive. Use additional precautions if you are vomiting.
Pregnancy should be avoided on semaglutide, and fertility can improve as weight falls — which catches people out.
In moderation, though many people find they want it less. Alcohol worsens the nausea and adds calories that undermine the point.
Stop the medication and seek urgent medical assessment. Severe, persistent abdominal pain radiating to the back can indicate pancreatitis.
This is the one symptom not to wait on.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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