Semaglutide
Semaglutide (Ozempic / Wegovy / Rybelsus) — evidence & status

Class: peptide
Synonyms: semaglutide
GLP-1 receptor agonist
Ozempic (type-2 diabetes brand)
Wegovy (obesity brand)
Rybelsus (oral brand)
Function tags: metabolic
type-2 diabetes
obesity / weight
cardiovascular / kidney (all approved)
Overall evidence grade: A
WADA prohibited: no
WADA note: Sport: GLP-1 receptor agonists are not currently on the WADA Prohibited List (unlike the GH secretagogues in this register).
Last updated: 2026-07-13

In brief: Semaglutide is a GLP-1 receptor agonist and one of the most-prescribed medicines in the world — FDA-approved for type-2 diabetes (Ozempic), obesity (Wegovy) and oral T2D (Rybelsus), with expanded cardiovascular and kidney indications. Its efficacy rests on one of the largest Phase 3 programmes in modern medicine (grade A). The compounded version that flooded the market is now largely prohibited following the February-2025 shortage resolution.

## Identity an **acylated GLP-1 analog** — a ~31-amino-acid peptide (< 40 aa → peptide) based on human GLP-1(7-37) with substitutions plus a C18 fatty-diacid chain that binds albumin, giving a long half-life (once-weekly injection; also an oral tablet formulation). It is marketed under the trade names **Ozempic** (type-2 diabetes), **Wegovy** (obesity/weight management) and **Rybelsus** (oral tablet). ## Mechanism (as proposed) a GLP-1 receptor agonist — enhances **glucose-dependent insulin** secretion, suppresses **glucagon**, **slows gastric emptying**, and reduces **appetite** centrally → glycemic control and weight loss.

## Related reading

See also (cosmetic): [Skincare on GLP-1s — "Ozempic face"](/learn/ozempic-face-skincare). Rapid weight loss on this drug can drive visible facial changes (hollowing, laxity, lines); this is an appearance effect of fast weight loss, not a dosing or safety matter.

Evidence grades by outcome:
outcome: Type-2 diabetes glycemic control
grade: A
base: SUSTAIN Phase 3; FDA-approved
effect: Robust HbA1c reduction
caveat: —
outcome: Chronic weight management (obesity)
grade: A
base: STEP Phase 3 (~15% subQ); OASIS (oral); FDA-approved
effect: Substantial weight loss
caveat: Effect wanes if stopped; GI tolerability
outcome: Cardiovascular risk reduction
grade: A
base: SELECT (Wegovy), SOUL (oral); FDA-approved
effect: Reduced major CV events
caveat: —
outcome: Kidney (T2D + CKD)
grade: A
base: FLOW; FDA-approved (2025)
effect: Reduced eGFR decline / ESKD / CV death
caveat: —
outcome: Safety
base: Large trials + post-marketing
effect: Well-characterised
caveat: GI effects (nausea/vomiting/diarrhea); labeled risks; requires clinical oversight

Legal status:
region: US
status: Approved / prescription
note: FDA-approved across multiple indications (Novo Nordisk brands only). Compounding: the injection shortage was declared resolved on 21 Feb 2025; the 503A/503B compounder phase-out deadlines have passed, so compounded semaglutide is now largely prohibited (narrow patient-specific exceptions aside). Gray-market and counterfeit "semaglutide" is unapproved and a documented safety risk.
region: EU
status: Approved / prescription
note: approved (EMA) as Ozempic / Wegovy / Rybelsus.
region: INT
status: widely approved
note: widely approved.

Cosmetic claims:

Note: Reference entry — explicitly NOT a sellable lane. Semaglutide is a patented, FDA-approved blockbuster prescription drug; it cannot be sold here as a cosmetic or "research" peptide, and compounded copies are now largely prohibited (below). It sits in the register for reference and completeness — the highest-demand, least-sellable case in the whole space (dominated by pharma and medical authorities). No dosing published here.

Sources:
SUSTAIN, STEP, SELECT, FLOW, SOUL, OASIS Phase 3 programmes; FDA prescribing information (Ozempic/Wegovy/Rybelsus); FDA Declaratory Order resolving the semaglutide shortage (Feb 2025).