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In Singapore, semaglutide, known as Ozempic and Rybelsus (for type 2 diabetes) and Wegovy (for weight loss), is a trending topic of interest and discussion, due to its popularity and effectiveness for the treatment of diabetes and obesity. Interest peaked in 2022-2024 when high-profile individuals such as Elon Musk and Oprah Winfrey posted on their social media accounts that they were taking this medication for weight management, leading to surging global demand and widespread supply shortages. In this guide, we will discuss in detail the mechanism of action of semaglutide, outcomes of semaglutide treatment (based on a review of clinical trials) and side effects that patients must know before starting treatment.
Semaglutide is a medication that mimics a natural hormone in the body called GLP-1 (glucagon-like peptide-1). GLP-1 is involved in regulating blood sugar levels and controlling appetite. Semaglutide works in several ways:
Semaglutide is used in the treatment of type 2 diabetes (to help manage blood sugar levels) and obesity (to support weight loss), under the brand names Rybelsus, Ozempic and Wegovy.
Semaglutide (Ozempic, WeGovy and Rybelsus) has been extensively studied, with multiple clinical studies proving that it is safe and effective in the treatment of type 2 diabetes, obesity, chronic kidney disease and cardiovascular disease
Semaglutide, a GLP-1 receptor agonist, has been shown in multiple clinical trials to be effective for the treatment of type 2 diabetes. Several landmark clinical trials have been conducted to measure semaglutide effectiveness in reducing HbA1c (a key marker for diabetic control), as well as its effects on obesity and cardiovascular risk. These are the SUSTAIN and STEP trials.
TLDR summary of SUSTAIN trials: Diabetic and overweight patients controlled their diabetes and lost weight when treated with Ozempic, even more so as compared to standard diabetic medication.
In the SUSTAIN 1-7 series of clinical trials which investigated the effectiveness of once weekly semaglutide injections (Ozempic) for the treatment of diabetic and obese patients, semaglutide (Ozempic) consistently demonstrated significant reductions in HbA1c levels compared to placebo and other usual diabetes medications (metformin, sitagliptin, dulaglutide). In addition, diabetic patients treated over a 30-56 week period experienced 4.5-6.5kg weight loss.
TLDR summary of STEP 1 trial: Patients treated with high dose once weekly semaglutide 2.4mg injections (WeGovy) lost a significant amount of weight over a 68-week period
The STEP 1 clinical trial, published in the New England Journal of Medicine in 2021, involved 1961 adult patients with obesity (BMI >30) or overweight (BMI >27 with 1 obesity-related comorbidity). The patients were randomised into the treatment arm with once-weekly semaglutide 2.4mg (WeGovy) versus placebo. After 68 weeks, the patient group treated with once-weekly semaglutide 2.4mg (WeGovy) experienced significant weight loss of 14.9% body weight reduction versus 2.4% placebo group. The average amount of weight loss in the treatment group was 15.3kg, as compared to 2.6kg in the placebo group. Most of the patients treated with WeGovy lost a significant amount of weight: 32% of patients lost over 20% body weight, 50.5% of patients lost over 15% body weight loss, 69.1% achieved 10% body weight loss and 86.4% achieved 5% body weight loss. Nausea and diarrhoea were the most common side effects which were transient and improved with time, with less than 5%
TLDR summary: The SUSTAIN 6 trial looked at the cardiovascular outcomes (cardiovascular death, heart attack and stroke) in high cardiovascular risk diabetic patients being treated with semaglutide (Ozempic) versus placebo- with the results showing a significant 26% reduction in cardiovascular death, heart attack and stroke in patients being treated with semaglutide (Ozempic)
The SUSTAIN 6 trial published in the New England Journal of Medicine showed that in patients with type 2 diabetes who were at high cardiovascular risk.
rate of cardiovascular death, nonfatal myocardial infarction (heart attack), or nonfatal stroke was significantly lower among patients receiving semaglutide (Ozempic) than among those receiving placebo. 3297 patients with type 2 diabetes were treated with once-weekly semaglutide injections (0.5 mg or 1.0 mg Ozempic) or placebo for 104 weeks. The primary outcome was cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. At baseline, 2735 of the patients (83.0%) had established cardiovascular disease, chronic kidney disease, or both. The primary outcome occurred in 108 of 1648 patients (6.6%) in the semaglutide treatment group and in 146 of 1649 patients (8.9%) in the placebo group- representing a 26% reduction in risk.
The effects of semaglutide (Ozempic, WeGovy and Rybelsus) on diabetes, hypertension, hyperlipidemia and obesity are well established- there are several emerging benefits of semaglutide that are an area of active research.
In recent years there have been a large number of case reports of women who were thought to be infertile becoming pregnant after being treated with Ozempic or semaglutide. The link between Ozempic and Fertility is still a topic of active research and is thought to be due to improved hormonal regulation that comes with weight loss. Ozempic is not used as a fertility treatment and is not recommended for pregnant or breastfeeding women.
In a randomized clinical trial with 48 participants, low-dose semaglutide (Ozempic 1mg) reduced the amount of alcohol consumed by patients with alcohol use disorder, and reduced cravings for alcohol and cigarettes, over 9 weeks. Another clinical study found reduced rates of alcohol use-related hospitalisations amongst patients being treated with Ozempic.
Currently, Semaglutide (Wegovy) is undergoing clinical trials to investigate its effectiveness in treating Non-Alcoholic Fatty Liver Disease which is also known as Metabolic Dysfunction associated steatotic liver disease, with US FDA approval pending. The mechanism of action of Semaglutide in treating fatty liver is thought to be indirect, through weight loss, although metabolic changes at the level of the mitochondria have been proposed.
Semaglutide (Ozempic, WeGovy and Rybelsus) has been in clinical use for over 20 years with its side effect profile well studied in clinical trials- Side effects from Semaglutide are generally mild and subside with time, with most symptoms improving after the initial 1-2 months.
Gastrointestinal side effects:
Nausea, vomiting, diarrhea, constipation
Neurological side effects:
Headache, dizziness
Ozempic Face:
Sagging skin and sunken hollow faces from weight loss
Rare but potentially significant side effects include:
Hepatobiliary risks: Gallstones, pancreatitis
Read more here for an in-depth discussion of the side effects and risks of Ozempic and WeGovy.
Due to a global supply shortage of medication, it is common for patients to need to convert between the different formulations of semaglutide (Ozempic, WeGovy and Rybelsus). WeGovy has been approved in Singapore but stocks have not yet arrived (estimated to become available in 2026), so patients started on Wegovy by their doctors overseas will have to convert to Ozempic when they are in Singapore. Ozempic and WeGovy contain the same key ingredient semaglutide and may be used interchangeably.
Ozempic supplies in Singapore are also inconsistent, with frequent supply shortages. In times of shortage, Ozempic stocks are diverted to government hospitals, with the treatment of subsidised patients with poorly controlled diabetes given priority. Hence, it is common for patients who were previously on Ozempic to need to switch to oral semaglutide (Rybelsus) or daily liraglutide injections (Saxenda).
Semaglutide (Ozempic, WeGovy and Rybelsus) are prescription medications that are only available at licenced medical clinics and hospitals. A doctor's consultation is required to determine medical suitability before the medication can be prescribed. Do not purchase these prescription medications from dubious online sources or from overseas. Due to the popularity of the medications, counterfeit and tainted products are common and patients need to ensure they obtain authentic medications from a reputable source. Do not accept the medication if it has been opened or the seal is broken.
WeGovy is not yet available in Singapore via official channels- any person or clinic who claims to have a supply of WeGovy is definitely not being completely honest. WeGovy is expected to be available in Singapore in 2026, and the prices of WeGovy are not fixed yet. Patients who were taking Wegovy from overseas clinics need to switch to Ozempic or Rybelsus in Singapore.
Ozempic is available in Singapore although supply may be an issue. The price of Ozempic ranges from $500-800 per box (4x1mg dosage).
Rybelsus is available in Singapore, price of Rybelsus ranges from $400-600 per box (3,7 and 14mg dosage).
To minimise side effects and allow the body to acclimatise to the medication, it is recommended to start Ozempic or Wegovy at a low dose of 0.25mg or 0.5mg per week for 1 month, before increasing to a medium dose of 1mg per week. Thereafter, depending on the effects of the medication and clinical requirements, the dosage may need to be increased to the maximum dose of 2mg (Ozempic) or 2.4mg per week (Wegovy).
Semaglutide (WeGovy, Ozempic and Rybelsus) is safe and effective for the treatment of diabetes, and obesity and reduces adverse cardiovascular outcomes. Further research is required to investigate the effect of semaglutide treatment on fatty liver, alcohol use disorder and fertility.
