| Name | Zofran (ondansetron) + Semaglutide (GLP-1 receptor agonist), available in both branded (Wegovy®, Ozempic®) and compounded forms. |
| Uses | Elective use in adult patients with a BMI ≥25 for weight loss and metabolic optimization. Zofran helps reduce nausea associated with Semaglutide. Not indicated for diabetes in this setting. |
| Route Of Administration | Semaglutide: subcutaneous injection weekly. Zofran: oral tablet (as needed), typically taken before or after semaglutide dose. |
| Frequency Of Use | Semaglutide: once weekly. Zofran: max 2 doses daily (PRN). Reassess semaglutide dosing every 4 weeks. |
| Concentration(s) | Branded: Wegovy® (0.25 mg, 0.5 mg, 1.0 mg, 1.7 mg, 2.4 mg doses); Ozempic® (0.25 mg, 0.5 mg, 1.0 mg). Compounded: 0.25–2.5 mg/mL. Zofran: 4 mg or 8 mg tablets. |
| Maximum Dosage (Day, Wk) | Semaglutide: do not exceed 2.4 mg/week (branded max). Compounded max: 2.5 mg/week. Zofran: max 16 mg/day (8 mg twice daily). |
| Contraindications | Absolute: History of medullary thyroid carcinoma (MTC) or MEN2, pancreatitis, gastroparesis, pregnancy/lactation. Zofran: hypersensitivity, congenital long QT syndrome. Relative: gallbladder disease, electrolyte disturbances, renal impairment. |
| Possible Side Effects | Semaglutide: nausea, vomiting, fatigue, GI upset, constipation, potential pancreatitis. Zofran: headache, constipation, dizziness, rare QT prolongation. |
| Compatibility With Other Treatments/Drugs | Avoid concurrent QT-prolonging drugs. Caution with sulfonylureas or insulin (risk of hypoglycemia). No known interactions between semaglutide and Zofran. |
| Allergies | Zofran: allergic reactions to ondansetron or other 5-HT3 antagonists. Semaglutide: sensitivity to polyethylene glycol or excipients in compound. |
| Administration Time | Semaglutide: inject weekly on the same day. Zofran: take 30–60 minutes before semaglutide dose if prone to nausea. |
| Dosing/Settings | Semaglutide: start at 0.25 mg weekly x 4 weeks, increase to 0.5 mg, then to 1.0 mg and higher as tolerated. Zofran: 4–8 mg PO PRN up to BID. |
| Test Spot Requirement | Not required. Begin semaglutide at the lowest dose to assess tolerance. Consider extra monitoring for first-time users. |
| Pre-Treatment Guidelines | Patient should be well-hydrated, eat light meals, and avoid alcohol. Recommend baseline labs (CBC, CMP, lipids, A1c optional). |
| Provider Clearance Guidelines | Confirm patient is ≥18, has BMI ≥25, no high-risk contraindications. Labs and full GFE completed. Defer if nausea is unmanageable even with Zofran. |
| Pre-Treatment Screening Workflow | 1. BMI ≥25. 2. Confirm absence of thyroid cancer, pancreatitis, or severe GI disease. 3. Confirm Zofran tolerance or no allergy. 4. Review consent and offer nausea management tips. |
| What To Do If Adverse Reaction Occurs | 1) Stop semaglutide. 2) For nausea: administer Zofran 4–8 mg. 3) If signs of pancreatitis (abdominal pain, vomiting), refer to ER. 4) Monitor vitals, document in EMR, notify physician. |
| Clinic Implementation Guidelines | Front desk: confirm exam and consent completed. Provider: review GFE, prescribe both meds. Supplies: semaglutide vial, Zofran tablets, injection supplies, sharps container. |
| Photographic Documentation Protocol | Optional. For weight management programs: take photos (front, side, back) at baseline and monthly intervals with patient consent. |
| Post-Treatment Care | Hydration, eat smaller low-fat meals, avoid overeating. Follow-up every 4 weeks. Adjust dose based on symptoms and weight loss progress. |
| Additional Documentation Requirements | Signed consent for semaglutide and Zofran, injection log, weight tracking, documentation of side effects, dosing rationale, and adverse event reporting. |