SINGAPORE – Wegovy, a higher-dose version of diabetes medication Ozempic whose weight loss side effects drew social media attention, has been approved by the Health Sciences Authority (HSA).

Adults who are obese, or who are overweight with at least one weight-related comorbidity such as high blood pressure, type 2 diabetes or high cholesterol, are eligible to take Wegovy.

The clinical trial results from using Wegovy have led it to be touted as a “blockbuster” drug, just like Ozempic, though the latter was designed to be an antidiabetic drug.

Twitter owner Elon Musk has even admitted that he used Wegovy, in addition to fasting, to help him shed weight.

Both drugs are manufactured by Denmark-headquartered pharmaceutical firm Novo Nordisk and contain the same active ingredient – semaglutide. 

Mimicking a natural hormone called glucagon-like peptide-1, semaglutide regulates blood sugar levels and works in the brain to induce the sensation of fullness, making the user eat less and curb appetite.

Self-administered weekly via a pre-filled injection pen, the dosage for both Ozempic and Wegovy starts at 0.25mg and is gradually increased over several months. 

The maximum dosage for Wegovy, which was approved here in February, is 2.4mg. The United States Food and Drug Administration (FDA) approved Wegovy for use, and recommended its use, in addition to a reduced calorie diet and increased physical activity, in 2021.

Ozempic was approved by the FDA in 2017 to have a maximum recommended dosage of 1mg weekly. In 2022, it approved a higher dosage of 2mg to provide additional blood sugar control.

Ozempic, which was approved for use in Singapore in April 2021, gained traction last year after users and celebrities raved about its weight loss attribute on TikTok.

The hashtag #ozempic on the platform has more than 741 million views, while #ozempicweightloss has racked up some 267 million views.

The surge in popularity caused a shortage of Ozempic in the United States, Australia and Europe, as doctors prescribed the drug off-label to non-diabetic individuals looking to lose weight. Diabetic patients scrambled to get their prescription or viable alternatives.

The term “off-label use” means that a drug is tapped for a medical condition or age group that it is not approved to treat, or administered in a different route or dosage not specified in the approved label.

The craze seems to have hit Singapore, with sellers on local e-commerce platforms looking to cash in. The HSA has removed four listings of Ozempic and Wegovy since the start of 2023.

Both drugs can be supplied only by a doctor or obtained through a prescription from a pharmacist.

An HSA spokesman said: “They contain potent ingredients which could lead to adverse effects if taken without medical supervision.”

Anyone who contravenes the prohibition on sale of prescription medicines may be fined up to $50,000 and/or jailed for up to two years under the Health Products Act, if convicted.

Many doctors worldwide have voiced concerns about the drugs. Some adverse reactions reportedly include gastrointestinal effects, liver and bile disorders, inflammation of the pancreas, increased heart beat and fatigue.

Users have also reported gaining back the weight they lost after dropping off either drug.

The HSA spokesman added: “(We) conduct careful and thorough evaluation to ensure that therapeutic products meet the requirements for safety, efficacy and quality, and that the benefits outweigh the risks, before they are approved for use in Singapore.”

Ozempic has been designated by the authority to treat insufficiently controlled type 2 diabetes mellitus, but it is allowed for off-label use.

However, the HSA stressed that doctors must use their clinical discretion, for which they are accountable. There must be a justifiable medical indication that using the drug off-label is in the patient’s best interest, that there is a rational basis for such use, and patients must be properly informed and agree to its use.

A handful of private clinics here offer Ozempic and are getting more requests from patients to be put on the drug, even if they do not have type 2 diabetes or are not obese.

Dr Muhd Taufiq Rashid, medical director at Pulse Medical Centre, said a few of his patients who see him for other conditions have asked him about Ozempic after it gained popularity online. Each Ozempic pen costs $408.30.

The clinic is considering bringing in Wegovy as there was also demand even before it was approved for use here, and it is getting more obese patients with health issues arising from their weight, he added.

Dr Taufiq has prescribed Ozempic to about 50 patients so far since the clinic started offering it in the middle of last year.

He prescribes it to patients who have diabetes and need to lose weight, are obese and have pre-diabetes, or are obese and are at high risk of getting diabetes.

“A few patients may find the side effects quite strong, but for most of them, it’s manageable. About two patients stopped using it but the rest continued and the symptoms got better,” he said.

Dr Sue-Anne Toh, co-founder of technology-enabled healthcare provider Novi Health, said the specialist clinic has received more requests from people for Ozempic, given the hype around the drug.

Patients will first have to consult a doctor to assess their suitability for the medication. If prescribed Ozempic, they will get consultations and digital coaching by Novi Health’s dietitian and health coach.

This ensures that patients are better supported to manage potential side effects, and get the most sustainable and optimal results with the medication.

The programme, which is inclusive of medication, costs $480 every four weeks or $1,200 for 12 weeks.

Dr Toh has encountered patients who get angry and demand to be on the drug, despite not fulfilling the required criteria.

The senior consultant endocrinologist said the buzz generated from social media and celebrities is worrying. She added that this has given Ozempic a “bad reputation” as people use it irresponsibly, even though it has helped patients with diabetes maintain their condition well and facilitated healthy weight loss.

“When it comes to weight loss, people often look for this magic bullet that will miraculously solve everything. But we are very clear what our mission is, which is to ensure that quality healthcare is accessible and people are empowered to live healthier lives in a sustainable manner.”

A former Ozempic patient here said he wanted to use the drug to address his health issues such as obesity, as well as heart palpitations and high blood pressure.

He has a family history of diabetes and had gained a lot of weight during the Covid-19 lockdown.

The 48-year-old teacher, who declined to be named, was very pleased with the results after taking the drug for about nine months in 2022. He went from 115kg to 79kg.

He noted that taking Ozempic allowed him to “reset his relationship with food” as he learnt to control his impulses.

However, he did suffer side effects such as nausea for two to three days after he updosed, lethargy and constipation.

He switched to Rybelsus, an oral tablet that also contains semaglutide, in November as a result of the global shortage. He said he will continue to take it for maintenance as he fears gaining all the weight back.

Rybelsus, which was approved by the HSA in June 2021, has been indicated to be used for the treatment of adults with insufficiently controlled type 2 diabetes mellitus to improve glycaemic control as an adjunct to diet and exercise.

“It’s a serious commitment. If you don’t want to be on a drug for an extended period, then you shouldn’t get involved with these medications.”