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For unopened pens, this date applies as long as they are stored correctly (usually refrigerated)

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Key considerations include: Disease activity status : Active inflammation may increase susceptibility to adverse effects Nutritional state : Patients already experiencing malabsorption or weight loss may not be appropriate candidates for medications that further reduce appetite Stricture presence : Delayed gastric emptying could theoretically worsen symptoms in patients with bowel narrowing Medication interactions : While subcutaneous semaglutide has minimal effects on most oral drug absorption, specific medications (such as levothyroxine with oral semaglutide/Rybelsus) may require monitoring Hypoglycemia risk : For patients with diabetes using insulin or sulfonylureas, dose reductions of these medications may be needed when starting semaglutide Diabetic retinopathy : Patients with pre-existing diabetic retinopathy should be monitored for worsening eye disease There is currently insufficient evidence to provide definitive guidance, making shared decision-making between patient and healthcare team essential

This twincretin approach is why many clinical discussions focus on whether tirzepatide offers a more potent metabolic effect

Effects of Semaglutide on Heart Failure Outcomes in Diabetes and Chronic Kidney Disease in the FLOW Trial

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