14.9%

Average weight change at 68 weeks in adults with obesity, against 2.4% on placebo

STEP-1, NEJM 2021

20%

Lower relative risk of heart attack, stroke or cardiovascular death in adults with obesity and established heart disease, 6.5% against 8.0% over a mean 3.3 years

SELECT, NEJM 2023

24%

Lower relative risk of major kidney events in adults with type 2 diabetes and chronic kidney disease

FLOW, NEJM 2024

These are averages from trials, not a result from this clinic and not a prediction for you. The 20% figure in SELECT is a relative reduction, hazard ratio 0.80; in absolute terms it is 1.5 percentage points over a mean 3.3 years, which means about 67 people have to be treated for that time for one to avoid an event. Both numbers are true and both are worth knowing.

How it works

It acts on the receptor for one gut hormone, GLP-1, that the body releases after a meal. You feel full sooner, you stay full for longer, and food leaves the stomach more slowly. In type 2 diabetes it also helps the pancreas release insulin when blood sugar is high. Tirzepatide acts on this receptor and on a second one, which is the main reason the average weight change is larger with tirzepatide.

Who it is for

Approved in India for adults with obesity, or with excess weight and a weight-related health problem, and for adults with type 2 diabetes. It is worth saying plainly that the two indications are held by different products. Some semaglutide products sold in India are approved for type 2 diabetes only, and prescribing one of those purely for weight in a person without diabetes is off-label use, which your doctor should tell you about and record.

Who must not take it

You or a close blood relative has had medullary thyroid cancer, or you have MEN2.
You are pregnant, trying to conceive, or breastfeeding.
You have had a serious allergic reaction to this medicine before.

Tell your doctor before starting if

You have had pancreatitis or gallstones.
Your stomach empties very slowly, or you have been told you have gastroparesis.
You have diabetic eye disease.
You have kidney disease.
You take insulin, or a sulfonylurea such as glimepiride or gliclazide.

How the dose is built up

When	Weekly dose	What it is for
Weeks 1 to 4	0.25 mg	Getting your stomach used to it. A starting dose, not a treatment dose.
Weeks 5 to 8	0.5 mg	First treatment dose.
Weeks 9 to 12	1 mg	Products approved for type 2 diabetes in India stop here.
Weeks 13 to 16	1.7 mg	Weight management products only.
Week 17 onwards	2.4 mg	The maintenance dose for weight. This is the dose STEP-1 and SURMOUNT-5 used.

Steps are four weeks apart at the earliest. Staying eight weeks instead of four is a perfectly reasonable decision if you are uncomfortable, and it is often the difference between continuing and stopping.

Taking it

Once a week, on the same day, at any time of day, with or without food.
Under the skin of the tummy, thigh or upper arm. Use a different spot each week.
If you miss a dose: take it if 5 days or less have passed. If more than 5 days have passed, skip it and take the next dose on your usual day.
To change your injection day: keep at least 3 days between the last dose and the next.
Storage: in the fridge, not the freezer, away from heat and light. Once in use, many pens may be kept at room temperature for a limited number of weeks; the leaflet in your box is the one that applies to your product. See the storage page for power cuts and travel.

If your product is a vial rather than a pen. Vials are common in India and they are where dosing errors happen, because you draw the dose up yourself. Use a U-100 insulin syringe, not a U-40 one. Have the first draw demonstrated in clinic. Ask for the dose to be written on the prescription in units as well as milligrams, and check it every time.

Side effects

Nausea, loose motions, constipation, vomiting, indigestion and less appetite are the common ones. They are worst in the first weeks and after each dose increase, and for most people they settle. More practical advice is on the side effects page.

Stop the injection and contact us the same day if you have:

Severe tummy pain that does not settle, especially if it goes through to your back.
Pain under the right ribs with fever, or yellow eyes.
Vomiting or loose motions so bad that you cannot keep fluids down.
Low sugar symptoms if you also take insulin or a sulfonylurea.
Swelling of the face, lips or throat, or difficulty breathing. Call 108.

Two things people are not told

Surgery, endoscopy or sedation. Tell the doctor and the anaesthetist, because food stays in the stomach longer than usual. They may ask you to hold a dose.
Muscle. Some of the weight lost is muscle unless you eat enough protein and do strength exercise. See the protein and muscle pages.

Why it is sometimes the better choice than tirzepatide

On weight alone, the head-to-head trial favours tirzepatide: 20.2% against 13.7% over 72 weeks (SURMOUNT-5, NEJM 2025). But weight is not the only outcome.

Heart. SELECT was a placebo-controlled trial in 17,604 adults with obesity and established cardiovascular disease but no diabetes, followed for a mean of 3.3 years, and it showed fewer heart attacks, strokes and cardiovascular deaths. Only about a third of the benefit was explained by the reduction in waist, so most of it is not simply a weight effect. Tirzepatide has no equivalent trial in this population yet.
Kidney. FLOW showed slower progression of kidney disease in type 2 diabetes.
Liver. ESSENCE showed benefit in metabolic fatty liver disease with scarring.
Cost. Since the Indian product patent expired in March 2026, Indian-made semaglutide has become far cheaper than tirzepatide, and for most patients paying out of pocket that is the deciding fact.

If you have had a heart attack or a stroke, that evidence can reasonably outrank the weight difference. That is a judgement for the consultation, not for a web page.

Indian-made semaglutide

The Indian product patent expired on 20 March 2026 and a number of Indian manufacturers now make semaglutide. These are lawful generics approved by the national regulator, most on Indian bioequivalence studies. They are not compounded or grey-market product, and it is wrong to suggest that they are. Three honest caveats:

The outcome trials above were run with the originator product. Bioequivalence supports the same effect, but that is an inference rather than a separate result.
A separate formulation patent runs to 2031, so many Indian products come as vials or reusable cartridge pens rather than prefilled disposable pens. Device handling is where real-world dosing errors happen.
Most Indian semaglutide products are approved for type 2 diabetes rather than for weight. Only a few carry a weight indication. Ask which one you have been given, and why.

Where money is the binding constraint, a medicine taken for two years beats a more effective one taken for three months. That is not second best. On the outcome that matters it is the right answer, and the treatment options planner works it out with you.

What it costs

Originator pens hold four weekly doses, so a pen is roughly a month. Indicative prices in September 2026 run from about ₹5,660 a pen at 0.25 mg to about ₹8,999 a pen at the 2.4 mg weight maintenance dose. More than one originator brand is sold in India now, at different prices, so what you pay at a given dose depends on which one your pharmacy stocks: the dearer brand runs to about ₹16,400 at 2.4 mg. Prices were cut twice, in November 2025 and again on 31 March 2026, and many websites still quote the older, higher figures.

If you are quoted nearer ₹16,400 for the 2.4 mg dose, ask about this. At that price you are paying about what tirzepatide costs, and in the one trial that compared the two directly tirzepatide produced a larger average weight change. That does not settle it. If you do not have diabetes, semaglutide is the only one of the two with a placebo controlled trial showing fewer heart attacks and strokes, because that is who its trial enrolled. If you do have type 2 diabetes, tirzepatide has carried an approved cardiovascular indication since August 2026 as well, from a trial run against another active medicine. The kidney evidence is semaglutide's alone in both cases. It is a question worth putting to whoever is prescribing for you, with the price you have actually been quoted in hand.

Indian-made semaglutide runs from roughly ₹1,300 to about ₹8,000 a month depending on the manufacturer, the presentation and the dose, with multi-dose vials at the bottom of that range and prefilled pens at the top. Prices change, so check at the pharmacy. Our fees are on the cost page.

If you stop

In the STEP-1 extension, people who stopped regained about two-thirds of what they had lost: an average loss of 17.3% at the point of stopping had shrunk to 5.6% a year later. Blood pressure, cholesterol and sugar drifted back with it. Plan stopping rather than simply running out. The stopping page explains how.

If you are planning a pregnancy, say so early. It has to be stopped roughly two months before you try to conceive.

Sources: STEP-1 (NEJM 2021), STEP-2 (Lancet 2021), STEP-4 (JAMA 2021), STEP-5 (Nature Medicine 2022), the STEP-1 extension (Diabetes, Obesity and Metabolism 2022), SELECT (NEJM 2023), FLOW (NEJM 2024), ESSENCE (NEJM 2025), SURMOUNT-5 (NEJM 2025), and the Indian prescribing information. Prices are indicative Indian maximum retail prices in September 2026, they change often, and they are not a quotation. No medicine is sold or supplied through this website. Reviewed on 11 September 2026 by Dr. Khizer Hussain Junaidy, Diabetologist & Bariatric Physician, Telangana State Medical Council registration no. 04937.

Semaglutide injection