GLP-1 clinical practice

Semaglutide + Metformin + B12 Support

Semaglutide GLP-1 therapy with metformin added for complementary insulin sensitisation and Vitamin B12 supplementation to offset metformin-induced B12 depletion. Growing evidence supports GLP-1 + metformin combination for enhanced weight loss and glycaemic outcomes.

Duration

Steps

8

Total Weeks

15

Route

SubQ

Protocols

3

Source

clinical practice

Protocol Timeline

Step Weeks Dose Compound Note
1 4 0.25 mg Semaglutide (Injectable) Initiation dose — for GI tolerability, not therapeutic
2 4 0.5 mg Semaglutide (Injectable) First therapeutic dose
3 4 1 mg Semaglutide (Injectable) Standard target dose — increase if additional glycemic control needed
4 0 2 mg Semaglutide (Injectable) Maximum dose — maintenance
1 1 500 mg Metformin Once daily with evening meal (ER formulation)
2 1 1000 mg Metformin Once daily with evening meal
3 1 1500 mg Metformin Once daily with evening meal
4 0 2000 mg Metformin Maximum ER dose once daily. If inadequate, split to 1000 mg BID.

Rationale

Metformin depletes Vitamin B12 via reduced intrinsic factor production — B12 supplementation is mandatory with metformin. Monitor B12 annually. Start metformin at low dose and titrate up to reduce GI side effects (which compound semaglutide GI effects).

Compounds Used

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Doseline provides informational tools only. It is not a medical device and does not provide medical advice. Always consult a qualified healthcare provider.