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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