GLP-1 Semaglutide With TeleHealth Subscription Program

Semaglutide is an injectable prescription medicine used for adults with obesity or overweight (excess weight) who also have weight-related medical problems to help them lose weight and keep the weight off.

Semaglutide should be used with a reduced calorie meal plan and increased physical activity.

Semaglutide should not be used with other semaglutide-containing products or other GLP-1 receptor agonist medicines.

It is not known if Semaglutide is safe and effective when taken with other prescription, over-thecounter, or herbal weight loss products.

It is not known if Semaglutide can be used safely in people with a history of pancreatitis.

It is not known if Semaglutide is safe and effective for use in children under 18 years of age.

If you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

If you have had a serious allergic reaction to semaglutide or any of the ingredients in Semaglutide. See the end of this Medication Guide for a complete list of ingredients in Semaglutide. Symptoms of a serious allergic reaction include:

• swelling of your face, lips, tongue or throat
• fainting or feeling dizzy • problems breathing or swallowing
• very rapid heartbeat
• severe rash or itching

Before using Semaglutide, tell your healthcare provider if you have any other medical conditions, including if you:

• have or have had problems with your pancreas or kidneys.
• have type 2 diabetes and a history of diabetic retinopathy.
• have or have had depression or suicidal thoughts, or mental health issues.
• are pregnant or plan to become pregnant. Semaglutide may harm your unborn baby. You should stop using Semaglutide 2 months before you plan to become pregnant.
• are breastfeeding or plan to breastfeed. It is not known if Semaglutide passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using Semaglutide.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Semaglutide may affect the way some medicines work and some medicines may affect the way Semaglutide works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. Semaglutide slows stomach emptying and can affect medicines that need to pass through the stomach quickly. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

• Read the Instructions for Use that comes with Semaglutide.
• Use Semaglutide exactly as your healthcare provider tells you to.
• Your healthcare provider should show you how to use Semaglutide before you use it for the first time.
• Semaglutide is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm. Do not inject Semaglutide into a muscle (intramuscularly) or vein (intravenously).
• Change (rotate) your injection site with each injection. Do not use the same site for each injection.
• Use Semaglutide 1 time each week, on the same day each week, at any time of the day.
• If you miss doses of Semaglutide for more than 3 days, DO NOT take your medication, and you must communicate with your healthcare provider prior to restarting your treatment. Failure to do so may result in serious nausea/vomitting/GI symptoms.
• You can take Semaglutide with or without food.
• If you take too much Semaglutide, you may have severe nausea, severe vomiting and severe low blood sugar. Call your healthcare provider or go to the nearest hospital emergency room right away if you experience any of these symptoms.

Semaglutide may cause serious side effects, including:

• Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents,Semaglutide and medicines that work like Semaglutide caused thyroid tumors, including thyroid cancer. It is not known ifSemaglutide will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.Do not use Semaglutide if you or any of your family have ever had a type of thyroid cancer called medullary thyroidcarcinoma (MTC), or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2(MEN 2).
• inflammation of your pancreas (pancreatitis). Stop using Semaglutide and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
• gallbladder problems. Semaglutide may cause gallbladder problems including gallstones. Some gallbladder problems need surgery. Call your healthcare provider if you have any of the following symptoms:
• pain in your upper stomach (abdomen)
• yellowing of skin or eyes (jaundice)
• fever
• clay-colored stools

Increased risk of low blood sugar (hypoglycemia) in patients with type 2 diabetes, especially those who also take insulin or sulfonaureas (medications for type 2 diabetes).

The chance of low blood sugar from semaglutide ALONE is very low, however it increases with other diabetic medications (insulin and sulfonaureas). Talk to your healthcare provider about how to recognize and treat low blood sugar.

You should check your blood sugar before you start taking Semaglutide and while you take Semaglutide. Signs and symptoms of low blood sugar may include:

• dizziness or light-headedness
• sweating
• shakiness
• blurred vision
• slurred speech
• weakness
• anxiety
• hunger
• headache
• irritability or mood changes
• confusion or drowsiness
• fast heartbeat
• feeling jittery
• Gastrointestinal (GI) Issues: Semaglutide may not be suitable for individuals with chronic GI conditions, including Crohn's disease, ulcerative colitis, severe gastroesophageal reflux disease (GERD), and gastroparesis. It's crucial to discuss your medical history and the potential risks with your healthcare provider before initiating treatment.
• Recent Bariatric Surgery: If you've had bariatric surgery, it's essential to inform your healthcare provider. Semaglutide should be used cautiously, as it can affect your gastrointestinal tract and may require dose adjustments to ensure safe and effective treatment.
• Kidney problems (kidney failure): In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.

Serious allergic reactions; Stop using Semaglutide and get medical help right away, if you have any symptoms of a serious allergic reaction including:

• swelling of your face, lips, tongue or throat
• severe rash or itching
• very rapid heartbeat
• problems breathing or swallowing
• fainting or feeling dizzy
• change in vision in people with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Semaglutide.
• increased heart rate. Semaglutide can increase your heart rate while you are at rest. Your healthcare provider should check your heart rate while you take Semaglutide. Tell your healthcare provider if you feel your heart racing or pounding in your chest and it lasts for several minutes.
• depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

The most common side effects of Semaglutide may include:

• nausea
• stomach (abdomen) pain
• dizziness
• stomach flu
• diarrhea
• medicines to treat type 2 diabetes mellitus such as sulfonylureas or insulin.
• headache
• feeling bloated
• heartburn
• vomiting
• tiredness (fatigue)
• belching
• constipation
• upset stomach
• gas

Talk to your healthcare provider about any side effect that bothers you or does not go away. These are not all the possible side effects of Semaglutide.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

After reconstitution, store vials of Semaglutide in the refrigerator from 2-8°C - do not freeze. All used needles must be placed in a sharps disposal unit to prevent cutting or piercing the skin and transfer of pathogens. Never put used syringes in household or other regular trash bins. If you cease using Semaglutide, consult your doctor or pharmacist about how to properly dispose of the leftover medication.

Cyanocobalamin injection is used to treat and prevent a lack of vitamin B12 that may be caused by any of the following: pernicious anemia (lack of a natural substance needed to absorb vitamin B12 from the intestine); certain diseases, infections, or medications that decrease the amount of vitamin B12 absorbed from food; or a vegan diet (strict vegetarian diet that does not allow any animal products, including dairy products and eggs). Lack of vitamin B12 may cause anemia (condition in which the red blood cells do not bring enough oxygen to the organs) and permanent damage to the nerves. Cyanocobalamin injection also may be given as a test to see how well the body can absorb vitamin B12. Cyanocobalamin injection is in a class of medications called vitamins. Because it is injected straight into the bloodstream, it can be used to supply vitamin B12 to people who cannot absorb this vitamin through the intestine.

• Tell your doctor and pharmacist if you are allergic to cyanocobalamin injection, nasal gel, or tablets; hydroxocobalamin; multi-vitamins; any other medications or vitamins; or cobalt.
• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: antibiotics such as chloramphenicol; colchicine; folic acid; methotrexate (Rheumatrex, Trexall); para-aminosalicylic acid (Paser); and pyrimethamine (Daraprim). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• Tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have or have ever had Leber's hereditary optic neuropathy (slow, painless loss of vision, first in one eye and then in the other) or kidney disease.
• Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using cyanocobalamin injection, call your doctor. Talk to your doctor about the amount of vitamin B 12 you should get every day when you are pregnant or breast-feeding.

Cyanocobalamin comes as a solution (liquid) to be injected into a muscle or just under the skin. It is usually injected by a healthcare provider in an office or clinic. You will probably receive cyanocobalamin injection once a day for the first 6-7 days of your treatment. As your red blood cells return to normal, you will probably receive the medication every other day for 2 weeks, and then every 3-4 days for 2-3 weeks. After your anemia has been treated, you will probably receive the medication once a month to prevent your symptoms from coming back.

Cyanocobalamin injection will supply you with enough vitamin B12 only as long as you receive injections regularly. You may receive cyanocobalamin injections every month for the rest of your life. Keep all appointments to receive cyanocobalamin injections even if you feel well. If you stop receiving cyanocobalamin injections, your anemia may return and your nerves may be damaged.

Cyanocobalamin injection is also sometimes used to treat inherited conditions that decrease the absorption of vitamin B12 from the intestine. Cyanocobalamin injection is also sometimes used to treat methylmalonic aciduria (an inherited disease in which the body cannot break down protein) and is sometimes given to unborn babies to prevent methylmalonic aciduria after birth. Talk to your doctor about the possible risks of using this drug for your condition.This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Cyanocobalamin injection may cause side effects. Tell your doctor if either of these symptoms is severe or does not go away:

• diarrhea
• feeling as if your entire body as swollen

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor

• immediately
• muscle weakness, cramps, or pain
• leg pain
• extreme thirst
• frequent urination
• confusion
• shortness of breath, especially when you exercise or lie down
• coughing or wheezing
• fast heartbeat
• extreme tiredness
• swelling of the arms, hands, feet, ankles or lower legs
• pain, warmth, redness, swelling or tenderness in one leg
• headache
• dizziness
• red skin color, especially on the face
• hives
• rash
• itching
• difficulty breathing or swallowing

Cyanocobalamin injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).