Consent to Saxenda/Ozempic Treatment

Main Benefits of Saxenda/Ozempic

Saxenda/Ozempic is 97% similar to natural human GLP-1 and therefore acts as a physiological regulator of appetite. It reduces food intake by diminishing feelings of hunger and enhancing feelings of fullness/satiety. The exact underlying mechanism of action is not entirely clear.
Saxenda/Ozempic is a newly licensed medication indicated for appetite reduction as an adjunct to a reduced-calorie diet and increased physical activity for weight management of patients with an increased Body Mass Index (BMI).
For long-term success, the treatment needs to be combined with lifestyle changes, including nutritional, exercise, and behavioral habits. Access to support modules is available through the WeightJourney online service.
Weight loss can lead to secondary benefits, including improvement in weight-related health problems such as cardiovascular risk factors (including hypertension, blood glucose levels, and waist circumference) and physical health-related Quality of Life.

I understand that I have the right to be informed of the procedure, any feasible alternative options, and the risks and benefits. Except in emergencies, procedures are not performed until I have had an opportunity to receive such information and to give my informed consent.

Since every human being is unique, we cannot guarantee any specific result from Saxenda/Ozempic treatment. Medication and/or medical conditions may negatively impact outcomes, as well as lifestyle factors. Treatment should be discontinued after 12 weeks on the full 3mg/day dose if the patient has not lost at least 5% of their initial body weight. The minimum recommended duration of therapy is 4 weeks of dose escalation followed by 12 weeks of full dose therapy in cases with no contraindications or side effects of ongoing treatment. If escalation to the next dose step is not tolerated for 2 consecutive weeks, discontinuation of treatment should be considered. Daily doses higher than 3.0 mg are not recommended.

Patients need to follow the instructions carefully as provided separately in the patient instruction sheet. Patients must agree to notify their practitioner of any contraindications or side effects of the treatment. We will write to your GP to notify them of the details of the program and any blood results (if completed). It is essential to engage with the 2-weekly telephone review and monthly face-to-face reviews with your doctor throughout the treatment program.

HEALTH CONCERNS: If you suffer from a medical or pathological condition, you need to consult with an appropriate healthcare provider such as your GP or Consultant. If you are under the care of another healthcare provider, it is important that you inform your other healthcare providers of your use of Saxenda/Ozempic

Laboratory testing will be done to any patient identified at risk to determine areas of dysfunction, not to diagnose or treat. Potential blood tests:

Full blood count
Liver function test
Kidney function tests
Cholesterol levels, HbA1c, Glucose

Patient groups who may require blood test monitoring at additional cost:

Age 50 or above
High blood pressure
Diabetics
Any significant medical problem

I confirm that I accept the extra blood tests with further monitoring as above if required with an additional cost as specified in the Patient price list.

COMMUNICATIONS: Every Client is an individual, and it is not possible to determine in advance how your system will react to the treatment. It is sometimes necessary to adjust your program as we proceed. It is your responsibility to do your part by following healthy dietary guidelines, exercise your body and make necessary behavioral modifications.

I understand that:

Alternatives to Saxenda/Ozempic therapy are surgical procedures, oral medical treatments (including Orlistat), and/or dietary and lifestyle changes alone.
Several weeks to months of treatment may be required depending on your individual response.
If a missed dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
It is essential to combine eating, exercise, and behavioral modifications with Saxenda/Ozempic.
Saxenda/Ozempic should not be used in combination with another GLP-1 receptor agonist, insulin, or insulin secretagogues (such as sulfonylureas) due to the risk of hypoglycemia.
Upon initiation of Saxenda/Ozempic treatment in patients on warfarin or other coumarin derivatives, more frequent monitoring of International Normalized Ratio (INR) is recommended.
Saxenda/Ozempic causes a delay of gastric emptying and has the potential to impact the absorption of concomitantly administered oral medications. Monitor for potential consequences of delayed absorption of oral medications concomitantly administered with Saxenda/Ozempic.
There are several special warnings and precautions for use of Saxenda/Ozempic including warnings on pancreatitis, cholelithiasis, cholecystitis, thyroid disease, heart rate, dehydration, and hypoglycemia in people with type 2 diabetes.
Thyroid adverse events, such as goiter, have been reported, particularly in patients with pre-existing thyroid disease. Saxenda/Ozempic should therefore be used with caution in patients with thyroid disease.
A higher rate of cholelithiasis and cholecystitis (gallstone and gallbladder disease) has been observed in patients treated with liraglutide. Cholelithiasis and cholecystitis may lead to hospitalization and cholecystectomy (surgery to remove the gallbladder). Patients should be aware of the characteristic symptoms of cholelithiasis and cholecystitis.
Signs and symptoms of dehydration, including renal impairment and acute renal failure, have been reported in patients treated with Liraglutide. Patients treated with liraglutide should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Patients should also be aware of the symptoms of increased heart rate.
Acute pancreatitis has been observed with the use of Liraglutide. Patients and their caregivers should be told how to recognize signs and symptoms of acute pancreatitis and advised to seek immediate medical attention if symptoms develop. If pancreatitis is suspected, liraglutide should be discontinued; if acute pancreatitis is confirmed, liraglutide should not be restarted.
Saxenda/Ozempic may cause dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Saxenda/Ozempic causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. Patients should be aware of symptoms of thyroid tumors (such as a mass in the neck, difficulty swallowing, difficulty breathing, shortness of breath, or persistent hoarseness).

Risks of Saxenda/Ozempic Treatment Include but Are Not Limited to:

Common or very common, reported in ≥5%: Dysgeusia (altered sense of taste), dry mouth, insomnia, asthenia; burping; constipation; diarrhea; dizziness; dry mouth; gallbladder disorders; gastrointestinal discomfort; gastrointestinal disorders; insomnia; nausea; vomiting, hypoglycemia, dyspepsia, gastritis, gastroesophageal reflux disease, flatulence, eructation, upper abdomen pain, abdomen distension, cholelithiasis, injection site reactions, fatigue, increased lipase, and increased amylase.
Uncommon: Malaise; pancreatitis; tachycardia; urticaria.
Rare: Renal impairment, allergic reaction, anaphylaxis.

Summary of Saxenda/Ozempic Side Effects:

Do not take Saxenda/Ozempic if any of the below contraindications apply to you:

Aged under 18 or above 75
Severe renal/kidney impairment (with eGFR of 30 or below) or a history of renal disease
Severe hepatic/liver impairment
Personal or family history of medullary thyroid cancer (MTC)
Hypersensitivity to Saxenda (Liraglutide) or to any of the excipients: disodium phosphate dihydrate, propylene glycol, phenol, and water for injection.
Concurrent treatment with any other products for weight management
Weight problems related to endocrinological or eating disorders
Concurrent insulin or sulfonylurea
Patients on warfarin (more frequent INR monitoring required)
Concurrent use of any medicinal products which may cause weight gain
Pregnancy, breastfeeding, or trying to/planning to become pregnant
Congestive heart failure New York Heart Association (NYHA) class IV
History of pancreatitis, gallbladder disease, inflammatory bowel disease, diabetic gastroparesis
Patients with a personal or family history of MEN 2 (Multiple Endocrine Neoplasia syndrome)

I understand that I have the right to consent to or refuse any proposed treatment at any time prior to its performance. At any stage during the treatment, I have the right to request that the procedure is terminated; however, I accept that I will not be reimbursed once supply has commenced.
I am clear about the risks of using the medication.
I am clear about the expected weight loss outcomes of this program.
I am clear about the diet, exercise, and behavioral changes I need to make.

I understand and agree that I am financially responsible for the payment I made for and that any amount I paid for the sessions or procedures I booked will only be valid up to 3 months from the date I made the payment. I understand that I need to utilize the sessions or procedures within the 3-month period. I agree that my payment made is non-refundable or non-transferable post this period.

I declare that I have read and fully understood all points in this consent and that all of my questions were answered to my satisfaction and I take full responsibility for my decision in this consent.