Synopsis
Select licensed weight-management medicines through current NICE and commissioning criteria, prescribe with reproductive and acute-adverse-effect safeguards, and stop or escalate treatment using agreed outcomes.
- Anti-obesity medicine is an adjunct to an individualised nutrition, activity and behavioural programme, not a cosmetic shortcut or a replacement for follow-up.
- Eligibility differs by product, NICE technology appraisal, comorbidity, BMI, ethnicity, service setting and local phased commissioning; verify the live pathway before promising access.
- As at 27 August 2026, licensing was broader than NHS access: NICE TA875 described the commissioned 2.4 mg weekly semaglutide injection route, while the MHRA had also authorised 7.2 mg injected Wegovy, 25 mg oral Wegovy and Foundayo (orforglipron); a licence does not itself create NICE recommendation, NHS funding or local availability.
Key red flags
Severe persistent upper-abdominal pain, often radiating to the back with nausea or vomiting, is not ordinary titration discomfort; stop the incretin medicine and arrange urgent assessment.
Investigation priorities
Confirm eligibility and provide reproducible outcomes for shared decisions.
Management branches
Behavioural care alone is insufficient and pharmacotherapy is being considered.
- Verify the current NICE appraisal, local commissioning route and product licence, applying ethnicity-adjusted thresholds and weight-related comorbidity criteria correctly.
- Assess pregnancy plans, pancreatitis and gallbladder history, GI motility, diabetes medicines, renal function, eating disorder, anaesthetic plans and ability to follow up.
Key medicines
Tirzepatide for weight managementStart 2.5 mg subcutaneously once weekly for 4 weeks, then 5 mg weekly; if needed increase in 2.5 mg steps after at least 4 weeks at a dose, to maximum 15 mg weekly.
Semaglutide for weight managementFor the NICE TA875 commissioned injection route, start 0.25 mg subcutaneously once weekly and escalate at 4-week intervals through licensed strengths toward 2.4 mg weekly, delaying escalation when tolerability requires. The separately authorised 7.2 mg injected dose is not evidence of NHS funding; use only the exact live SmPC and commissioned pathway.