This SOP outlines the guidelines for prescribing weight loss medications to ensure safe and effective treatment for patients at GP Health Hub Limited.
This applies to all healthcare professionals involved in assessing, prescribing, and monitoring weight loss medications. Obesity is a complex, chronic condition that contributes to multiple comorbidities. Pharmacological treatment may be appropriate for patients who meet specific clinical criteria, as part of a multidisciplinary approach.
The generic term ‘patients’ is used throughout to refer to people receiving medicines. The Clinic will not provide services to anyone less than 18 years of age.
BMI: Body Mass Index (kg/m²)
Weight-related comorbidities: Adults with any other comorbidities in addition to being overweight or obese, such as hypertension, cardiovascular disease, osteoarthritis, dyslipidaemia, sleep apnoea, NAFLD, PCOS, impaired glucose tolerance, etc.
Non-diabetic hyperglycaemia: A haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol (6.0% to 6.4%) or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre
Fatty liver: A condition where excess fat builds up in liver cells, often due to obesity, alcohol, or metabolic syndrome. It can be non-alcoholic (NAFLD) or alcohol-related, and may progress to liver inflammation or cirrhosis.
Chronic kidney disease: A long-term condition where the kidneys gradually lose function, leading to reduced ability to filter waste. It is often caused by diabetes, hypertension, or glomerular disease and may progress to end-stage renal failure.
The use of medicines is underpinned by a series of legal, statutory and professional frameworks that include:
This SOP draws on the relevant aspects of these frameworks to ensure that the management of medicines is conducted safely, securely, and legally.
Clinicians prescribing semaglutide should refer to the Wegovy® SmPC (Semaglutide, solution for injection in pre-filled pen, Novo Nordisk Limited) as published on the MHRA product information database.
Clinicians prescribing tirzepatide should refer to the Mounjaro® SmPC (Tirzepatide, solution for injection in pre-filled pen, Eli Lilly and Company Limited) as published on the MHRA product information database.
These SmPCs provide the detailed UK-approved guidance for dosing, indications, contraindications, and monitoring when prescribing these medications for weight management.
This SOP should be read in conjunction with the Medicines Management Policy covering the prescribing process, off-label prescribing, repeat prescribing, and monitoring.
A full medical and medication history, allergy check, weight and comorbidity assessment, and readiness for change must be documented. Baseline measurements include weight, height, BMI, BP and waist circumference. For non-Caucasian patients, apply lower BMI thresholds (reduce by 2.5 kg/m²). Clinicians must assess capacity and obtain and document verbal consent.
Before prescribing, clinicians must ensure they have sufficient and reliable information. If more information is needed, they should seek patient consent to contact the NHS GP. If a patient refuses they should not be prescribed weight loss medications by a GP Health Hub clinician. Patient must be made aware that information obtained from them will be confirmed with their NHS GP prior to prescribing medication.
Clinicians must explain the benefits, risks, administration, expected outcomes, monitoring, and follow-up arrangements. Document patient consent, understanding of risks, and the treatment plan in the medical notes.
Clinic staff may prescribe MHRA and NICE-recommended medications: Semaglutide and Tirzepatide only. All medicines are adjuncts to diet and activity changes.
| Medication | Indications & BMI Thresholds | Setting | Route & Frequency | Pregnancy & Contraception | When to Stop Treatment |
|---|---|---|---|---|---|
| Tirzepatide | BMI ≥30, or ≥27.5 with comorbidities; ≥25for non-Caucasian patients | Remote GP with structured support | Weekly SC injection; start 2.5 mg, titrate to max 15 mg | Do not use in pregnancy; advise non -oral contraception | Stop if <5% weight loss after 3 months maintenance |
| Semaglutide | BMI ≥30, or ≥27.5 with comorbidities; ≥25for non-Caucasian patients | Remote GP with structured support | Weekly SC injection; start 0.25 mg, titrate to max 2.4 mg | Do not use in pregnancy; advise non -oral contraception | Stop if <5% weight loss after 3 months maintenance |
Clinicians must follow the SPC and BNF for prescribing. Provide support on lifestyle, and document off-label use if applicable, explaining reasons to the patient.
Tirzepatide is a long-acting GIP (glucose-dependent insulinotropic polypeptide) receptor and GLP-1 (glucagon-like peptide-1) receptor agonist that increases insulin sensitivity and secretion, suppresses glucagon secretion, and slows gastric emptying
Initially 2.5 mg once weekly for 4 weeks, then increased to 5 mg once weekly for at least 4 weeks, then increased if necessary up to 15 mg once weekly, dose to be increased in steps of 2.5 mg at intervals of at least 4 weeks
Alopecia; appetite decreased (in patients with type 2 diabetes); asthenia; burping; constipation; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; hypersensitivity; hypotension; lethargy; malaise; nausea; vomiting
Gallbladder disorders; pancreatitis acute; taste altered; weight decreased (in patients with type 2 diabetes)
Angioedema
Hypoglycaemia
Discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain. If pancreatitis confirmed, do not restart treatment
*Information from British National Formulary ( BNF )
Semaglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying
0.25 mg once weekly for at least 4 weeks, then increased if tolerated to 0.5 mg once weekly for at least 4 weeks, then increased if tolerated to 1 mg once weekly for at least 4 weeks, then increased if tolerated to 1.7 mg once weekly for at least 4 weeks, then maintenance 2.4 mg once weekly.
Appetite decreased (in patients with type 2 diabetes); burping; cholelithiasis; constipation; diarrhoea; fatigue; gastrointestinal discomfort; gastrointestinal disorders; nausea; vomiting; weight decreased (in patients with type 2 diabetes)
Pancreatitis acute; taste altered
Alopecia; diabetic retinopathy (in patients with type 2 diabetes); dizziness; headache; hypoglycaemia
Angioedema
Discontinue if symptoms of acute pancreatitis occur, such as persistent, severe abdominal pain. If pancreatitis confirmed, do not restart treatment.
*Information from British National Formulary ( BNF )
Schedule follow-ups at 4, 8, and 12 weeks, then quarterly. Monitor weight, BMI, BP, and side effects which should be documented. Patients should be advised on home monitoring and submitting results. Discontinue treatment if targets are not met, and offer maintenance support.
Clinicians must seek explicit consent to share treatment details with the NHS GP. If the patient refuses, document the discussion and respect the decision. They should not be prescribed weight loss medication if they do not consent for notes to be shared with their NHS GP.
Maintain clear, accurate records of eligibility, exclusion, consent, prescribing decisions, monitoring, and adverse events.
Avoid in pregnancy and breastfeeding. Exercise caution in psychiatric or cardiovascular disease. Be vigilant for eating disorders or misuse, and direct patient to mental health services if needed.
Prescribing is appropriate if the patient:
Do NOT prescribe remotely if:
| Drug | Best For | Avoid In | Key Advantage |
|---|---|---|---|
| Cyclizine | Mild to moderate nausea; sedating; good for younger, non-complex cases | Elderly (sedation), glaucoma, BPH | Rapid relief, less cardiac risk |
| Ondansetron | Moderate to severe nausea, low sedation, elderly or cardiac risk groups | Caution in QT prolongation | Well-tolerated, non-sedating |
| Prochlorperazine | Nausea with anxiety, vestibular component (dizziness, vertigo) | Parkinson’s, extrapyramidal risks | Useful in anxious/nervy patients |
Patients should be advised to:
Contact their GP if symptoms:
Follow-up recommended at 1 week or sooner to reassess (with either GPHH or NHS GP):
During review : If nausea persists despite treatment, consider:
Clinicians must complete training in obesity management, stay updated with guidelines, and engage in annual CPD.
This SOP will be reviewed annually. Compliance is monitored through audits, with findings reported to the directors of GP Health Hub Limited.
Person Responsible: Dr Wewage Anthony Shanika Dep
GP Health Hub will transform your healthcare experience with GP led remote consultations.
