Revisiting: Is there a ceiling dose beyond which semaglutide stops adding benefit?

Revisiting: Is there a ceiling dose beyond which semaglutide stops adding benefit? — that is the question, and I have not found it answered plainly anywhere I have looked.

Putting the numbers in the first post, because a question about a compound without them turns into a question about somebody's impression of it.

semaglutide, monoisotopic mass near 4113.6 Da, 13 weeks of my own notes, and 9 lots from 2 suppliers with a purity figure on each. That is the whole basis of what follows.

What I want checked is the reasoning I have built on top of it, not the figures themselves.

The 2.4 mg maintenance dose in the weight-management programme and the 1.0 mg diabetes dose are frequently discussed as though they were the same drug at different strengths. They are, but the trials behind them enrolled different populations for different endpoints, so the evidence does not transfer sideways.

I am describing what is, rather than arguing for what should be.

Worth separating two things that post #2 runs together.

On alcohol: the labelling does not contraindicate it, but it raises gastric irritation risk and semaglutide already does that. There is no published interaction study and the conservative position is to limit it if you are titrating or if gastrointestinal symptoms are troublesome.

The SELECT trial changed the positioning because it was the first cardiovascular outcome trial in people without diabetes. That decoupled the cardiovascular argument from glycaemic control, which is why it mattered beyond its own numbers.

It is worth checking rather than assuming, which costs nothing.