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Prescription-only, clinician-titrated. Subcutaneous (Wegovy weight management: escalate to 2.4 mg once weekly; Ozempic diabetes: 0.5-2.0 mg once weekly). Oral (Rybelsus diabetes: 3-14 mg once daily). DO NOT self-dose.

Any time

Subcutaneous once-weekly injection (Ozempic / Wegovy)

Prevention and maintenance are DIFFERENT doses and are often conflated. Preventing the first onset of acute pouchitis used 900 billion CFU/day (1 sachet). Maintaining remission in established chronic or refractory pouchitis — where the effect size is largest — used 6 g/day, which at 5 x 10^11 viable bacteria per gram is about 3 trillion CFU/day, in both maintenance trials. As a ulcerative colitis add-on, 3.6 trillion CFU daily; the active-UC induction trial went highest at 3.6 trillion CFU TWICE daily (7.2 trillion/day), and the paediatric trial lowest at 450 billion/day weight-based

Any time

Refrigerated sachet of the De Simone Formulation

• Personal or family history of medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
• Prior serious hypersensitivity to semaglutide or any GLP-1 receptor agonist

• Insulin and sulfonylureas
• Oral medications (general)
• Other GLP-1 receptor agonists

• Severe immunocompromise or immunosuppression (class-level precaution for live probiotics)
• Critical illness or indwelling central venous catheter

• Systemic antibiotics