Setmelanotide
Setmelanotide (Imcivree) is an FDA-approved MC4R agonist for chronic weight management in patients with obesity due to specific genetic conditions (POMC, PCSK1, or LEPR deficiency).
Mechanism of Action
Selective agonist of melanocortin 4 receptors (MC4R) in the hypothalamus, restoring the satiety signaling pathway that is disrupted in certain genetic obesity syndromes.
Dosage Overview
Dose Range
1 mg – 3 mg
Route
subcutaneous
Frequency
1x daily
Cycle Length
12–52 weeks
Reconstitution
Typical Dosage (Research)
Adults: Start 2mg daily, titrate based on tolerability up to 3mg daily. Pediatrics (6+): Weight-based dosing starting at 1mg daily.
Subcutaneous injection once daily. Requires genetic testing to confirm eligible mutations before prescribing.
Considerations for Men & Women
Women: FDA-approved for rare genetic obesity (POMC, PCSK1, LEPR deficiency). May cause hyperpigmentation and spontaneous penile erections (in males) or sexual adverse events. Women may experience disturbances in sexual function as a melanocortin agonist.
Men: Spontaneous erections are a common side effect due to melanocortin pathway activation (similar to PT-141). Hyperpigmentation affects both sexes equally. Monitor for injection site reactions.
Individual responses vary. These notes reflect general trends from research literature and are not medical advice.
Quick Calculator
Concentration: 2.5 mg/ml
Volume to inject: 0.40 ml
Syringe units (U-100): 40.0 units
Pre-filled with Setmelanotide defaults. Adjust values as needed.
Side Effects & Risks
Injection site reactions, skin hyperpigmentation, spontaneous penile erections, depression, and suicidal ideation (boxed warning). GI effects less common than GLP-1s.
Boxed warning for depression and suicidal ideation - requires monitoring. May cause sexual adverse reactions. Only for genetically confirmed obesity.
Who Uses Setmelanotide
Patients with genetically confirmed POMC, PCSK1, or LEPR deficiency obesity - a very specific population.
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