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
Quick Calculator
Concentration: 2,500 mcg/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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