Introduction
Ozempic and Wegovy: two drugs that have skyrocketed in popularity over the past few years. That’s because many people have lost a significant amount of weight on them. Celebrities Tracy Morgan, Sharon Osbourne, and Chelsea Handler have confessed to taking Ozempic, the active ingredient of which is semaglutide.
As with any medication, semaglutide has potential adverse effects. If you’re on Ozempic, Wegovy, or Rybelsus (another semaglutide drug), it’s only natural to research their potential risks. What are the common side effects of semaglutide?
In this article, we investigate semaglutide’s side effects and how you and your healthcare provider can manage or prevent them. Read on to learn more.
What is semaglutide?
First things first: what is semaglutide, the active ingredient in Ozempic, Wegovy, and Rybelsus?
Semaglutide falls under a group of drugs called glucagon-like peptide-1 receptor agonists, or GLP-1 Ra, for short. Basically, they mimic the gut-based hormone GLP-1 which triggers the pancreas to release insulin whenever blood sugar levels are elevated.
Another effect of semaglutide is that it slows down digestion or gastric emptying, making a person feel fuller for longer. Because appetite is suppressed, a person taking semalgutide loses weight in the process.
Oral and subcutaneous routes
Semaglutide is the generic name behind popular drugs Ozempic and Wegovy, also of another brand, Rybelsus. Both Ozempic and Rybelsus treat type 2 diabetes, while Wegovy treats obesity. Patients administer both Ozempic and Wegovy subcutaneously (injected under the skin), while they administer Rybelsus orally (tablet form).
While both formats are effective in blood sugar and weight management, experts have linked certain side effects to these.
Dosage and administration
One of the possible causes of a medicine’s adverse effects is a patient’s non-compliance or non-adherence to a doctor’s instructions. It’s important to remember that proper dosage and administration are key to achieving optimal results while on semaglutide.
When starting treatment on semaglutide, healthcare providers will typically start off patients on a low dose. Gradually, they will increase the dosage until they achieve a maintenance dose. With this approach, they minimize the risk of certain side effects as the body adjusts to the drug.
When it comes to administering semaglutide, patients administer Ozempic and Wegovy once weekly, with or without meals. On the other hand, they must take Rybelsus once daily on an empty stomach upon waking up. Patients must take care not to inject subcutaneous semaglutide into a muscle or vein. Meanwhile, in the case of Rybelsus, they should take it the same way every time.
As with most drugs, semaglutide is a medication that must supplement a balanced diet and exercise. Lifestyle changes will help the drug work at its best in the body.
Why do semaglutide side effects occur?
Apart from a patient’s non-compliance or non-adherence to a physician’s instructions, there are other potential triggers. This includes early use of the drug, discontinued use, or changes to the dosage
The effects of a drug will vary from person to person. Generally, though, these occur when a patient reacts to a drug ingredient or when a drug clashes with another substance. This could also be in the form of food, a vitamin or supplement, or an essential oil.
What are the common side effects of semaglutide?
Gastrointestinal reactions account for 10% or more of semaglutide’s side effects. These include:
- nausea (up to 44% of cases),
- diarrhea (up to 30%),
- vomiting (up to 24%),
- constipation (up to 24%),
- an increase in the pancreatic enzyme lipase (up to 22%),
- abdominal pain (up to 20%),
- and an increase in the digestive enzyme amylase (up to 13%).
Lipase is an enzyme produced by the pancreas which breaks down fats in food tp be absorbed by the intestines. Meanwhile, amylase is a digestive enzyme also produced by the pancreas and also by salivary glands to help digest carbohydrates.
An abnormally high level of lipase may indicate that you have a problem with your pancreas such as pancreatitis. It may also hint at kidney failure, cirrhosis, or a bowel problem.
High levels of amylase, meanwhile, may indicate acute pancreatitis or chronic pancreatitis, even pancreatic, breast, colon, ovarian, or lung cancer.
Other common side effects of semaglutide include indigestion, belching, gassiness, gastroenteritis, or gastritis (inflammation of the stomach lining). These occur for every 1 to 10% of cases.
It’s worth noting that these side effect are mild and can be managed with the help of your healthcare provider. Semaglutide’s more serious adverse effects, meanwhile, are rare.
Studies on semaglutide side effects
In a study published in 2022 in the journal Nature Medicine, a group of scientists looked at the efficacy and safety of once-weekly subcutaneous semaglutide for the long-term treatment of adults with obesity.
GI adverse effects
Gastrointestinal adverse effects, mostly mild to moderate, occurred more often in participants taking semaglutide than those in the placebo group. The most common were nausea, diarrhea, vomiting, and constipation.
The semaglutide group showed more adverse effects than those in the placebo group. Meanwhile, gallbladder-related disorders were also observed in two participants, and cancerous tumors were recorded in two participants.
Another study, published in Diabetes, Obesity and Metabolism, reported semaglutide’s most common side effects were nausea, diarrhea, vomiting, and constipation.
During the dose-escalation period, researchers observed a higher incidence of GIAEs, peaking at Week 20 and then declining afterward.
A 2018 study in Diabetes, Obesity and Metabolism evaluated dose levels by analyzing participants’ response to varying exposure to semaglutide.
Nausea was the most common gastrointestinal side effect. The researchers found that the higher the exposure to semaglutide of female participants, the higher the incidence of nausea. Incidentally, two of the researchers worked at semaglutide manufacturer Novo Nordisk.
Similar to the study published in 2021, more cases of nausea were reported as doses were increased. It was also more frequent in female versus male participants.
Preventing the side effects of semaglutide
While the incidence of gastrointestinal adverse effects may seem inevitable for first-time semaglutide users, it can definitely be managed.
In a study published in 2022 in the Journal of Clinical Medicine, researchers gathered expert advice on dealing with the GLP-1 Ras’ side effects. These experts included endocrinologists, nephrologists, primary care physicians, cardiologists, internists, and diabetes nurses.
The authors emphasized the importance of patient education. This is to create awareness on what first-time semaglutide users can expect, preventing side effects, and dealing with these.
The collected advice was grouped into three parts: eating habits, food composition, and lifestyle.
Under eating habits:
- Eat slowly.
- Eat smaller portions.
- Eat only if really hungry.
- Stop eating when satiated.
- Increase meal frequency.
- Don’t use straws.
- Minimize distractions while eating. Enjoy savoring the food.
- Do not lie down after meals.
- Refrain from too much physical activity after meals.
- No meals near bedtime.
On food composition:
- Go for a low-fat diet.
- Boil foods over other cooking methods. Use an oven or griddle to cook food.
- Drink clear drinks (small sips only, not too much).
- Eat water-rich foods.
- Avoid sweets, dressings, spicy or canned foods.
On lifestyle:
- Get fresh air. Do light exercises.
- Use a food diary to identify what foods work better for you.
The study also provided advice as to how to manage the common side effects of GLP-1 Ras. Here are the experts’ recommendations.
To manage nausea:
- Eat crackers, apples, mint, ginger-based drinks 30 minutes after taking or injecting GLP-1 Ra.
- Avoid strong smells.
For vomiting:
- Seek generous hydration.
- Have more frequent meals, in smaller amounts.
Managing diarrhea:
- Seek generous hydration (water, lemon, bicarbonate)
- Avoid sport drinks.
- Avoid high-fiber content foods (You will gradually restore these upon improvement). Yes to chicken broth, rice, carrots, ripe peeled fruit, baked fruit. No to dairy products, laxatives, coffee, alcohol, soft drinks, very cold/hot foods, products with “ol” ending sweeteners
For constipation:
- Ensure enough fiber in your diet.
- Increase physical activity.
- Have a healthy, balanced diet
- Seek generous hydration (water, sugar-free liquids)
Should severe nausea or vomiting occur or persist, do not drink during meals. Instead, drink 30 to 60 minutes before and/or after meals.
For any other persistent or severe GIAEs, contact your doctor as soon as possible.
Duration of semaglutide side effects
Most patients taking Ozempic, for instance, will only experience mild and short-term side effects. These typically go away on their own within a few days or weeks.
Some side effects of Wegovy, meanwhile, may cause long-term complications like gallbladder and pancreas problems, stomach paralysis, and blocked intestines. The situation typically improves when the patient discontinues use of the drug.
Before you start taking semaglutide, consult your healthcare provider about any potential side effects and their potential duration.
Conclusion
Semaglutide is massively popular for the weight loss benefits of its drugs Ozempic and Wegovy. Although only Wegovy is FDA-approved for weight loss, Ozempic and Rybelsus, another anti-diabetic semaglutide, are prescribed off-label for weight management.
Just like any drug, semaglutide has mild to moderate side effects. The most common of these are nausea, vomiting, constipation, diarrhea, and abdominal pain. Serious side effects, meanwhile, are rare.
Several studies found that the higher the exposure to a GLP-1 Ra, the higher the incidence of gastrointestinal adverse effects. This eventually declines with time.
Thankfully, these adverse effects can be managed or minimized through changes in diet and lifestyle. A group of researchers sought the advice of health experts to create a guide for managing GLP-1 Ras’ adverse effects. These covered eating habits, food composition, and lifestyle, creating a holistic approach to dealing with common adverse effects.
As with any treatment, patients should report to their healthcare provider any adverse effects of semaglutide. In addition, they must how to best deal with these.
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