What Does Semaglutide Do?
Semaglutide is similar in structure to glucagon-like peptides that your body makes naturally and has many benefits. This protein works on the body and brain levels to slow the emptying of food from the stomach, regulate insulin levels, decrease hunger and food cravings, and increase the feeling of being full.
Semaglutide and other GLP-1 receptor agonists are designed to last longer than GLP-1, which is made naturally in your body. In addition to lowering blood sugars, GLP-1 medications have been shown to decrease the risk of death from cardiovascular disease and improve kidney function.
Wegovy has an additional indication for reducing the risk of cardiovascular death, heart attacks, and stroke in adults with cardiovascular disease who are also overweight or obese.
Who is Semaglutide Recommended For?
Semaglutide is a prescription medication used for chronic weight management in adults with obesity. Semaglutide can help obese adults achieve substantial weight loss and improve health outcomes.
To qualify for semaglutide for weight loss, individuals must meet certain criteria and undergo a thorough medical evaluation:
1. Generally, individuals with a body mass index (BMI) of 30 or higher or a BMI of 27 or higher with at least one weight-related health condition, such as type 2 diabetes, high blood pressure, or high cholesterol, may qualify for semaglutide treatment.
2. Before starting semaglutide, a healthcare provider will conduct a thorough medical evaluation to assess the individual’s overall health and determine if semaglutide is a safe and appropriate treatment option.
This evaluation may include reviewing the individual’s medical history, current medications, and any potential risks or contraindications for semaglutide treatment.
3. To achieve long-term weight management success with semaglutide treatment, individuals must also have realistic weight loss goals and be committed to making lifestyle changes, such as adopting a healthy diet and engaging in regular physical activity.
4. Individuals who meet the criteria for semaglutide treatment, such as having a body mass index (BMI) of 27 or higher and at least one weight-related medical condition, may be prescribed semaglutide by their healthcare provider.
If you’ve been diagnosed with diabetes, the American Association of Clinical Endocrinology (AACE) recommends lifestyle interventions as the first line of treatment. If you have other risk factors, such as a high risk for cardiovascular disease, a GLP-1 receptor agonist may be recommended.
What are the Potential Side Effects and Health Risks of Semaglutide?
Semaglutide is also associated with several side effects. Common side effects of taking semaglutide as a weight loss medication include:
- Gastrointestinal issues like nausea, vomiting, and diarrhea
- Constipation
- Stomach pain
- Headache
- Excessive burping
- Heartburn
- Fatigue
- Flatulence
- Gastroesophageal reflux disease
- Belching
- Bloating
- Excessive gas
- Fever
- Hair loss
- Change in taste
- Pain or skin changes at the injection site
- Weakness
These most common side effects of Ozempic don’t tend to be dangerous and may dissipate as you grow used to the medication.
However, there is potential for more serious adverse effects, such as:
- Vision problems
- Swelling in extremities
- Dizziness or fainting
- Reduced urination
- Rash
- Rapid heart rate
- Swelling of throat, tongue, mouth, face, or eyes
- Problems swallowing or breathing
- Yellow eyes or skin
- Chronic upper stomach pain
- Damage to the retina
- Suicidal ideation
- Gallstones
- Pancreatitis
- Acute kidney damage
- Increased chance of developing thyroid tumors, including medullary thyroid carcinoma
Rapid weight loss can also have side effects on your body. Rapid weight loss will decrease your body’s metabolism and can cause loss of muscle mass in addition to the loss of fat. The muscle loss can further decrease your metabolism because muscle is an efficient calorie-burning tissue. Other side effects of rapid weight loss include:
- Loss of bone density
- Loss of strength
- Decreased immune system
- Inadequate nutrients
Who Should Not Take Semaglutide?
Like any medication, semaglutide is not for everyone. You should discuss with your healthcare provider any recommendations and risks related to this medication specific to your situation.
Semaglutide may not be appropriate for individuals with certain medical histories or conditions. According to the current regulations, there are some populations for whom semaglutide is contraindicated:
Individuals with a personal or family history of medullary thyroid carcinoma (MTC)
Semaglutide and other medications in the GLP-1 receptor agonist class are contraindicated for people with MTC because rodent studies conducted during the development of these medicines showed an increased risk of thyroid cancer. This may be due to factors specific to rodents, as these findings have not been seen in nonhuman primates or humans.
Patients with Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2)
Patients with MEN 2, a genetic condition that increases the risk of developing multiple types of endocrine tumors, including MTC, should avoid semaglutide.
People With Allergies to Semaglutide
Another reason not to take the medication is a known allergy or sensitivity to semaglutide or its components. Semaglutide is a protein, so the body can form an immune reaction to it.
If you experience shortness of breath, swelling, or a different allergic reaction to semaglutide, then you should avoid semaglutide.
People Who Are Pregnant
Women or those assigned female at birth (AFAB) who are pregnant should not take semaglutide. There aren’t many studies about using semaglutide and other GLP-1s in pregnancy. Limited animal studies have shown an increased risk of birth defects, growth issues, and pregnancy loss, but there are no studies in humans.
The FDA has recommended against the use of GLP-1 medications in pregnancy and has recommended discontinuation of these medications at least two months before a planned pregnancy to allow time for the medication to get out of your system.
Women who are breastfeeding
Breastfeeding mothers should also avoid semaglutide as it’s not known if the drug passes into breast milk.
People With Severe Gastrointestinal Disease
People with severe gastrointestinal diseases, such as gastroparesis (delayed stomach emptying), should not take semaglutide as it can worsen these conditions.
People With Pancreatic Diseases
People who have had acute pancreatitis or pancreatic cancer shouldn’t take GLP-1 receptor agonists. These medications may increase the risk for pancreatitis, though the data is mixed.
These complications are infrequent, and additional studies are needed to determine whether the medication carries an increased risk. The current recommendation is that semaglutide and other GLP-1 receptor agonists should be stopped if pancreatitis is suspected and should not be restarted if pancreatitis is present.
People With Acute Gallbladder Disease
GLP-1 receptor agonist medications increase the risk of gallstones, which may be caused by rapid weight loss. These medications may also change gallbladder motility, which could contribute to gallstone formation.
If you develop symptoms of gallbladder disease, it may be necessary to stop the medication, but you should talk with your healthcare provider before stopping any medication.
People With Suicidal Behavior
There is some indication that weight-loss medications such as semaglutide may increase the risk of suicidal thoughts. The data on this is mixed, but it is recommended to avoid using these medications in people with a history of suicide attempts or who currently have suicidal thoughts.
Children and Adolescents
The safety and effectiveness of semaglutide in individuals under 18 years of age have not been established, so it is not recommended for this age group.
People with type 1 diabetes
Semaglutide is not indicated for the treatment of type 1 diabetes or diabetic ketoacidosis.
People who are on other weight loss medications
People using other weight-loss medications should avoid using semaglutide. Always talk with your healthcare provider before starting semaglutide treatment.
People who already have slow gastric emptying
If you have slow gastric emptying, using semaglutide could cause problems by slowing it even further. It’s best to avoid semaglutide if you experience slow gastric emptying.
People with severe renal impairment
While semaglutide can be used with caution in patients with renal impairment, those with severe renal impairment or end-stage renal disease should use it under strict medical supervision, if at all.
Vision problems and eye issues
Semaglutide should be used with caution in patients with a history of vision problems or eye issues. It has been found to possibly worsen diabetic retinopathy, which is a blurriness and degradation of eye quality when patients have diabetes.
People who’ve had bariatric surgery
Semaglutide should be used with caution in patients who have previously had bariatric surgery. These patients should be closely monitored by their healthcare team if they are on GLP-1 receptor agonists.
Important Considerations
Hypoglycemia Risk: When used in combination with other medications that lower blood glucose (such as insulin or sulfonylureas), there is an increased risk of hypoglycemia. Patients should be aware of the signs and symptoms of low blood sugar and manage their glucose levels accordingly.
Signs of low blood sugar may include dizziness, weakness, confusion, irritability, anxiety, excessive sweating, trembling, rapid heartbeat, and hunger. Severe hypoglycemia may result in vision or coordination problems, extreme confusion, and even seizures.
Semaglutide can interact with other medications: Concomitant Synthroid use can disrupt glucose regulation by semaglutide, leading to higher glucose levels than desired. Prednisone may suppress semaglutide-induced glucose regulation, also leading to higher glucose levels than desired.
Furosemide can decrease the sensitivity of glucose to insulin in skeletal muscles, so semaglutide may still have slightly higher blood glucose levels than expected. Growth hormone analog medications can also lead to issues with insulin sensitivity and glucose regulation, which can lead to higher blood glucose levels than desired.
Alcohol Consumption: Alcohol consumption can disregulate glucose metabolism and cause hypoglycemia, especially in lower to moderate amounts.
Alcohol can cause hyperglycemia with heavier consumption. Alcohol consumption in semaglutide use can cause dizziness, so it's important to limit or avoid alcohol consumption.
Cannabis Use: Although there have been no direct studies of cannabis use with semaglutide, cannabis itself can cause dizziness, and semaglutide can also cause dizziness. It's important to limit or avoid cannabis consumption when using semaglutide.
Herbal Medications: Certain herbal medications, including bitter melon, prickly pear, gymnema, and alpha-lipoic acid, can increase the risk or severity of hypoglycemia when taken with semaglutide.
Oral Medication Absorption: Activating DLP1 receptors by semaglutide in the stomach can reduce gastric emptying, which may slow the absorption of certain oral medications.
Overdosing: Using too much semaglutide or taking it too frequently can lead to an overdose and increase the risk of harmful side effects, dangerously low blood sugar, or hypoglycemia.
Alternatives to Semaglutide
For individuals who can’t use semaglutide, exploring alternative treatment options is essential. While semaglutide belongs to a specific class of medications, there are other avenues to consider. These may include medications from different classes or non-pharmacological approaches such as dietary changes, exercise regimens, and behavioral therapy.
One such option is LookMeds compounded semaglutide, which may provide an alternative for those facing medication shortages, high costs, or limited insurance coverage. Compounded versions can offer customized dosing options while maintaining the efficacy of standard semaglutide treatments.
Some alternative medications for diabetes include metformin, sulfonylureas (glimepiride, glipizide, and glyburide), TZDs (rosiglitazone and pioglitazone), alpha-glucosidase inhibitors (acarbose and miglitol), bile acid sequestrants (colesevelam), SGLT2 inhibitors, DPP-4 inhibitors, and dopamine-2 agonists.
Alternatives to semaglutide to treat weight loss include other GLP-1 receptor agonists, including liraglutide, phentermine-topiramate, bupropion-naltrexone, orlistat, and setmelanotide.
Lifestyle changes, such as healthy eating patterns and regular physical activity, are necessary to achieve and support weight loss goals. Before starting your weight loss journey, you should talk with your healthcare provider to ensure you are healthy enough to lose weight.
Consultation with a Healthcare Professional
Before starting any weight management medication, it is paramount to consult with a healthcare professional. During the consultation, healthcare providers assess the patient’s medical history, current health status, and any potential contraindications to ensure the treatment's safety and efficacy.
Patients should openly communicate any concerns or questions they have regarding semaglutide or alternative options to make informed decisions about their health.
Bottom Line
In conclusion, while semaglutide holds promise for individuals battling obesity, it’s essential to discern whether you should abstain from its use to safeguard your well-being.
By meticulously assessing candidacy and exploring alternative treatments, healthcare providers at LookMeds can support patients on their weight management journey.
Do you qualify for semaglutide? Find out with this 3-minute survey.
