As more people turn to blockbuster diabetes and obesity drugs likes Wegovy, Ozempic and Mounjaro, some are grappling with an unwelcome trade-off: how to balance uncomfortable, sometimes painful, side effects with the benefits of reduced food cravings and the loss of substantial weight.
Most people who take the drugs have no serious side effects, and even minor ones like nausea, diarrhoea, vomiting can usually be controlled with a careful diet and medical supervision.
But patients say some unwelcome and scary effects, including heart palpitations, surprised them, forcing them off the medication, reports The Washington Post.
The drugs have the potential to help millions of people lose weight, easing the country’s epidemics of diabetes and obesity: more than 14% of adults in the US have diabetes and almost 42% are obese, according to the US Centres for Disease Control and Prevention (CDC).
The benefits of the medications may be broader, with Novo Nordisk, the company that makes Wegovy revealing study results this month showing the drug reduced the risk of heart problems by 20% in certain patients.
Americans are increasingly aware of the drugs’ promises. According to a KFF health tracking poll, nearly half of adults indicated they would “generally be interested” in taking a “safe and effective” weight-loss drug, and nearly seven in 10 adults had heard at least “a little” about the medications.
Ozempic is approved for type 2 diabetes but is often taken off-label for weight loss. Wegovy, which has the same active ingredient, called semaglutide, is cleared for obesity and reduces body weight by an average of 15%, according to a key study.
An Eli Lilly diabetes drug called tirzepatide helped people reduce body weight by up to 26%, on average, in late-stage studies, the company said recently. The medication is already approved for diabetes under the brand name Mounjaro and is expected to be cleared for obesity by the end of the year.
Novo Nordisk, which makes Ozempic and Wegovy, said gastrointestinal side effects are mild to moderate and well-recognised. “Semaglutide has been extensively examined in robust clinical development programmes, large real world evidence studies, and has cumulatively more than 9.5m patient years of exposure,” the company said.
Lilly said side effects from tirzepatide “were mostly mild to moderate, usually occurred during the dose-escalation period, and subsided once treatment discontinued”.
A recently published analysis of pharmacy and medical claims data showed nearly 70% of patients who had taken Wegovy and another weight-loss drug, Saxenda, were no longer using the medications; the analysis did not address patients’ reasons for stopping the medications.
Obesity experts say patients’ experiences with side effects vary.
“Some people get very sick, others have no side effects at all,” said Robert Kushner, a professor of medicine and medical education at Northwestern University who conducted pivotal trials involving semaglutide, which were paid for by Novo Nordisk. Kushner also has worked with other healthcare companies.
In a Mayo Clinic study earlier this year, half of 305 patients using semaglutide drugs for weight loss over one year suffered side effects, the most common being nausea and diarrhoea. Another study noted that 82% of participants taking a semaglutide drug reported adverse effects, generally mild to moderate gastrointestinal problems. Just nine participants, (less than 6% ) of the group, quit because of the side effects.
Obesity experts say many side effects can be reduced by a cautious approach to two important areas: dosing and diet. To avoid nausea and vomiting, high-fat foods, which take longer to digest, or large amounts of food should be avoided, particularly right after the injections.
In some cases, providers who lack experience with the drugs are being too aggressive about ramping up dosages, experts say. Wegovy doses should be increased gradually, taking five months to go from 0.25mg to 2.4mg. If the treatment causes nausea, the dose should be kept the same – or decreased – until the patient adjusts.
Still, the recommended dosing schedules don’t always prevent side effects.
In one case, a schoolteacher was on the lowest dose of Wegovy before increasing it after a month. The next day, nausea pulverised her. Co-workers gave her ginger ale and a motion-sickness pill, but she vomited and retreated to a classroom cupboard to agonise in pain. That night, the symptoms were so bad she checked into a hospital, where she had nausea and an elevated heart rate for several days.
The nausea disappeared. But days after leaving the hospital, her chest and throat still felt sore from the vomiting. She has stopped taking Wegovy and plans to halve her food portions.
“We want instant results, and this seemed like a miracle drug,” she said.
This month, another woman with a similar story sued Novo Nordisk and Eli Lilly, alleging the companies have downplayed severe gastrointestinal issues. She said she was prescribed Ozempic, then Mounjaro, over year and a half, and wound up hospitalised because of stomach pains and vomiting that was so violent she lost teeth.
The woman’s law firm, Morgan and Morgan, says it has been retained by more than 500 clients in 45 states with similar stories.
Another undesirable result of the drugs is potential loss of lean muscle along with fat, which can occur when there is rapid weight loss, regardless of the method used. Lean muscle is important for keeping bones strong, protecting against diabetes and reducing the risk of falls, a concern especially for older people.
Loss of lean muscle can happen to anyone who loses weight quickly, regardless of the method, doctors said.
There are other things to consider when taking the medications. The drugs should be stopped before elective surgery, the American Society of Anaesthesiologists said.
“We’ve received reports that the delay in stomach emptying could be associated with an increased risk of regurgitation and aspiration of food into the airways and lungs during general anaesthesia and deep sedation,” the organisation said.
Recently, the European Medicines Agency said it had begun investigating the class of drugs that includes Ozempic and Wegovy, after three reports from Iceland’s health regulator of patients thinking about self-harm or suicide. The review has been expanded to evaluate 150 reports of possible cases of self-injury or suicidal thoughts.
See more from MedicalBrief archives:
Weight loss drug trial suggests significant heart benefit
UK reviews weight-loss drugs after ‘suicidal thoughts’
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