People with type 2 diabetes in South Africa have been left without one of their cheapest and most effective treatments because doctors are now also prescribing it as a weight loss drug, resulting in a shortage for the past six months, writes Zano Kunene for Bhekisisa.
Ozempic, given as a weekly injection, can help people with type 2 diabetes – which kills almost as many people in South Africa as TB – stay alive. Made by Danish pharmaceutical company Novo Nordisk, it lowers the blood sugar by causing the pancreas to release extra insulin when they eat. But it also helps to make people feel full for longer after meals.
Using Ozempic for weight loss took off on social media in 2022, not only in South Africa but worldwide, as previously reported in MedicalBrief. #Ozempic, for instance, has 300m views on TikTok.
The unexpected demand drained stock globally in May 2022, Novo Nordisk told Australia’s medicines regulator, and South Africa’s stocks dried up three months later. At first, diabetics could switch to an alternative called Trulicity, also a weekly injection which works like Ozempic.
But then Trulicity’s manufacturer, Eli Lilly, announced its stocks are running low too, for reasons “closely related to the shortage of Ozempic”. The medicine will only be fully restocked from 31 March, the producers say.
The medicine comes in a 1.5ml injection pen, costing between R1 200 and R1 500. Depending on how much help a patient needs to control their blood sugar, a weekly dose of between 0.25mg and 2mg is prescribed. Each millilitre in the tube contains 1.34mg of the drug, so one pen can last between one and eight weeks.
In South Africa, Ozempic is registered as a schedule four medicine, specifically to treat type 2 diabetes, and only to be administered by a doctor or prescribing nurse
But doctors are able to prescribe the medicine “off-label” too, which in this case is to help overweight or obese people shed kilos. A person is considered heavily overweight when their body mass index is 25 or higher, and obese when this number reaches 30 or more.
Is it a miracle cure?
Ozempic is part of a group of medicines called GLP-1 receptor agonists, which help prod the body not only to release insulin while you eat but also make the stomach empty into the small intestine slower. So you feel full for longer and your appetite is kept in check.
One Ozempic pen, enough for eight weeks’ supply, is at least R500 cheaper than an injection filled with either of two other drugs used to control blood sugar. But because these alternatives are taken daily, instead of once weekly like Ozempic, one pen would last only about two weeks.
Moreover, Ozempic is longer acting and works better for weight loss than other options.
Weight loss remedies
Research shows many obese or heavily overweight people are unable to lose weight (and keep it off) by exercising and restricting what they eat because of their genes or not being able to buy healthy food easily (rather than simply not having enough self-discipline to make good food choices).
For those with a body mass index of more than 35, the best solutions to keep off the weight for longer, according to studies, are bariatric surgery or appetite-suppressing medicines like Ozempic.
But Joel Dave, head of the division of endocrinology at the University of Cape Town, said Ozempic “only works while you take it” and “doesn’t address the underlying reasons for weight gain, so people need to take it lifelong, if they want to maintain their weight loss”.
Are doctors allowed to prescribe drugs off-label?
Prescribing a medicine off-label is not illegal in South Africa, but there are rules.
The Medicines and Related Substances Act says medicines must be registered for a specific use. Ozempic is strictly to help people with type 2 diabetes control their blood sugar level.
Using it to treat any other condition is risky as the South African Health Products Regulatory Authority (Sahpra) has not reviewed how it works in such cases.
When prescribing a medicine off-label, doctors have to decide whether it’s the best option for their patient. Because the Consumer Protection Act also applies to medicines, prescribers must get a patient’s consent for offering an off-label treatment as consumers have the right to receive goods “reasonably suitable for the purposes for which they are intended”.
In the case of medicines, this would be the one indicated in the package insert. Under this law, the doctor must also warn the patient about any dangers of using the medicine in this way. However, this is impossible without enough data on its alternative use.
What is being done to increase stock?
Tobeka Boltina, head of the clinical, medical and regulatory affairs department of Novo Nordisk South Africa, says they are aware of the seriousness of the situation and are “working closely with authorities” to avoid upsetting patients’ treatment.
The company is looking into registering Wegovy, which is similar to Ozempic but used specifically for weight loss, in South Africa. Because Wegovy is meant as a weight loss medicine, this could take pressure off the demand for Ozempic.
Sahpra says it has not yet received such an application.
See more from MedicalBrief archives:
TikTok turns diabetes drug into popular diet pill
Doctors warn about ageing side-effects of diabetes weight-loss drugs
Eli Lilly tightens diabetes drug access, frustrates obese patients