GLP-1 Weight Management Tips
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[From NEJM, drug label for Ozempic/Wegovy/Mounjaro, and other sources;
copyright belongs to all of those sources not My Heart Spark P.C.]
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Please work with your primary care provider to maintain BMI >18.5 and adhere to the following tips.
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If you have diabetes mellitus, please provide a primary care provider approval letter with commitment to monitor for low blood sugars and any other complications.
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Individuals who take a GLP-1 agonist medication once weekly can experience substantial and sustained reductions in body weight.
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“The patient should not use this medication if the patient has had inflammation of the pancreas (pancreatitis).”
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“The safety of this medication in combination with other products intended for weight loss, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been established.”
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“This medication should not be coadministered with other semaglutide-containing products or with any GLP-1 receptor agonist.”
“This medication should not be used in patients with a personal or family history of medullary thyroid cancer or in patients with multiple endocrine neoplasia (MEN) 2, and in patients with a prior serious hypersensitivity reaction to a similar drug or to any of the excipients in this drug. Serious hypersensitivity reactions, including anaphylaxis and angioedema have been reported.”
The most common adverse events with GLP-1 agonist medications are gastrointestinal, and most are mild to moderate in severity,
“Common side effects including nausea, vomiting, diarrhea, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distention, eructation, hypoglycemia in patients with type 2 diabetes, flatulence, gastroenteritis, gastroesophageal reflux disease, and nasopharyngitis, occurring primarily during dose escalation, are mitigated over time and can be lessened with slow dose escalation.”
“Serious adverse events are rare and may include cholelithiasis, pancreatitis, and hypoglycemia.”
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Common side effects
The most common side effects of this medication include nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion, and stomach (abdominal) pain. These are not all the possible side effects of this medication. Talk to your healthcare provider about any side effect that bothers you or doesn’t go away.
Tell your healthcare provider if you have any side effects. You can report side effects at 1-800-FDA-1088 or www.fda.gov/medwatch .”
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“The medication may cause serious side effects, including:
* Inflammation of the pancreas (pancreatitis). Stop using this medication and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
* Low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use this medication with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, or mood changes, hunger, weakness and feeling jittery.
* Serious allergic reactions. Stop using this medication and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat.
* Kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.
* Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use this medication. Tell your healthcare provider if you have stomach problems that are severe or will not go away.
* Changes in vision. Tell your healthcare provider if you have changes in vision during treatment with this medication.
* Gallbladder problems. Gallbladder problems have happened in some people who use this medication. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), and clay-colored stools.
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* “Risk of Thyroid C-Cell Tumors: Patients should be further evaluated if serum calcitonin is measured and found to be elevated or thyroid nodules are noted on physical examination or neck imaging.”
* “Acute Pancreatitis: Observe patients carefully for signs and symptoms of acute pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back, and which may or may not be accompanied by vomiting). If acute pancreatitis is suspected, discontinue this drug promptly, and if acute pancreatitis is confirmed, do not restart.”
* “Acute Gallbladder Disease: Substantial or rapid weight loss can increase the risk of cholelithiasis. If cholelithiasis is suspected, gallbladder studies and appropriate clinical follow-up are indicated.”
* “Hypoglycemia: This drug lowers blood glucose and can cause hypoglycemia. Inform patients of the risk of hypoglycemia and educate them on the signs and symptoms. Monitor blood glucose in patients with type 2 diabetes.”
* “Acute Kidney Injury: There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which in some cases required hemodialysis, in patients treated with semaglutide. Patients with renal impairment may be at a greater risk of acute kidney injury, but some events have been reported in patients without known underlying renal disease. A majority of the events occurred in patients who experienced nausea, vomiting, or diarrhea, leading to volume depletion. Monitor renal function when initiating or escalating doses of this medication class in patients reporting severe adverse gastrointestinal reactions and in patients with renal impairment reporting any adverse reactions that could lead to volume depletion.”
* “Hypersensitivity Reactions: Serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) have been reported with this medication class. If hypersensitivity reactions occur, discontinue use of this medication class, treat promptly per standard of care, and monitor until signs and symptoms resolve. Use caution in a patient with a history of anaphylaxis or angioedema with another GLP-1 receptor agonist.”
* “Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: In a trial of adult patients with type 2 diabetes, diabetic retinopathy was reported by 4.0% of patients on this medication class and 2.7% of placebo patients. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy.”
* “Heart Rate Increase: Mean increases in resting heart rate of 1 to 4 beats per minute (bpm) were observed in adult patients on this medication class compared to placebo in clinical trials. More adult patients on this medication class compared with placebo had maximum changes from baseline of 10 to 19 bpm (41% versus 34%) and 20 bpm or more (26% versus 16%). In a clinical trial in pediatric patients aged 12 years and older with normal baseline heart rate, more patients treated with this medication class compared to placebo had maximum changes in heart rate of 20 bpm or more (54% versus 39%). Monitor heart rate at regular intervals and instruct patients to report palpitations or feelings of a racing heartbeat while at rest. If patients experience a sustained increase in resting heart rate, discontinue this medication class.”
* “Suicidal Behavior and Ideation: Suicidal behavior and ideation have been reported in clinical trials with other weight management products. Monitor patients for depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Discontinue this medication class in patients who experience suicidal thoughts or behaviors and avoid in patients with a history of suicidal attempts or active suicidal ideation.”
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“History of severe depression – this is a warning, not a contraindication. All patients who are being treated for depression should be cautioned that either medicine can worsen depression and they should update family and cohabitants that if they appear to be more depressed to go directly to their local Emergency Department.”
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“The use of this drug in patients treated with insulin has not been evaluated. When initiating this drug? consider reducing the dose of concomitantly administered insulin secretagogues (such as sulfonylureas) or insulin to reduce the risk of hypoglycemia.”
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“This drug may cause a delay of gastric emptying and has the potential to impact the absorption of concomitantly administered oral medications. Monitor the effects of oral medications concomitantly administered with this drug.”
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“Pregnancy: May cause fetal harm. When pregnancy is recognized, discontinue this drug. Discontinue this drug in patients at least 2 months before a planned pregnancy.”
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“Avoid during lactation.”
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“This medication may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.”
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“Do not use this medication if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).”
“Do not use this medication if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).”
“Do not use this medication if you are allergic to it or any of the ingredients in this medication.”
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“Monitor for unstable glucose levels, belly pain, new back pain, nausea, diarrhea, or constipation.”
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“Avoid use if history of cholelithiasis, pancreatitis, or hypoglycemia."
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Diet bottom line: limit Bread, pasta, sugar, and cereal.
Physical activity bottom line: pursue 10,ooo steps daily.
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Please contact the FDA if you develop any concerning adverse side effect from the medication.