Gastrointestinal Side Effects of Ozempic/Wegovy: What to Do About Them
Ozempic and Wegovy are new medication first used in the treatment of diabetes(Ozempic) and now both being used with high success rates for obesity. The limiting factor in the use of these drugs are common gastrointestinal side effects. They are frequent in people taking Ozempic/Wegovy (72.9%).
They included nausea (43.9%), diarrhea (29.7%), vomiting (24.5%) and constipation (24.2%). Less common are heartburn, burping and non specific abdominal pain.
Ozempic/Wegovy Produce the Same Weight Loss With or Without GI Side Effects:
Weight loss was comparable in participants with GI side effects vs. without GI sides when patients compared in each medication. Researchers reported that GI side effects were not significant factors influencing weight loss. The weight is due to the medications effect on multiple centers of the brain, the stomach, muscles and liver. The latter two organs reducing blood glucose concentrations.
Dose Escalation Often Produces GI Side Effects of Ozempic and Wegovy
The frequency of GI sides is increased during or following dose escalation, especially in the first 2 days of the adjustment. The GI side effects are mostly transient (with the exception of constipation), not serious (99.5%), and of mild-to-moderate severity (98.1%). Since the dose escalations are predicatable, its easy to make some food changes and/or have some OTC medications available to reduce these side effects. Its just takes a little planing. When using Ozempic the injections can be reduced by injecting 1/2 of the dose on different days of the week.
Constipation May Be On Going Problem with Ozempic and Wegovy
Constipation may last longer than other GI side effects consistent with the more chronic nature of this condition and the fact it’s often due to other factors. Most commonly, it is due to the marked reduction of intake of food, especially fatty foods and oils when delays passage of stool thru the large bowel resulting in greater water absorption and frequent drying and hardening of the fecal matter.
Pancreatitis and Gallbladder Attacks in Treatment with Ozempic and Wegovy Very Rare
Acute pancreatitis has been reported in patients treated with these medications. Patients should be observed for any signs and symptoms of acute pancreatitis (e.g. persistent severe abdominal pain). Trials have not shown an increased risk of pancreatitis with these medications, that does exist in diabetics. Standard blood tests and imaging studies might be needed to exclude more serious problems.
Cholelithiasis (gallstones) may occur with rapid weight loss with any diet and an increased incidence has been reported in patients treated with Ozempic/Wegovy for weight management – appropriate clinical follow-up is required if gallstones are suspected.
Abdominal pain from Ozemic-Wegovy
Ozempic/Wegovy GI Side Effects Reduced by Changing Foods & Eating Habits
No foods are strictly “off-limits” when taking Ozempic or Wegovy—in other words, there’s nothing to need to worry about that could prevent the medication from working normally. However, there are a few guidelines you’ll want to keep in mind in order to maximize weight loss and minimeffects ize GI side by simple changes in eating.
Fried foods and fatty foods, such as fast food, and foods high in sugar tend to be the toughest for your body to digest and the most likely to cause nausea. Patients taking Ozempic/Wegovy who experience nausea andother GI symptoms should consider the following tips:
Ozempic/wegovy semiglutides produce delyaed gastric emtying
1.Eat smaller meals, more frequently
2. Try to stop eating before feeling completely full
3. Avoid fatty, greasy or high carb foods since they cause more nausea
4. Eat foods that are light and bland
5.Drink clear or ice-cold drinks (like water or unsweetened tea), avoid carbonated drinks
Wegovy Side Effects Reduced by OTC or Prescription Medications- Depends on Type of Symptoms
Nausea is clearly the most common GI side effect. It’s often seen in the very beginning and during dose escalation, but for most people it gets less and less significant as time passes. Studies have shown it’s due the delayed gastric emptying as well as direct effect of these drugs in the brain.
Rx: OTC meds like Gas-X, Pepto- bismol, Imodium and prescription Zofran orally or ompazine by injection.
There is a transient worsening or new onset of gastroesophageal reflux disease (GERD; a known complication of obesity) during treatment for many patients. Medications such as proton-pump inhibitors or H2-blockers can be used on a temporary basis.
Rx: Omeprazole( Prilosec- once or even twice a day), for breakthrough pain H2-blockers such as Pepcid AC, Tagamet, Protonix, Prevacid.
One of the most common side effects due to the medication or even more likely the change of food. Treatment includes the usual treatment of constipation.
Rx: Fiber such as Metamucil capsules 2-3 twice a day with several glasses of water, stool softeners and/or Miralax.
This less common side effect is usually transitory and occurs more in the initial phase rather than with higher doses. Often treatment for GERD like symptoms can stop the vomiting. If severe, then the anti-emetics
Rx:OTC products: Dramamine, Bonine, Gravol, Pepto-Bismol, Emetrol, prescription products include Zofran, Compazine, Phenergan
Pancreatitis, Gallbladder Disease:
Both these medical problems are much more serious than the non-specific symptoms due to gastric motility or GERD. Both consist of severe, recurrent pain, often going to the back. Anyone with severe pain needs to be fully evaluated potentially including laboratory tests and/or diagnostic imaging. Obviously, the Ozempic/Wegovy should be discontinued and not restarted if pancreatitis is found.
Other Non- Related Causes
Clinicians should also consider whether any existing or recently initiated concomitant prescription or non-prescription medications could be responsible. For example, metformin can cause GI side effects.
Lowering the Dose of Ozempic/Wegovy
Given the dose-dependent nature of these GI side effects lowering the dose and/or delaying the escalation should be considered for patients unable to tolerate the medications with the aim of achieving a dose that enables patients to gain at least some of the benefits with minimal GI side effects.
If GI symptoms occur and dose escalation is paused or the dose reduced, dose escalation can be retried once the patient is symptom-free at the lower dose. Such escalation should be slower than previously used. Many patients to with GI side effects are able to achieve the full dose, although the time required for titration can be longer than expected.
If patients experience GI side effects with other drugs of this class and are unable to tolerate them, despite best efforts to alleviate the symptoms, treatment should be stopped. Switching to a different class of obesity pharmacotherapy could be considered, if appropriate