Monday Musings: More Concerns About Ozempic and Saxenda (with audio)
Gastric problems, suicidal ideation may be connected
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Two months ago, I wrote about Ozempic and Wegovy (semaglutide) and their new popularity. Ozempic was initially approved to treat type 2 diabetes and Wegovy, a higher dose of semaglutide, for weight loss. I expressed some concern about the side effects and other issues, such as what happens when you can’t afford to continue the medication.
Since I wrote that piece, news stories have emerged reporting that some people who used semaglutide are experiencing severe gastric problems even a year after they stopped taking the drug. In addition, the American Society of Anesthesiologists (ASA) now recommends that patients who take Ozempic and similar medications stop taking them before undergoing elective procedures.
There are also reports that semaglutide and another weight loss drug, liraglutide (brand name Saxenda), may be causing thoughts of suicide or self-harm. The cases of three patients in Iceland with these possible side effects were reported to the Icelandic Medicines Agency, and are being investigated by the European Medicines Agency.
Semaglutide slows down stomach emptying; liraglutide suppresses your appetite.
Slower stomach emptying
Semaglutide is in a group of drugs called GLP-1 agonists. While you are eating, the semaglutide mimics a hormone that tells your body you’re full. It also slows your digestive process. The longer the food stays in your stomach, the longer you feel full and won’t want to eat. The less you eat, the higher the chance you will start to lose weight. Some people have compared it to gastric bypass surgery, where a surgeon makes your stomach smaller, so less food makes you feel fuller faster.
This slowdown in gastric emptying can result in related side effects though, such as:
Excessive gas in the stomach or intestines
Gas pain
Heartburn
Stomach pain
Diarrhea
Generally, these more common symptoms ease after patients take the medication for a while, but for some, they never lessen and only go away when they stop taking the drugs. However, there are some reports of continuing abdominal issues even a year later.
According to this news article, two women were diagnosed with gastroparesis, stomach paralysis, after taking semaglutide. While rare, their experience does point out that there can be extended issues with the drug. According to the article, the drug manufacturer said in a statement:
“Gastrointestinal (GI) events are well-known side effects of the GLP-1 class. For semaglutide, most GI side effects are mild to moderate in severity and short duration. GLP-1’s are known to cause a delay in gastric emptying, as noted on the label of each of our GLP-1 RA medications. Symptoms of delayed gastric emptying, nausea and vomiting are listed as side effects.”
Perhaps a bigger concern is the warning from the ASA
The ASA issued the following statement, attributed to ASA President Michael W. Champeau, MD:
“While there is currently a lack of scientific data on how GLP-1 receptor agonists affect patients having surgery and interact with anesthesia, we’ve received anecdotal 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 anesthesia and deep sedation.”
When people are scheduled for a surgical procedure that requires an anesthetic, they are told to fast for several hours beforehand so their stomach is empty. This is to prevent the risk of vomiting food particles, which could then be inhaled and enter the lungs. The ASA is concerned that even with fasting, delayed stomach emptying may mean that there may still be something in the stomach, even if the patients fast as instructed.
Psychiatric side effects
The Iceland experience with liraglutide raises concerns for some people who take the medication for weight loss. While not common, there is a special warning in the U.S. for liraglutide that lists several serious side effects, including:
New or worsening depression
Thinking about self-harm
Unusual changes in mood or behavior
Interestingly, the warning about self-harm (suicidal ideation) is not listed in the European Union product information.
There is also no official mention of psychiatric side effects from semaglutide that I could find. Still, last month Medscape reported that the drug is being investigated for instances of suicide and self-harm along with liraglutide. The authors wrote:
“Of more than 1200 reports of adverse reactions with semaglutide, 60 cases of suicidal ideation and seven suicide attempts have been reported since 2018, according to the US Food and Drug Administration's (FDA's) Adverse Event Reporting System (FAERS) public database. For liraglutide, there were 71 cases of suicidal ideation, 28 suicide attempts, and 25 completed suicides out of more than 35,000 reports of adverse reactions.”
So now what?
If you are taking any of these drugs and you have a history of depression or any other mental health issue, speak with your doctor about your particular situation. Regardless of your history, even if the thoughts are new, if you do experience any feelings of self-harm or thoughts of suicide, please seek immediate help.
In the United States, dial 988 for the Suicide and Crisis Hotline.
In Canada, If you're in immediate danger or need urgent medical support, call 911.
If you or someone you know is thinking about suicide, call Talk Suicide Canada at 1-833-456-4566. Support is available 24 hours a day, 7 days a week.
For residents of Quebec, call 1-866-277-3553 or visit suicide.ca.
What do you think? Leave your comments below. Let’s get a conversation going.
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