Is ozembic (sulfonamide) safe to use in patients with Turner syndrome?

Ozempic (Semaglutide) Use in Turner Syndrome

Ozempic (semaglutide) can be used in patients with Turner syndrome, but requires careful cardiovascular monitoring due to the increased risk of aortic complications in this population.

Cardiovascular Considerations in Turner Syndrome

Turner syndrome patients have significant cardiovascular risks that must be considered when prescribing any medication:

• Approximately 50% have structural cardiac defects 1
• 10-25% have bicuspid aortic valve 1
• ~8% have aortic coarctation 1
• ~33% have aortic dilatation 1
• 36:100,000 Turner syndrome years risk of aortic dissection (vs 6:100,000 in general population) 1

Ozempic Safety Assessment

When considering Ozempic for Turner syndrome patients:

1. Baseline Cardiovascular Assessment:

   • Transthoracic echocardiography (TTE) and cardiac MRI are mandatory before starting treatment 2
   • Calculate Aortic Size Index (ASI) in patients ≥15 years old 2
   • Assess for bicuspid aortic valve, aortic coarctation, and other congenital defects 1

2. Risk Stratification:

   • Low risk: Normal cardiac imaging, no hypertension
   • Moderate risk: ASI 2.0-2.5 cm/m², or presence of bicuspid aortic valve
   • High risk: ASI ≥2.5 cm/m², history of aortic coarctation, or uncontrolled hypertension 2

3. Monitoring Requirements:

   • Low risk: Cardiovascular evaluation every 5-10 years 2
   • Moderate risk: Cardiovascular evaluation every 3-5 years 2
   • High risk: Annual cardiovascular evaluation 2

Specific Considerations for Ozempic

Ozempic (semaglutide) has no specific contraindications for Turner syndrome patients, but:

1. Blood Pressure Effects:

   • Monitor blood pressure regularly as hypertension is a risk factor for aortic complications 2
   • Ozempic may cause modest blood pressure reduction, which could be beneficial in this population

2. Weight Management Benefits:

   • Turner syndrome patients have increased risk of metabolic syndrome and type 2 diabetes 3
   • Ozempic's weight reduction effects may be particularly beneficial

3. Medication Interactions:

   • Many Turner syndrome patients receive hormone replacement therapy (HRT) 2
   • No known significant interactions between Ozempic and standard HRT regimens

Practical Recommendations

1. Pre-Treatment Assessment:

   • Complete cardiovascular evaluation with TTE and cardiac MRI
   • Calculate ASI if patient is ≥15 years old
   • Assess baseline blood pressure, liver function, and metabolic parameters

2. Dosing Considerations:

   • Start with the lowest dose (0.25mg weekly) and titrate gradually
   • Monitor for gastrointestinal side effects, which are common with Ozempic

3. Ongoing Monitoring:

   • Regular blood pressure monitoring
   • Cardiovascular imaging according to risk stratification
   • Immediate evaluation for any symptoms of chest or abdominal pain (potential aortic dissection) 1

4. Patient Education:

   • Instruct patients to report any sudden, severe chest or abdominal pain immediately
   • Explain the importance of adherence to cardiovascular monitoring schedule

Conclusion

Ozempic can be used in Turner syndrome patients with appropriate cardiovascular assessment and monitoring. The metabolic benefits may be particularly valuable in this population, but the increased risk of aortic complications necessitates careful cardiovascular surveillance.