Is there a relationship between Glucagon-like peptide-1 (GLP-1) receptor agonist medications, such as liraglutide (Victoza) and semaglutide (Ozempic), and vocal chord paralysis?

Relationship Between GLP-1 Medications and Vocal Chord Paralysis

There is currently no established relationship between GLP-1 receptor agonist medications and vocal chord paralysis based on the available evidence.

Known Adverse Effects of GLP-1 Receptor Agonists

GLP-1 receptor agonists have well-documented adverse effects, but vocal chord paralysis is not among the commonly reported or established side effects:

• The most frequently reported adverse effects are gastrointestinal in nature, including nausea, vomiting, diarrhea, dyspepsia, and gastroesophageal reflux 1
• These gastrointestinal side effects are dose-dependent and more common with short-acting than long-acting GLP-1 receptor agonists 1
• Other documented adverse effects include:
  • Acute pancreatitis (rare) 1
  • Gallbladder disorders 1
  • Cardiac arrhythmia/tachycardia 1
  • Delayed gastric emptying, which can increase risk of regurgitation and aspiration during anesthesia 1

Otolaryngologic Side Effects

Recent research has begun to investigate potential otolaryngologic adverse events associated with GLP-1 receptor agonists:

• A retrospective analysis of the FDA's Adverse Event Reporting System found significant signals for certain otolaryngologic adverse events with GLP-1 receptor agonists 2
• Specifically, liraglutide showed significant signals for dysphonia (voice disorders), dysgeusia (taste disorders), tinnitus, and Bell's palsy 2
• Semaglutide was associated with significant signals for anosmia, dry mouth, dysgeusia, and Bell's palsy 2
• However, vocal chord paralysis specifically was not identified as a significant adverse event in this analysis 2

Clinical Implications

When considering GLP-1 receptor agonist therapy:

• The contraindications and cautions for GLP-1 receptor agonists do not currently include vocal chord disorders or paralysis 1

• Established contraindications include:

  • History of serious hypersensitivity reaction to the drug
  • Personal or family history of medullary thyroid cancer
  • Multiple endocrine neoplasia syndrome type 2 (MEN2)
  • Severe renal impairment for certain GLP-1 RAs (exenatide, lixisenatide) 1

• For patients experiencing voice changes while on GLP-1 receptor agonists:

  • Consider that dysphonia (voice disorder) has been reported with liraglutide, though vocal chord paralysis specifically has not been established 2
  • Evaluate for other potential causes of voice changes or vocal chord dysfunction
  • Monitor symptoms and consider dose adjustment or medication change if symptoms persist

Conclusion

While GLP-1 receptor agonists have been associated with various side effects including some otolaryngologic adverse events, there is currently no established relationship between these medications and vocal chord paralysis specifically. Dysphonia (voice disorders) has been reported with liraglutide, but this does not necessarily indicate vocal chord paralysis. Patients experiencing voice changes while on GLP-1 receptor agonists should be evaluated for other potential causes of vocal dysfunction.