Can Ozempic (semaglutide) be taken by someone undergoing chemotherapy?

Ozempic (Semaglutide) Use During Chemotherapy

Patients undergoing chemotherapy should avoid taking Ozempic (semaglutide) due to increased risk of pulmonary aspiration during procedures, potential for severe gastrointestinal side effects that may compound chemotherapy-induced symptoms, and limited safety data in this specific population. 1

Risks of Ozempic During Chemotherapy

Aspiration Risk

• GLP-1 receptor agonists like semaglutide significantly delay gastric emptying, increasing the risk of regurgitation and pulmonary aspiration during procedures that may be required during cancer treatment 1
• Multiple case reports document regurgitation and pulmonary aspiration in patients on semaglutide despite extended fasting periods (12-20 hours), potentially requiring ICU admission 1
• Patients on semaglutide have shown 24.2% incidence of increased residual gastric content compared to 5.1% in control groups, even with extended fasting 1

Gastrointestinal Side Effects

• Common adverse effects of semaglutide include nausea, vomiting, dyspepsia, diarrhea, and gastrointestinal reflux 1
• These side effects could compound the gastrointestinal toxicities commonly experienced during chemotherapy, potentially worsening quality of life 1
• Chemotherapy often causes nausea, vomiting, and mucositis, which would be exacerbated by semaglutide's gastrointestinal effects 1

Other Safety Concerns

• Semaglutide has been associated with risk of acute pancreatitis, a rare but serious adverse effect 1, 2
• Potential for gallbladder disorders that may complicate cancer treatment 1, 2
• Risk of acute kidney injury, which could be problematic in patients receiving nephrotoxic chemotherapy agents 3, 2

Special Considerations

Medication Administration

• Cancer patients often undergo multiple procedures requiring anesthesia, where delayed gastric emptying from semaglutide significantly increases aspiration risk 1
• Even stopping semaglutide 4-6 days before procedures has not eliminated aspiration risk in documented cases 1
• Dosing errors with semaglutide can lead to severe adverse events, which may be more likely in patients dealing with complex chemotherapy regimens 4

Nutritional Impact

• Cancer patients often struggle with maintaining adequate nutrition during treatment 1
• Semaglutide's appetite-suppressing effects and gastrointestinal side effects could further compromise nutritional status during chemotherapy 1
• Weight loss from semaglutide may not be desirable in cancer patients already at risk for cancer cachexia 1

Recommendations for Cancer Patients

• For patients requiring chemotherapy, discontinue semaglutide and consider alternative glucose-lowering medications if needed for diabetes management 1
• If diabetes management is required during chemotherapy, consider medications with lower risk of gastrointestinal side effects, such as DPP-4 inhibitors which have a neutral effect on weight and gastrointestinal symptoms 1
• For patients with type 2 diabetes undergoing chemotherapy who previously used semaglutide, metformin may be considered if kidney function is adequate (eGFR >30 mL/min/1.73 m²) 1
• If a patient has been taking semaglutide and requires an urgent procedure during chemotherapy, consider implementing extended fasting protocols and airway protection measures 1

Monitoring Requirements

• For cancer patients who must remain on semaglutide during chemotherapy (though not recommended), close monitoring for:
  • Signs of dehydration due to combined gastrointestinal effects 1, 2
  • Nutritional status and weight loss 1
  • Renal function, particularly with concurrent nephrotoxic chemotherapy 2
  • Symptoms of pancreatitis (severe abdominal pain) 2

While semaglutide has not shown increased cancer risk in studies 5, the practical risks of using it during chemotherapy outweigh potential benefits due to aspiration concerns, compounding of gastrointestinal side effects, and potential nutritional impact during a critical treatment period.