From the Guidelines
GLP-1 receptor agonists, such as semaglutide and liraglutide, can cause significant side effects, including gastrointestinal issues, pancreatitis, and potential thyroid tumors, and should be used with caution and careful monitoring, as reported in the most recent study 1. When considering the use of GLP-1 receptor agonists for weight loss, it is essential to weigh the potential benefits against the risks of side effects. The most common side effects of these medications include:
- Gastrointestinal issues, such as nausea, vomiting, diarrhea, and constipation
- Injection site reactions, such as redness or itching
- Elevated heart rate and hypoglycemia
- Potential for pancreatitis and gallbladder problems
- Rare cases of thyroid tumors, which is why they are contraindicated in people with personal or family history of medullary thyroid carcinoma, as noted in 1. To minimize side effects, doctors typically start with a low dose and gradually increase it over several weeks, allowing the body to adjust, as seen in the study 1. Staying well-hydrated and eating smaller, more frequent meals can also help manage gastrointestinal symptoms. The potential benefits of GLP-1 receptor agonists for weight loss, with an average weight loss of 6.0% to 9.6% from baseline, as reported in 1, must be carefully considered against the potential risks and side effects, and patients should be closely monitored for any adverse effects. It is crucial to note that these medications are contraindicated in individuals who are or may become pregnant, and individuals of reproductive potential must be counseled regarding the use of reliable methods of contraception, as stated in 1. Overall, the use of GLP-1 receptor agonists for weight loss requires careful consideration of the potential benefits and risks, as well as close monitoring for side effects, as reported in the most recent study 1.
From the FDA Drug Label
In the five adult glycemic control trials of at least 26 weeks duration, mildly elevated serum bilirubin concentrations (elevations to no more than twice the upper limit of the reference range) occurred in 4.0% of VICTOZA-treated patients, 2.1% of placebo-treated patients and 3.5% of active-comparator-treated patients. The following additional adverse reactions have been reported during post-approval use of VICTOZA. Because these events are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure • Gastrointestinal: Acute pancreatitis, hemorrhagic and necrotizing pancreatitis sometimes resulting in death, ileus • General Disorders and Administration Site Conditions: Allergic reactions: rash and pruritus • Hepatobiliary: Elevations of liver enzymes, hyperbilirubinemia, cholestasis, cholecystitis, cholelithiasis requiring cholecystectomy, hepatitis • Immune system: Angioedema and anaphylactic reactions • Metabolism and nutrition: Dehydration resulting from nausea, vomiting and diarrhea • Neoplasms: Medullary thyroid carcinoma • Nervous system: Dysgeusia, dizziness • Pulmonary: Pulmonary aspiration has occurred in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures requiring general anesthesia or deep sedation • Renal and urinary: Increased serum creatinine, acute renal failure or worsening of chronic renal failure, sometimes requiring hemodialysis. • Skin and subcutaneous tissue: Cutaneous amyloidosis In glycemic control trials, acute pancreatitis was confirmed by adjudication in 7 OZEMPIC-treated patients (0.3 cases per 100 patient years) versus 3 in comparator-treated patients (0.2 cases per 100 patient years). One case of chronic pancreatitis was confirmed in an OZEMPIC-treated patient. The following serious adverse reactions are described below or elsewhere in the prescribing information: • Risk of Thyroid C-cell Tumors [see Warnings and Precautions (5.1)] • Pancreatitis [see Warnings and Precautions (5.2)] • Diabetic Retinopathy Complications [see Warnings and Precautions (5.3)] • Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin [see Warnings and Precautions (5.5)] • Acute Kidney Injury [see Warnings and Precautions (5.6)] • Hypersensitivity [see Warnings and Precautions (5.7)]
The side effects of GLP-1 and injectables to lose weight include:
- Gastrointestinal: Acute pancreatitis, hemorrhagic and necrotizing pancreatitis, ileus
- General Disorders and Administration Site Conditions: Allergic reactions, rash, and pruritus
- Hepatobiliary: Elevations of liver enzymes, hyperbilirubinemia, cholestasis, cholecystitis, cholelithiasis requiring cholecystectomy, hepatitis
- Immune system: Angioedema and anaphylactic reactions
- Metabolism and nutrition: Dehydration resulting from nausea, vomiting, and diarrhea
- Neoplasms: Medullary thyroid carcinoma
- Nervous system: Dysgeusia, dizziness
- Pulmonary: Pulmonary aspiration
- Renal and urinary: Increased serum creatinine, acute renal failure or worsening of chronic renal failure, sometimes requiring hemodialysis
- Skin and subcutaneous tissue: Cutaneous amyloidosis
- Pancreatitis: Acute and chronic pancreatitis
- Diabetic Retinopathy Complications: Increased risk of diabetic retinopathy complications
- Hypoglycemia: Increased risk of hypoglycemia with concomitant use of insulin secretagogues or insulin
- Acute Kidney Injury: Increased risk of acute kidney injury
- Hypersensitivity: Serious hypersensitivity reactions, including anaphylaxis and angioedema 2 3
From the Research
GLP-1 Agonists and Weight Loss
- GLP-1 agonists, such as semaglutide and liraglutide, are used for the treatment of diabetes and obesity, and have been shown to produce significant weight loss in obese patients 4, 5.
- These medications work by potentiating insulin release, reducing gastric emptying, and decreasing food intake 4.
Side Effects of GLP-1 Agonists
- The most common side effects of GLP-1 agonists include gastrointestinal adverse events such as nausea, vomiting, diarrhea, and abdominal pain 4, 6.
- Other potential side effects include pancreatitis, biliary disease, hypersensitivity reactions, and renal adverse events 4.
- Rare but serious adverse events include gallbladder disorders and acute pancreatitis 6.
- GLP-1 agonists may also increase the risk of diabetic retinopathy and hypoglycemia when used with sulfonylureas or insulin 4.
Efficacy of GLP-1 Agonists for Weight Loss
- Semaglutide has been shown to produce an average weight loss of 15% at 1 year, making it a highly effective treatment for obesity 5.
- Other GLP-1 agonists, such as liraglutide and tirzepatide, have also demonstrated significant weight loss outcomes in clinical trials 5, 6.
- The efficacy of GLP-1 agonists for weight loss makes them a promising treatment option for individuals with obesity 7, 8.
Considerations for Use
- GLP-1 agonists should be used under the guidance of a healthcare provider, with careful monitoring for potential side effects and adverse events 4, 6.
- Individualized dosing and thorough patient assessment are essential to optimize the safe use of GLP-1 agonists 6.
- Further research is needed to refine guidelines for the use of GLP-1 agonists, particularly regarding new concerns such as delayed gastric emptying and its implications for anesthesia 6.