From the Research
There are no absolute contraindications to GLP-1 receptor agonists for patients with multiple sclerosis (MS) who are also taking buprenorphine/naloxone (Suboxone), as evidenced by a recent study 1 that found GLP-1 agonists to be safe in MS patients with similar tolerability to the general population. However, caution is warranted due to potential overlapping side effects. GLP-1 medications can cause gastrointestinal symptoms like nausea, vomiting, and constipation, which may compound similar side effects from Suboxone. For MS patients specifically, there are no known disease-specific interactions between GLP-1 medications and MS pathophysiology or common MS medications, as noted in a review of the role of GLP-1 agonists in MS treatment 2. When starting a GLP-1 medication in this situation, it's advisable to begin with the lowest available dose and titrate slowly to minimize gastrointestinal side effects, as suggested by the analysis of head-to-head clinical studies of GLP-1 receptor agonists 3. Patients should be monitored for adequate hydration and electrolyte balance, as both medication classes can potentially affect these. Additionally, since GLP-1 medications can delay gastric emptying, this could theoretically affect the absorption of other medications, including Suboxone, though significant clinical interactions have not been widely reported. Any patient experiencing severe nausea, vomiting, or signs of dehydration should contact their healthcare provider immediately. Key considerations in managing MS patients on GLP-1 agonists and Suboxone include:
- Monitoring for potential gastrointestinal side effects and managing them appropriately
- Ensuring adequate hydration and electrolyte balance
- Being aware of the potential for delayed gastric emptying and its effects on medication absorption
- Regularly reviewing the patient's MS treatment plan and adjusting as necessary to optimize disease management and minimize drug interactions.