Five years ago I was on 13 different medications—13! That’s a lot of foreign substances to put into my body every day. Medications are chemical substances that have been altered to prevent them from having toxic effects, but also formulated to target the cause of an abnormal physical or metabolic condition. Each medication has its own mechanism of action and because of that they sometimes clash with other meds. These interactions (clashes) can be harmless while others have serious negative effects. Taking several medications at the same time is called polypharmacy, and it has been a big problem for years.
Americans have experienced a big increase in drug interactions as a direct result of polypharmacy. Mixing multiple medications together is bound to be a potentially serious problem, and it certainly is. Interactions come in the form of blocking or delaying one another from being absorbed in the GI tract or causing adverse effects on organ systems after absorption while circulating throughout the body.
Were it not for computer programs pharmacies use to detect interactions and the watchful eye of alert pharmacists, serious interactions would be more common than they are. Physicians are aware of most major interactions and have interaction alerts built into their prescribing software, but occasionally troublesome combinations slip through. Pharmacy alerts are also very helpful.
One drug whose absorption is affected by numerous factors is the oral form of GLP-1 semaglutide. Prior to just recently, GLP-1’s were available only as subcutaneous injections—the drug was absorbed directly into the blood stream. Nothing was present to impede that action. Oral semaglutide, on the other hand, is taken into the stomach and passed through the duodenum to the small intestine where it is absorbed. Semaglutide delays passage of food and meds from the stomach. Anything already in the stomach will alter the effects of semaglutide and will delay semaglutide from getting into the small intestine.
Poor, or delayed, absorption of semaglutide blunts its desired effect, ie. weight loss. When the amount of weight lost is less than anticipated, switching to the injectable form is the right move.
Most of the time, it is the family doctor who is responsible for dealing with polypharmacy. He must review the patients meds and evaluate the continued need for each. Also to check reference sources for potentially serious interactions and make changes or adjust dosages to lessen or eliminate the impact. GLP-1’s are no more prone to have interactions than any other drug. But because their use has important ramifications, it’s important for family doctors to be well-educated on the problems they can encounter.
Reference: Peck J. Oral GLP-1’s Beyond the Hype: The Polypharmacy Challenge. www.medscape.com/viewarticle/oral-glp-1s-beyond-hype.
