Last week, I published an article titled “Weight Loss a Different Way.” In it, I reported on the increasing frequency of use of a class of drugs mainly prescribed to control blood sugar levels in diabetics. In addition to its blood sugar-lowering properties, a secondary benefit of this class of drugs was its ability to cause as much as a 15% loss in total body weight. Both diabetics and non-diabetics were flooding their physicians with requests for this drug.
The drug class is GLP-1 (glucagon-like peptide-1) agonists. The generic name is semaglutide, and it was marketed as Wegovy and Ozempic. A third brand, Rybelsus, is less effective for weight loss. One other GLP-1 agonist (there are ten), liraglutide, marketed as Saxenda, was found to be effective at lowering weight, as well, but hasn’t received the attention given semaglutide.
As semaglutide and liraglutide became used by more and more patients, demand overtook supply, but also adverse effects gradually appeared. GLP-1 agonists work by delaying gastric emptying (making you feel full all the time), stimulating gut hormones, and suppressing the normal muscular activity of the intestinal tract. You feel full, you’re not hungry, so you eat less. This is ok unless you have general anesthesia or conscious sedation for a surgical operation. Anesthesiologists are seeing instances of vomiting while under anesthesia, a serious problem, which causes aspiration of food particles into the lungs. Patients were choking and becoming asphyxiated.
Additionally, liraglutide and semaglutide have caused acute gall bladder problems and episodes of acute pancreatitis. In fact, a retrospective analysis of patients on GLP-1 agonists, showed those patients had a 9 times greater risk of pancreatitis, a 4 times greater risk of bowel obstruction, and a 3 times greater risk of gastroparesis (paralysis of the stomach). Altering the motility of the GI tract has serious adverse effects. These problems, along with reports of depression and suicidal ideation, and the 150 instances of self injury, led doctors, especially anesthesiologists, to warn colleagues about having a cavalier attitude toward these drugs.
To counteract these effects, pharmaceutical manufacturers and diabetic clinicians have suggested guidelines for the safer use of these drugs. Rather than start therapy at the recommended maintenance dose, they suggest the “start low and go slow” method. That means start the drug at a sub-therapeutic dosage and increase to the maintenance dose gradually over a period of several weeks. This allows the patient to adapt to the new drug without inducing troublesome side effects. In the case of anesthesia, patients should not take semaglutide for 7 days prior to general anesthesia.
Another drawback to GLP-1 agonists is the financial pain caused by the out-of-pocket expense for a drug that costs $16,000.00 a year. Neither Nutri-System nor Weight Watchers combined cost that much!
So, as is the case with everything medical, when there are good effects, there also are adverse effects. That’s just the way it is. Balancing between the two is the really tricky poropsition.
Reference: Medical News and Perspectives: As Semaglutide’s Popularity Soars, Rare but Serious Adverse Effects Are Emerging jamanetwork.com 2023 Nov 15;doi:10.1001/jama.2023.16620
