If you or someone you know has been struggling to lose weight, you’ve probably heard of Ozempic, made with semaglutide. Because it lowers blood sugar levels and promotes weight loss, it’s no surprise that many consider it a wonder drug. Even Hollywood celebs and business tycoons swear by its pound-shedding benefits.
But just like any drug, it comes with risks, warnings, and potential side effects. Some medical conditions make others especially vulnerable to the drug’s adverse effects.
To stay on the safe side, it’s important to know, ‘Who should not take semaglutide?’ In this article, we look at semaglutide’s diagnostic criteria, as well as who should avoid semaglutide.
What is semaglutide?
You may be familiar with Ozempic, but how familiar are you with its active ingredient, semaglutide? Knowing what it is and how it works will allow us to better understand its contraindications.
In our gut is a hormone called glucagon-like peptide-1, or GLP-1 for short. Whenever our blood sugar levels spikes, GLP-1 triggers the pancreas to release insulin, which brings these down to normal levels.
Semaglutide is a glucagon-like peptide-1 receptor agonist, or GLP-1 Ra. Whenever blood sugar levels are high, it responds in the same way, performing the same action.
At the same time, semaglutide also delays gastric emptying, or that process where food exits the gut and enters the small intestine. Because digestion is slowed down, you don’t think about food as much and you feel fuller for longer. With fewer food cravings and a curbed appetite, people on semaglutide lose a considerable amount of weight. The drug also signals to the brain that you’re already full.
Oral and subcutaneous semaglutide
You have two options of how you can take semaglutide during your treatment: either subcutaneously or orally.
Ozempic and Wegovy come in disposable injectable dosing pens and people inject them under the skin or subcutaneously. Because of this, people refer to them as subcutaneous semaglutide.
Rybelsus, meanwhile, is oral semaglutide as it comes in tablet form and is taken by mouth.
Safety and efficacy
You’ll be glad to know that semaglutide has FDA approval to treat type 2 diabetes and obesity. The following are highlights from the research that proves semaglutide’s safety, efficacy, and tolerability.
In the STEP 5 trial, researchers examined the two-year effects of semaglutide in adults who were overweight or with obesity. Participants lost an average of 15 percent of their body weight with semaglutide. Meanwhile, those in the placebo group lost approximately 2.6 percent of their body weight.
Participants taking semaglutide also lost 14.4 centimeters or 5.7 inches off their waistline. Additionally, their systolic blood pressure improved by 5.7 mmHg. Participants in the semaglutide group also experienced better diastolic blood pressure, blood sugar levels, total cholesterol, and triglycerides.
A study in December 2022, meanwhile, found that participants on semaglutide lost more body fat than body mass. In addition, they consumed less food, had better food control, and less food cravings, especially for greasy food.
Side effects
Whether using semaglutide for blood glucose control or weight management, there’s still the risk of experiencing the drug’s side effects.
Gastrointestinal reactions account for 10% or more of semaglutide’s side effects. These include:
- nausea (up to 44% of cases),
- diarrhea (up to 30%),
- vomiting (up to 24%),
- constipation (up to 24%),
- abdominal pain (up to 20%),
Other common side effects which occur in 1 to 10% of cases include indigestion, belching, gassiness, gastroenteritis, or gastritis. Gastroenteritis is the short-term infection and inflammation of the digestive system, while gastritis is the inflammation of the stomach lining.
Note that these common side effects of semaglutide are mild and you can manage these with your healthcare provider. Semaglutide’s more serious adverse effects, meanwhile, are rare.
Who Should Avoid Semaglutide
If you are considering taking semaglutide, it’s important to understand whether or not you are eligible for it. Who should avoid semaglutide? Here’s what you need to know.
Just like any drug, consult your physician first before taking it, also as semaglutide is only available with a prescription. If you have or have had any of the following conditions, inform your doctor to avoid any potential contraindications.
History of medullary thyroid cancer (MTC)
When taking semaglutide, you run the risk of developing thyroid gland tumors such as medullary thyroid cancer (MTC). Researchers discovered this after lab rats developed more thyroid C-cell tumors after taking semaglutide.
MTCs are tumors from the thyroid gland’s C cells or parafollicular cells which synthesize, store, and release calcitonin or thyrocalcitonin. Calcitonin is the hormone that regulates the level of calcium in the blood.
When you have MTC, it triggers the production of calcitonin. While there are no direct negative side effects of having too much calcitonin in the blood, MTC can metastasize and affect tissues, particularly lymph nodes. Lymph nodes are responsible for filtering unhealthy cells such as cancer cells.
History of gallbladder disease
Patients taking semaglutide may also want to steer clear of the drug if they have a history of gallbladder disease. A study found that there was a higher incidence of acute cholecystitis among those taking GLP-1 receptors such as semaglutide.
Acute cholecystitis refers to the inflammation of the gallbladder. This usually happens when a gallstone obstructs the cystic duct. Complications from this condition include gallbladder tissue death or gangrenous cholecystitis.
History of pancreatitis
For those with a history of pancreatitis or have risk factors for pancreatitis, they should consider stopping taking semaglutide altogether.
Although rare, patients who take semaglutide run the risk of getting pancreatitis, or inflammation of the pancreas. This is because semaglutide triggers the pancreas to produce insulin. The pancreas is the organ responsible for releasing enzymes that aid in digestion. It also produces and secretes insulin.
Multiple endocrine neoplasia syndrome type 2 (MEN2)
Another health condition that makes a person ineligible to take semaglutide is multiple endocrine neoplasia syndrome type 2 or MEN2.
MEN2 is a rare hereditary disorder wherein tumors develop in the endocrine glands. Endocrine glands are responsible for manufacturing and releasing hormones into the blood. Potential side effects include a mass found in the neck, difficulty swallowing, and prolonged hoarseness of the voice.
In addition, MEN2 is a hereditary condition linked to MTC, parathyroid cancers, and pheochromocytoma. Pheochromocytoma is a neuroendocrine tumor that hormone-producing chromaffin cells produce.
Pregnant or planning to get pregnant
If you’re pregnant or planning to get pregnant shortly, you must avoid semaglutide. According to animal studies by the FDA, taking semaglutide while pregnant may result in birth defects, growth problems, or death. If planning to get pregnant, stop taking semaglutide at least two months before. This is to ensure the body is already free of the drug.
Breastfeeding
If nursing, women must also avoid semaglutide as it may seep into breast milk and transfer to the baby. Breast milk absorbs only 0.4 to 0.1% of semaglutide and will likely not cause any adverse effects. However, it is better to avoid potential complications especially when nursing a premature infant. This is because they have developing digestive and immune systems.
Drinking alcohol
Diabetic and a regular drinker? You should consult your physician if you plan on taking semaglutide while having the occasional dose of alcohol. This is because it can interfere with your blood glucose levels.
Drinking alcohol can increase (hyperglycemia) or decrease (hypoglycemia) blood sugar levels, depending on the amount of alcohol and consumption frequency. While there are no FDA warnings against drinking alcohol while on semaglutide, it can make blood sugar levels erratic. Correspondingly, this is not conducive to helping manage diabetes.
Taking other medication
Your physician must be aware of all medicines you’re taking as one may have a potential side effect on another. For instance, some drugs with insulin may clash or have a negative side effect when taken alongside Ozempic. These include antibiotics, antifungals, corticosteroids, beta-blockers, calcium channel blockers, sulfonylureas, non-steroidal anti-inflammatory drugs, or monoamine oxidase inhibitors (MAOIs).
Undergoing a surgery or procedure that requires an empty stomach for anesthesia
According to a PBS report, American and Canadian anesthesiologists observed patients inhaling food and water into their lungs while sedated. This was the case even when they stopped eating six to eight hours before the surgery or procedure.
Semaglutide affects signals between the brain and the stomach involved in appetite and feelings of fullness. Because semaglutide also has a way of prolonging the emptying of the stomach’s contents, the patients’ tummies are still full. As a result, this puts them at a higher risk for pulmonary aspiration.
Pulmonary aspiration is a health condition wherein a person accidentally inhales a foreign substance into their lungs. The inhalation of harmful substances can potentially lead to pneumonia and even death.
In 2023, the American Society of Anesthesiologists advised patients to pause weight-loss drugs on the day of a surgery/procedure. Additionally, they advised patients to skip weekly injections a week prior to any surgeries or procedures involving sedation.
Novo Nordisk’s own clinical trial and safety data did not show any link of semaglutide to aspiration. However, the medication delays the emptying of the stomach’s contents and has possible gastrointestinal side effects.
Conclusion
Despite semaglutide’s popularity in managing type 2 diabetes or promoting weight loss, it still has potential side effects and contraindications. Before considering taking semaglutide, you must make sure to do sufficient research and consult your physician.
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