Semaglutide is prescribed for managing type 2 diabetes and chronic weight management. It functions as a glucagon-like peptide-1 (GLP-1) receptor agonist, mimicking a natural hormone’s action. This action regulates blood sugar levels by increasing glucose-dependent insulin secretion, reducing glucagon release, and slowing gastric emptying. Semaglutide also influences brain areas controlling appetite and fullness, contributing to weight loss.
Understanding Common Side Effects
Gastrointestinal side effects are common when starting semaglutide or after a dose increase. These reactions generally lessen over several weeks as the body adjusts. Nausea, vomiting, diarrhea, and constipation are frequently reported.
Other effects include abdominal pain, heartburn, bloating, gas, and fatigue. To manage these symptoms, eat smaller, more frequent, bland meals. Stay well-hydrated and avoid eating too close to bedtime or being overly active immediately after a meal.
Identifying Serious Risks and Who Should Not Take Semaglutide
While semaglutide offers benefits for diabetes and weight management, it carries a risk of serious, less common, adverse effects. Pancreatitis, an inflammation of the pancreas, can manifest as severe, persistent abdominal pain that may radiate to the back, sometimes with vomiting. Gallbladder problems, including gallstones (cholelithiasis), are another potential risk, with symptoms such as pain in the upper stomach, fever, or yellowing of the skin or eyes.
Kidney problems, including acute kidney injury, have been reported, often in patients experiencing dehydration from severe vomiting or diarrhea. Adequate hydration is therefore important. Rapid improvements in blood sugar control, particularly in individuals with a history of diabetic retinopathy, may temporarily worsen this eye condition, requiring careful monitoring. Severe allergic reactions, such as anaphylaxis or angioedema, are also possible, characterized by swelling of the face, lips, tongue, or throat, or breathing difficulties.
The U.S. Food and Drug Administration (FDA) has issued a boxed warning for semaglutide due to a risk of thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), observed in rodent studies. It is currently unknown whether semaglutide causes these tumors in humans, as the relevance of the animal findings to human health has not been definitively established.
Given these potential risks, semaglutide should not be used by individuals with a personal or family history of MTC. The medication is also contraindicated for those with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), a rare genetic condition that increases the risk of MTC. Semaglutide should also be avoided by individuals who have experienced a severe allergic reaction to the medication or any of its ingredients. Use during pregnancy and breastfeeding is not recommended, as animal studies indicate potential risks to the fetus and human data are insufficient. Women planning a pregnancy are advised to stop semaglutide at least two months before conception.
Guidelines for Safe Use and Monitoring
Following prescribed dosage and administration instructions is important for safe use. The medication is typically administered as a once-weekly subcutaneous injection, on the same day each week, at any time of day, with or without meals. The injection site should be rotated among the abdomen, thigh, or upper arm.
Open communication with a healthcare provider is also important. Patients should inform their doctor about all existing medical conditions, including any history of pancreatitis, kidney disease, or diabetic retinopathy. They should also disclose all medications, over-the-counter drugs, vitamins, and herbal supplements. Semaglutide can delay gastric emptying, potentially affecting the absorption of other oral medications, so monitoring the effectiveness of these concurrent medications may be necessary.
When semaglutide is used with other medications that lower blood sugar, such as insulin or sulfonylureas, there is an increased risk of hypoglycemia (low blood sugar). In such cases, the dosage of insulin or sulfonylureas may need to be adjusted to reduce this risk. Regular monitoring by a doctor, including blood sugar level checks, kidney function assessment, and general health check-ups, is advised to detect adverse effects early.
If a dose is missed, it should be administered as soon as possible within five days of the missed dose. If more than five days have passed, the missed dose should be skipped, and the regular dosing schedule resumed. Lifestyle changes, such as a reduced-calorie diet and increased physical activity, complement the medication’s effects and contribute to overall health.