Semaglutide is a drug belonging to the class of medications: Glucagon-like peptide -1 receptor agonists (GLP-1 RA). GLP-1 is a hormone of the gastrointestinal tract which is stimulated upon consumption of food. GLP -1 RA helps improve insulin sensitivity, stimulates appetite centres of the brain to suppress appetite, hunger and satiety. It also helps in managing weight. 

Currently there are 3 FDA (Food and Drug Administration) approved semaglutide products available for prescription use. These include

  • Ozempic subcutaneous injection

  • Rybelsus tablets

  • Wegovy subcutaneous injection

Smoking is an addictive social habit. The prevalence of smoking among 6.4 million adults of the United Kingdom above the age of 18 years was observed to be higher among males (14.6%) than females (11.2%) in the year 2022.

Tobacco consumption and smoking can negatively impact health. It may also result in reduction in Disability Adjusted Life Years (DALY). According to WHO (World Health Organisation), one DALY lost is equal to one year of full health lost. 

Smoking can lead to more deaths than deaths caused by HIV, drugs, alcohol, road accidents, fire accidents combined. 

Impact of smoking on health

According to the CDC (Centres for Disease Control and Prevention), smoking can lead to disability and disease affecting life quality such as –

  • Cancer (bladder, cervix, blood, larynx, oesophagus, pancreas, stomach etc.)

  • Heart diseases

  • Stroke

  • Chronic Obstructive Pulmonary Disorder (COPD) 

  • Rheumatoid arthritis

  • Eye issues

  • Tuberculosis

  • Emphysema

  • Chronic bronchitis

  • Increased pregnancy risks – Preterm delivery, ectopic pregnancy, stillbirths, clefts in infants, low birth weight (LBW) infants, miscarriage, infertility. 

Thereby smoking increases risk of  coronary heart disease and stroke by 2-4 times, lung cancer in men by 25 times and similarly by 25.7 times in women.

Quitting smoking is an important life decision an individual takes. Stopping smoking can reduce the risk of the above mentioned health problems.

Though there are several measures one can take to quit smoking, semaglutide can help in this process and reduce the risk of cancers and cardiovascular events.


Benefits of semaglutide for smokers

Ongoing research suggests anecdotal evidence of the benefits of semaglutide for smokers owing to the following potential mechanisms:

  1. Appetite regulation – The influence of semaglutide on appetite and weight loss, helps people feel good and motivates them to improve their general health. This helps individuals get motivated to quit smoking habits whilst losing weight.

  1. Weight management – Weight gain may be a possible concern for individuals addicted to smoking. The fear of the long term effect of smoking leading to weight gain. This can be attributed to the effect of nicotine withdrawal, retarded metabolism, increase in hunger and sedentary lifestyle.

Most people who stop smoking, gain weight. This is due to the fact that the heat and chemicals in cigarette increase their metabolic rate. When they stop smoking their metabolism slows down leading to weight gain. Also when people stop smoking their hand mouth reflex stays and hence compensate by eating more to accommodate the hand mouth reflex.

  1. Improved dopamine levels – Individuals are addicted to smoking, due to the stimulation of dopamine, “the feel good hormone”. Semaglutide can possibly influence the pathway of dopamine to improve food intake. It is said to be understood that this activity of dopamine helps to suppress nicotine cravings and addiction. Withdrawal symptoms are easier to handle on semaglutide.

  1. Behavioural intervention – Semaglutide promotes behavioural modification. The urge for smoking may get diminished and coping with de-addiction becomes manageable for the individual. 

Semaglutide vs quit-smoking aids 

Semaglutide provides complementary benefits over traditional quit-smoking aids which have been in use in recent years such as nicotine replacement therapy (NRT), bupropion etc.. 

  • The effectiveness of semaglutide in smoking de-addiction depends on individual to individual.  

  • Semaglutide can be used as an added agent to smoking cessation aids.

  • It suppresses smoking-addiction cravings.

Semaglutide helps in managing both the barriers to smoking de-addiction. The 2 possible barriers for an individual to quit smoking are:

  • Management of withdrawal symptoms

  • Weight gain

Effect of nicotine withdrawal and triggers

There is an existing level of nicotine present in the body post cessation of smoking. The body demands nicotine when these levels decline. Withdrawal of nicotine may lead to psychological and physiological cravings for tobacco products.

  1. Weight gain – There is an increase in appetite and hunger in individuals which can lead to an increase in weight. This can be attributed to stress to cope with the new lifestyle habit. A study conducted on 348 patients, revealed 161 patients maintained their initial weight or a change in weight >5% to their baseline weight while 57 patients had a weight gain of more than 5%. 18 patients showed >10% increase in baseline weight. Semaglutide can help with managing weight during smoking de-addiction which is a cause of worry for many individuals.

  2. Feelings of irritation or frustration

  3. Restlessness

  4. Difficulty concentrating

  5. Difficulty sleeping

  6. Anxiety and depression

Side effects of semaglutide

The side effects caused due to use of any semaglutide product can be defined in terms of short term or long term complications. Specific dietary modifications may help with gastro intestinal short term symptoms. However, long term complications may require the intervention of a certified medical supervisor.

Possible short term complications due to cigarette smoking in semaglutide users are –

  • Dizziness

  • Nausea

  • Vomiting

  • Abdominal pain

  • Constipation

  • Diarrhoea

  • Belching

  • Headache

  • Fatigue


Possible long term complications due to cigarette smoking in semaglutide users are –

  • Severe allergic reaction to any of the ingredients of semaglutide.

  • Gallbladder problems

  • Inflammation of the pancreas (pancreatitis).

  • Low blood glucose levels.

  • Kidney problems

  • Rapid heart rate

  • Diabetic retinopathy (damage of the retina due to high blood glucose levels).

  • Suicidal ideation and depression.

Ongoing research

Ongoing studies on the benefits of semaglutide for smokers is still ongoing. Sufficient translational work is necessary to confirm the helpfulness of the drug in the addiction of smoking.  

A study is currently being conducted by the University of North Carolina, Chapel hill and National Institute on Drug Abuse (NIDA) to understand the effect of GLP-1 receptor agonists on nicotine response and smoking behaviour on dependent smokers. The study is currently in its second phase and results are awaited.


How to have a sustainable smoking de-addiction with semaglutide?

If an individual is interested in using semaglutide as an aid to smoking cessation, they may need to –

  1. Get a comprehensive health check up by a certified medical practitioner.

  2. The medical supervisor will decide the individual’s suitability and prescribe an appropriate dosage and instructions to administer the medication.

  3. Adopt a lifestyle change for the better – following a healthy diet, practising physical activity and managing stress are principal requirements.

  4. Create a support group or get a trustworthy individual like a parent or a therapist’s help.

  5. Perseverance is key to staying off nicotine. Taking deep breaths, staying hydrated and healthy distractions may help.


Note

  • The primary usage of semaglutide is for weight loss or managing glycaemic levels. The effect of semaglutide on the urge to smoke is an added benefit of the drug.

  • It is not a magic solution to smoking de-addiction. It must be supplemented with behavioural therapy, other medications, support groups etc. which have given consistent results.

  • Semaglutide may not be addictive or act as a substitute to nicotine.

  • There isn’t sufficient evidence to prove the de-addictive property of the drug. Sufficient research is required.

  • Wegovy must not be clubbed with other prescription drugs, herbal products and other medications.

  • There is a potential for weight gain when taken off the drug.

  • Wegovy must only be taken under medical supervision.