Wegovy is the trade name for semaglutide. Semaglutide is a synthetic version of the incretin hormone glucagon-like peptide -1 (GLP-1) secreted in the gut. The FDA (Food and Drug Administration) has approved 2 other commercial semaglutide drugs – Ozempic and Rybelus. Wegovy and Ozempic are available as subcutaneous injections while Rybelsus is available in an oral form.
Indications and contraindications of Wegovy
An individual may be given Wegovy if they fall in either of the below categories:
- BMI greater than 30 kg/m2.
- BMI between the ranges of 27-30 kg/m2 with existing comorbidities like diabetes, hypertension, hyperlipidaemia, obstructive sleep apnoea (OSA), heart attack, stroke, blood vessel disorders.
- Adolescents who are above 12 years of age with a BMI > 95th percentile or weighing greater than 60kg.
Note – A lower BMI (reduced by 2.5 kg/m2) threshold is used for individuals of South Asian, Chinese, other Asian, Middle Eastern, Black African or African Caribbean family backgrounds.
Contraindications of Wegovy are:
- Individuals with a family or personal history of MEN 2 (multiple endocrine neoplasia) or MTC (medullary thyroid cancer) or any thyroid cancer.
- Pregnant and lactating mothers
- Individuals above 75 years of age
- Individuals with type 1 diabetes
Alcohol consumption can be regarded as an activity to socialise, relax and celebrate. Continuous and uncontrolled use of alcohol may lead to alcohol use disorder.
The effect of alcohol may vary from individual to individual based on:
- Age
- Health conditions
- Family history
- Quantity of alcohol consumed
- Frequency of alcohol intake
- Any associated medication/recreation drugs intake
Consequences of excessive alcohol consumption
Consumption of alcohol leads to circulation of alcohol in the bloodstream. The quantity of alcohol in the blood is directly proportional to the quantity of alcohol consumed. Higher the alcohol intake, higher the consequences and severity of alcohol’s effects. Some symptoms are –
- Minimal inhibitions
- Slurred speech
- Physical disability
- Forgetfulness
- Loss of memory
- Difficulty concentrating
- Difficulty breathing
- Decreased immunity
- Pancreatitis
- Fatty liver
- Cirrhosis
- Reduced bone density
- Cancer of the liver, brain, colon, rectum, breast, oesophagus etc.
- Coma
- Death
The social impact of alcohol consumption is worrisome due to increased risk of:
- Sexual assault
- Suicide
- Homicide
- Vehicle collision (road traffic accidents)
- Accidents
- Unsafe sex
- Increased risk of abortion
- Adolescent pregnancy
Benefits of semaglutide for people consuming excess alcohol
Currently the FDA has approved 3 drugs for alcohol dependence, namely – Acamprosate, disulfiram, naltrexone.
Animal studies conducted on the effectiveness of semaglutide in alcohol de addiction revealed –
- Alcohol consumption in individuals is attributed to it’s rewarding effect and increase in dopamine (the happy hormone).
- The severity of these two mechanism can lead to alcohol use disorder (AUD).
- AUD is a multifaceted disorder characterised by increased reactivity to stress, impulsive behaviour, stress, decreased emotional regulation, other social factors etc.
- GLP-1 may help in modulating the alcohol’s neurobiological mechanism.
- Apart from its glucose lowering effect and weight loss benefit, GLP-1 helps in alcoholism due to its long acting effect.
- The study revealed that alcohol-dependent rats treated with semaglutide:
- Had reduced their alcohol consumption by half in comparison to rats who were not given treatment.
- The rates of relapse, a common issue post alcohol abstinence was less.
These studies conducted on rats may translate to humans too in the future due to the similarity in the mesolimbic dopamine system in humans and rats. However further clinical studies are required to ascertain the benefit of semaglutide for alcoholics.
Experience with our patients at the London obesity clinic and Simplyweight
Dr Rajeswaran, consultant endocrinologist, has had patients who are on semaglutide, both Wegovy and Ozempic mentioning that they are not able to consume the same amount of alcohol which they previously had.
People on semaglutide feel that the effect of alcohol starts even at a lesser volume. Dr Rajeswaran feels that “In normal individuals, after 20 minutes of consumption of alcohol, the alcohol reaches the pancreas, small intestine and liver. Therefore metabolism of alcohol starts. When people are on semaglutide, the stomach and intestinal movement slows down. So, there is more alcohol available in the system which may reduce the tolerability.”
Alcohol withdrawal
Sudden alcohol withdrawal can lead to characteristic symptoms such as –
- Rapid heartbeat
- Increased sweating
- Increased blood pressure
- Excessive sweating
- Tremors
- Seizures
- Hallucination and delirium
- Difficulty speaking
- Anxiety
- Distress
- Anhedonia
Relapse of heavy drinking may be the result of the inability to cope with alcohol withdrawal.
Tips for alcohol de-addiction
- Limit your alcohol intake to 14 units/week.
- Alcohol withdrawal symptoms may manifest 6 hours after the last drink of alcohol.
- Seek help from a trustworthy friend or family member.
- Consult a medical practitioner to strategise the de-addiction process.
- Consider de-addiction therapy with a psychologist.
- Practise meditation and breathing techniques.
- Have a balanced and nutritious meal.
- Practise physical activity and exercise.
Side effects of semaglutide
The side effects of any semaglutide product can be short term or long term. Dietary changes may help with gastrointestinal symptoms.
Possible short term complications:
- Dizziness
- Nausea
- Vomiting
- Abdominal pain
- Constipation
- Diarrhoea
- Belching
- Headache
- Fatigue
Possible long term complications:
Long term complications may require the intervention of a medical professional.
- 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
Conclusion
- Semaglutide like Wegovy is approved for weight management or blood sugar management in particular. The effect of semaglutide in terms of alcohol de-addiction is an added benefit of the drug.
- Wegovy must only be taken under medical supervision.
- Semaglutide is not a magic injection to stay sober. It must be complemented with behavioural therapy, other medications, support groups etc. which have given consistent results.
- Semaglutide may not be addictive or act as a substitute to alcohol.
- There isn’t sufficient clinical evidence to prove the de-addictive property of the drug. More research is required.
- Wegovy must not be taken along with other prescription drugs, herbal products and other medications.
- There is a potential for weight gain or alcohol relapse when taken off the drug.
- Both men and women should limit your alcohol intake to 14 units/week.
