Semaglutide is an active component used in the medications – Ozempic, Wegovy and Rybelsus. Rybelsus and Ozempic are medications approved for the treatment of type 2 diabetes and Wegovy is approved for weight loss.
Semaglutide is a dupe of the naturally occurring hormone, Glucagon Like Peptide – 1 receptor agonist (GLP-1 RA). Semaglutide is available in an injectable form (subcutaneous injection) and as an oral drug (Rybelsus) in distinct doses. The form of the drug, dose and strength prescribed is variable based on the practitioners preferred choice and the patient’s requirements. It is the first approved drug to be used as the second line treatment alternative in diabetes management.
The common trade names of semaglutide are – Ozempic, Wegovy, Rybelsus etc.
Semaglutide – Mode of action
GLP-1 is an incretin hormone secreted in the gastrointestinal tract (GI tract) during a meal. Semaglutide works by enhancing the functioning of GLP-1 receptors through specific mechanisms. Such as:
- Stimulating the beta cells of the pancreatic islets to secrete more insulin.
- Ceases release of glucagon (a hormone secreted by the alpha cells of the pancreatic islets of langerhans during hypoglycaemia).
- Reduces occurrence of gluconeogenesis.
Benefits of Wegovy (semaglutide)
Semaglutide like Wegovy helps:
- Improves fasting blood sugar (FBS) and Post Prandial Blood Sugar (PPBS) levels.
- Improves insulin sensitivity.
- Reduces total energy intake (sudden changes in energy levels can lead to unhealthy food cravings, semaglutide like Wegovy helps counteract this effect).
- Retards gastric motility.
- Improves satiety (GLP-1 receptors present in the brain’s hypothalamus are responsible for this effect).
- Helps in weight loss.
A trial conducted for 12 weeks on 30 subjects with a treatment of once-weekly semaglutide dose up to 1 mg indicated a change in weight of an average of 5.0 kg loss of weight which may be attributed to decreased energy intake and appetite (a total of 24% reduction in energy across all meals consumed) in individuals on semaglutide vs placebo. However resting metabolic rate (RMR) did not change.
Wegovy contains semaglutide with several benefits including:
- Minimises risk of cardiovascular issues like stroke and heart attack.
As a result of weight loss, Wegovy ……
- Lowers blood pressure
- Improves joint pain
- Boosts mood and self esteem
- Promotes better sleep
Indications of Wegovy (Semaglutide)
An individual may be prescribed a semaglutide like Wegovy, if any of the below criteria are satisfied in addition to body mass index (BMI).
- An individual has a BMI greater than 30 kg/m2.
- An individual’s BMI falls between the ranges of 27 – 30 kg/m2.
- Adolescents who are above 12 years of age with a BMI > 95th percentile or weighing above 60kg.
- Individuals with existing comorbidities like diabetes, hypertension, hyperlipidaemia, obstructive sleep apnoea (OS), heart attack, stroke, and blood vessel disorders.
- People of South Asian origin with a lower BMI( 27.5 kg/m2) also fit the criteria.
Contraindications of Wegovy (semaglutide)
Semaglutide must never be used in patients with:
- Potential allergy to any of the ingredients used in the Semaglutide drug.
- Pancreatitis
- Gallbladder issues and gallstones
- Hypoglycaemia
- Diabetic retinopathy
- Acute kidney injury
- Tachycardia (fast heart rate)
- Suicidal behaviour and thoughts
- Pregnant and lactating women
- Children below 12 years of age
- Senior citizens above 75 years of age
Always consult a doctor if you wish to be considered for Wegovy.
What are the common side effects?
The common side effects of semaglutide are common across several of the drug forms available such as Wegovy. Of the given listed and known symptoms, the gastrointestinal symptoms are predominant due to the said mode of action of the drug.
- Gastrointestinal symptoms – Nausea, diarrhoea, vomiting, constipation, abdominal pain, indigestion/dyspepsia, abdominal distension, belching/eructation, gastroenteritis, and gastroesophageal reflux disease
- Headache
- Fatigue
- Dizziness
- Hypoglycaemia
- Diabetic retinopathy
How to prevent side effects of semaglutide?
Gastrointestinal symptoms may be more easily managed in comparison to other physiological side effects through dietary intervention.
Vomiting and nausea
This is the most common symptom in individuals who are on semaglutide. Higher doses of semaglutide can be correlated to vomiting and nausea. Nausea is comparatively more common.
Prevention:
- Have smaller meals.
- Avoid consumption of fatty and fried food which need an extended duration of digestion.
- Never lie down immediately after eating.
- Give a gap of 3-4 hours between meal time and bedtime.
- Avoid strong smells and spicy food.
- Individuals can have crackers, apples, mint or ginger based drinks 30 minutes post semaglutide.
- Vomiting may cause dehydration, staying hydrated is crucial.
Diarrhoea
Diarrhoea is a common side effect of semaglutide.
Prevention:
- Dehydration may be a sequel to diarrhoea. Generous hydration with addition of water, lemon or bicarbonate to drinks can be helpful.
- Bland food like chicken broth, white rice, ripe fruits or baked fruits are suitable to be included in the diet
- Avoid high fibre food during episodes of diarrhoea. They can be reintroduced once the stomach settles.
- Avoid sports beverages, dairy products, laxatives, coffee, alcohol, aerated beverages, artificial sweeteners, and extremely hot or cold food.
Constipation
Difficulty in passing stools is a less common symptom of semaglutide. It is rare but not absent.
Prevention:
- Have a fibre rich, balanced and wholesome diet
- Improve physical activity. Stay active throughout the day
- Stay hydrated. Water, tender coconut water, and juices etc., are good options
Abdominal distention
Gas and bloating may be commonly experienced in individuals on semaglutide.
Prevention
- Gradual and slow addition and increase of fibre to the diet can help improve symptoms. Rapid addition can worsen bloating.
Belching
A distinct burp with a peculiar smell and taste may be present when on semaglutide. This can also be due to GERD.
Prevention:
- Avoid fried, oily, spicy, fatty food, caffeine and alcohol.
Fatigue
This is a common side effect of Wegovy. A common cause of this may be due to the reduction in body’s energy intake in comparison to the previous calorie count which the body is used to. Patience and giving the drug time to work can help the body adapt to the new energy intake. Ensure you are well hydrated with water.Headache
If an individual with diabetes is prescribed semaglutide, they may initially have headache due to the hypoglycaemic effect of the drug. The medical practitioner can guide the individual further on managing this symptom.
Hypoglycaemia
Due to the unique mode of action of the semaglutide in comparison to other hypoglycaemic agents, the insulin response to meals is varied. The medical practitioner may have to alter the dose of the drugs.
Pancreatitis
This is a rare and serious side effect. There is insufficient evidence to understand if the cause is due to semaglutide. Pancreatitis is the inflammation of the pancreas. Symptoms may be – abdominal pain, nausea, vomiting, jaundice etc. which may coincide with GI symptoms caused by semaglutide. Seek urgent medical help if you have abdominal pain.
Vivid dreams
Intense dreams and nightmares may occur. However there is no known reason for these symptoms. If sleep is disturbed for a long period of time, it may affect one’s quality of life. A healthcare provider may delve in such a situation to aid the individual.
Hair loss
Hair loss may be a sudden but temporary side effect. This may also be called Telogen effluvium, which is the shedding of resting hair after metabolic stress, hormonal changes or medication. As the body adjusts to semaglutide, the hair fall subsides. If hair loss persist, immediately contact your doctor.Gallbladder issues
Gallstones are a possible side effect but not common. Symptoms of gallstones are – stomach pain, fever, jaundice, clay coloured stools. A pre-existing condition of the same may get worsened. A medical practitioner must be informed immediately of any new developments faced.
Allergies
An allergic reaction to semaglutide ingredients is rare but not impossible. Symptoms may be swelling of face, tongue, throat, dyspnea etc. It may be commonly manifested as itches, rashes, redness at the site of injection. Mild allergic reactions do not require any change per say.
Gastroparesis
Gastroparesis is the paralysis of the stomach caused due to the paralysis of nerves. Symptoms may be – nausea, early fullness, vomiting, delayed gastric emptying etc. Severe symptoms may require immediate and urgent attention.
Semaglutide are still under study. Long term side effects and other side effects are still under review and are uncertain.
Possible risks
- Animal studies on rodents, suggest a semaglutide induced thyroid C-cell tumours. Symptoms include – a mass in the neck, dysphagia (difficulty swallowing), dyspnea, hoarseness of voice.
- Individuals with a pre-existing history of medullary thyroid cancer (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2) may not be suitable to take the drug.
Note
- Never combine different semaglutide containing products, GLP-1 RA, other weight loss products, prescription drugs, herbal products and over the counter drugs.
- Always read the information label on the semaglutide drug prescribed.
- Insulin and insulin specific agents may require a change in dosage. The doctor must be kept aware of such medications to avoid severe hypoglycaemia.
- The medication must be coupled with a healthy diet, lifestyle intervention for a sustainable weight loss in the long run.
- There is a chance of weight regain when taken off semaglutide.
- Always take the medication under a certified medical practitioner.
Do not delay seeking help from a doctor or go to the nearest Accident & Emergency department if you have any of the above serious side effects.
