Patients grapple with side effects of popular weight-loss drugs – The Washington Post

As more people turn to blockbuster diabetes and obesity drugs such as Wegovy, Ozempic and Mounjaro, some are grappling with an unwelcome trade-off: how to balance uncomfortable, sometimes painful, side effects with the benefits of reduced food cravings and the loss of substantial weight.

In the case of Demoy, who lives in Moultonborough, N.H., she tried staving off nausea by drinking electrolytes to stay hydrated and eating more protein. Finally, her doctor lowered her weekly dose — and her symptoms eased.

All three drugs mimic a naturally produced hormone — called glucagon-like peptide-1 — that increases insulin production, suppresses appetite and slows the emptying of the stomach, creating a full feeling even when patients eat less. Mounjaro also mimics a second, closely related hormone called GIP, which also stimulates insulin production. Researchers say having two targets produces a more powerful effect.

Novo Nordisk, which makes Ozempic and Wegovy, said gastrointestinal side effects are mild to moderate and well-recognized. “Semaglutide has been extensively examined in robust clinical development programs, large real world evidence studies and has cumulatively over 9.5 million patient years of exposure,” a statement from the pharmaceutical company said.

The drugs’ list prices are about $1,000 to $1,300 a month. Private insurance generally covers diabetes drugs but often does not pay for medicines used for weight loss. A recently published analysis of pharmacy and medical claims data showed nearly 70 percent of patients who had taken Wegovy and another weight-loss drug, Saxenda, were no longer using the medications; the analysis did not address patients’ reasons for stopping the medications.

Stomach pain hit Blair so hard that she could see her skin rippling from the intense cramps. “I was projectile vomiting and other gross things,” she said. “It was so painful that I thought I was going to have to call 911.”

Her doctor switched her to Saxenda, a daily-injection drug from the class known as liraglutide approved by the Food and Drug Administration for managing obesity. The drug causes only occasional nausea and slight headaches, she said. But Blair says Ozempic — which helped her lose 17 pounds, down to 220 — was more effective in curbing obsessive thoughts about food.

“Have a modest dinner, watch out for fatty foods and oils for a day or two, and stop eating as soon as you feel full,” Kushner said. “Don’t take a shot on Friday night when you are planning on partying over the weekend.”

In some cases, providers who lack experience with the drugs are being too aggressive about ramping up dosages, experts say. Wegovy doses should be increased gradually, taking five months to go from 0.25 to 2.4 milligrams. If the treatment causes nausea, the dose should be kept the same — or decreased — until the patient adjusts.

Tia Koch, 40, a schoolteacher in Reading, Pa., was on the lowest dose of Wegovy before increasing it after a month. The next day, nausea hit her in waves. At school, co-workers gave her ginger ale and a motion-sickness pill, but she threw up and retreated to a classroom closet to agonize in pain. That night, the symptoms were so bad that Koch checked into a hospital, where she had nausea and an elevated heart rate for several days.

This month, a Louisiana woman with a similar story sued Novo Nordisk and Eli Lilly, alleging the companies have downplayed severe gastrointestinal issues. The patient asserted that she was prescribed Ozempic, then Mounjaro, over the course of a year and a half, and wound up hospitalized because of stomach pains and vomiting so violent she lost teeth. The woman’s law firm, Morgan and Morgan, says it has been retained by more than 500 clients in 45 states with similar stories.

Another undesirable result of the drugs is potential loss of lean muscle along with fat, which can occur when there is rapid weight loss, regardless of the method used, doctors said. Lean muscle is important for keeping bones strong, protecting against diabetes and reducing the risk of falls, a concern especially for older people. Loss of lean muscle can happen to anyone who loses weight quickly, regardless of the method, doctors said.

Sahar Takkouche, assistant professor in the division of endocrinology, metabolism and diabetes at Vanderbilt University Medical Center, said patients can take steps to minimize the loss of lean muscle, including eating enough protein and exercising. Strength training is especially important.

“We’ve received anecdotal reports that the delay in stomach emptying could be associated with an increased risk of regurgitation and aspiration of food into the airways and lungs during general anesthesia and deep sedation,” the organization said in a statement.

Demoy, the travel agent, said she plans to stay on Wegovy despite her bouts of lethargy and nausea. She originally had been taking Saxenda, but she said it stopped working as effectively — the obsessive thoughts about food crept back.

The side effects started only after she switched to Wegovy, initially at a weekly dose of 2.4 milligrams. Still, Demoy is pleased with the greater health benefits. Her cholesterol and sodium levels have dropped. Her blood pressure has come down enough that her doctor wants to wean her off two additional medications, she said.

This content was originally published here.

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