Adverse Events :
So you are considering starting a GLP-1 agonist. Perhaps you qualify for a Lilly or Novo discount (starter 1-3 months). Or you are willing to pay the high monthly price and have obtained a prescription. And finally you can find it at a reputable pharmacy (FDA approved) but are concerned about the adverse events. A good start to understand the risks (not the benefits) is published online 10/5/2023 in JAMA.
Unlike prior data of small numbers of semaglutide subjects in prior studies, this data is based upon a random sample of 16 million patients (2006-2020) from the PharMetrics Plus database (IQVIA) that captures 93% of all outpatient prescriptions and physician diagnoses in the US through the International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10.
The increase incidence of biliary disease (gallstones) is well documented as a side effect of significant weight loss with any type of diet. It is unclear if semaglutide gallstone incidence is higher than other weight loss meds.
The major concern relates to pancreatitis, bowel obstruction and gastroparesis.
The GLP-1 group had a 9 times greater risk of pancreatitis, a 4 times greater risk of bowel obstruction, and a more than 3 times greater risk of gastroparesis, which causes stomach paralysis (compared with users of Buproprion-Naloxone).
Of note is the recent FDA warning about bowel obstruction. As this data is obtained from prescriptions and physician ICD diagnosis, the severity of these adverse events is not known.
So should you start a semaglute for weight loss or Type 2 Diabetes, weight loss with or without cardio-vascular disease? This is an individual decision based upon risk tolerance vs potential benefits. The more recent positive data on decreasing morbidity and mortality for obesity related cardiac, vascular and stoke begins to tip the scale in favor of meds such as Wegovy or Zepbound.
Remember, without long term changes in your diet, activity and lifestyle, these meds may only be a short term fix to lifelong risk factors.
Data rules out suicide as a risk with semaglutides.