Who Should Not Take Semaglutide?

Obesity is a growing worldwide epidemic that is associated with multiple chronic health conditions. Newer options for treating obesity have become available over the past few years, and more and more people are considering these options. Semaglutide is one of the more popular medications on the market recently, and a lot of people are wondering whether this medication may help them on their weight loss journey. While this medication may be an option for many people, there are some who should not take semaglutide. Today’s article is about semaglutide and populations for which it may not be appropriate.

What Is Semaglutide?

Semaglutide is a protein that works on the glucagon-like peptide-1 receptor. It is in a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. Rybelsus® and Ozempic® are two forms of semaglutide approved by the Food and Drug Administration (FDA) for the treatment of diabetes. Wegovy® is the same medication but is approved by the FDA specifically for the treatment of obesity. [1] Semaglutide is available as a compounded medication from some specific compounding pharmacies but is still under patent and not available as a generic medication. Semaglutide is only available by prescription.

Rybelsus® is semaglutide available in oral form, while Ozempic® and Wegovy® are dispensed in prefilled pen syringes. Compounded semaglutide is administered in a vial that you draw up and inject. The dose of medication may vary depending on why it is being prescribed and the individual’s response to it.

Wegovy® has an additional indication for reducing the risk of cardiovascular death, heart attacks, and stroke in adults with cardiovascular disease who are also overweight or obese. [2]

What Are the Effects of Semaglutide?

Semaglutide is similar in structure to glucagon-like peptides that your body makes naturally. It has many benefits. This protein works at the level of the body and the brain to slow the emptying of food from the stomach, regulate insulin levels, decrease hunger and food cravings, and increase the feeling of being full. [2]

Semaglutide and other GLP-1 receptor agonists are designed to last longer than GLP-1, which is made naturally in your body. [3] In addition to lowering blood sugars, GLP-1 medications have been shown to decrease the risk of death from cardiovascular disease. They have also been shown to improve kidney function. [4]

Semaglutide is also associated with several side effects. These include [5]:

• Belching
• Bloating
• Excessive gas
• Stomach pain
• Heartburn
• Fever
• Yellowing of the skin or eyes
• Dizziness
• Headache
• Nausea and vomiting
• Shakiness
• Low blood sugars
• Diarrhea
• Constipation
• Hair loss
• Change in taste
• Pain or skin changes at the injection site
• Fatigue
• Weakness

Rapid weight loss can also have side effects on your body. Rapid weight loss will decrease your body’s metabolism and can cause loss of muscle mass in addition to the loss of fat. The muscle loss can further decrease your metabolism because muscle is an efficient calorie-burning tissue. Other side effects of rapid weight loss include [6]:

• Loss of bone density
• Loss of strength
• Fatigue
• Hair loss
• Decreased immune system
• Inadequate nutrients

Who Is Semaglutide Recommended For?

If you’ve been diagnosed with diabetes, the American Association of Clinical Endocrinology (AACE) recommends lifestyle interventions as the first line of treatment. After this, a GLP-1 receptor agonist may be recommended depending on whether there are other risk factors, such as a high risk for cardiovascular disease. [7]

Semaglutide, under the brand name Wegovy®, is approved for treating chronic weight management in people with a BMI of 27 or higher and at least one weight-related condition or in people with a BMI of 30 or higher. Weight-related conditions that may qualify you for semaglutide at a BMI of under 30 include [8]:

• High blood pressure
• Type 2 diabetes
• High cholesterol
• Obstructive sleep apnea

Who Should Not Take Semaglutide According to Current Guidelines?

Like any medication, semaglutide is not for everyone. You should discuss with your healthcare provider any recommendations and risks of this medication specific to your situation. Still, according to the current guidelines, there are some populations for whom semaglutide is contraindicated.

People With Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia Syndrome Type 2 (MEN2)

Semaglutide and other medications in the GLP-1 receptor agonist class are contraindicated in people with MTC or MEN2 because rodent studies during the development of the medicines showed an increased risk of thyroid cancers. This may be due to factors specific to the rodents, as these findings have not been seen in nonhuman primates or humans. [9]

People With Allergies to Semaglutide

A known allergy or sensitivity to semaglutide or its components is another reason not to take the medication. Semaglutide is a protein, so it is possible for the body to form an immune reaction to the medication. [9]

People Who Are Pregnant

Women or people who were assigned female at birth (AFAB) who are pregnant should not take semaglutide. There aren’t many studies about the use of semaglutide and other GLP-1s in pregnancy. Limited animal studies have shown an increased risk of birth defects, growth issues, and pregnancy loss, but there are no studies in humans. [10] The FDA has recommended against the use of GLP-1 medications in pregnancy and has recommended discontinuation of these medications at least two months before a planned pregnancy to allow time for the medication to get out of your system.

People With Pancreatic Diseases

People who have had acute pancreatitis or pancreatic cancer shouldn’t take GLP-1 receptor agonists. These medications may increase the risk for pancreatitis, though the data are mixed. [9] These complications are infrequent, and additional studies are needed to determine whether the medication carries increased risk. The current recommendation is that semaglutide and other GLP-1 receptor agonists should be stopped if pancreatitis is suspected and should not be restarted if pancreatitis is present. [9]

People With Acute Gallbladder Disease

GLP-1 receptor agonist medications increase your risk for gallstones, which may be caused by rapid weight loss. These medications may also change gallbladder motility, which could contribute to the formation of gallstones. If you develop symptoms of gallbladder disease, it may be necessary to stop the medication, but you should talk with your healthcare provider before stopping any medication. [9]

People With Suicidal Behavior

There is some indication that weight loss medications such as semaglutide may increase the risk of suicidal thoughts. The data on this is mixed, but it is recommended to avoid using these medications in people with a history of suicide attempts or who currently have suicidal thoughts. [4]

Other Contraindications

Semaglutide is not indicated for people with type 1 diabetes, people who are on other weight loss medications, and people who already have slow gastric emptying. People who have previously had bariatric surgery should be closely monitored by their healthcare team if they are on GLP-1 receptor agonists. [4]

Alternatives to Semaglutide

There are many alternatives to semaglutide for both managing diabetes and for managing weight. Your healthcare provider can help you choose the best medication for your unique health needs.

Some alternative medications for diabetes include metformin, sulfonylureas (glimepiride, glipizide, and glyburide), TZDs (rosiglitazone and pioglitazone), alpha-glucosidase inhibitors (acarbose and miglitol), bile acid sequestrants (colesevelam), SGLT2 inhibitors, DPP-4 inhibitors, and dopamine-2 agonists. [11,12]

Alternatives to semaglutide to treat weight loss include other GLP-1 receptor agonists, including liraglutide, phentermine-topiramate, bupropion-naltrexone, orlistat, and setmelanotide. [13]

Lifestyle Changes To Support Weight Goals

There are many options for losing weight. Lifestyle changes, such as healthy eating patterns and regular physical activity, are necessary to achieve and support your weight loss goals. As you start your weight loss journey, you should talk with your healthcare provider to ensure you are healthy enough to lose weight. [14]

Let Everlywell Support You on Your Weight Loss Journey

Obesity is a chronic, long-term problem that can have profound effects on your health, and it requires a comprehensive solution. At Everlywell, we’re here to support you on your weight loss journey. Our comprehensive Weight Care+ program gives you access to regular virtual visits with a licensed healthcare provider, lifestyle content and support, regular lab tests and supplements, and prescribed weight loss medications for qualified candidates. Personalize and take control of your weight loss journey with Everlywell today.

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