GLP-1s weight loss medications

We’re talking about the glucagon like peptide-1 receptor agonists or GLP-1s for short. While this class of medications has been around for over 20 years, you’re just hearing about Ozempic (semaglutide) FDA-approved for type 2 diabetes in 2017, Wegovy (semaglutide) FDA-approved for weight loss in 2021 and Mounjaro (tirzepatide) FDA-approved for type 2 diabetes and for obesity by the end of 2023. The reason you’re just hearing about these medications even though other name brands within this class also contributed to weight loss over the last 20 years, is because these newer medications are weekly rather than daily injections.

The medications enhance secretion of insulin from the pancreas which drives sugar into the cells to be used for energy. This is why these medications were first used to treat type 2 diabetes, the form of diabetes mostly associated with overweight and obesity. During study trials and in the real world, they were also found to be highly effective at appetite suppression and weight loss.

Despite the amazing weight loss and relatively good safety profile compared to weight loss meds that came before it, the media is always looking for a chink in the armor. Success apparently doesn’t generate as many clicks as scandal. And that’s why the media often highlights side effects associated with Ozempic even though these are side effects we’ve known about for over 20 years.

Success apparently doesn’t generate as many clicks as scandal.

And they often attach a clever name to the side effect to capture more eyes. Below we’ll review the main “complications” of these medications even though they’re really known side effects that, in some cases, are features of the medication, not a bug.

Stomach paralysis

This is just a scarier term for delayed gastric emptying. One way these medications help you lose weight is through delayed gastric emptying, meaning food moves more slowly from the stomach to the intestine. This results in a feeling of fullness so the patient eats less and loses weight.

Ileus

This is similar to delayed gastric emptying. These medications affect and slow motility or movement throughout the entire gastrointestinal track. This could lead to ileus, a slowing of the intestines so food stops moving forward and in the worse of circumstances leads to a bowel blockage. But that’s not common. What’s more common are the other GI side effects like nausea, vomiting, diarrhea or constipation. All treatable ailments if they occur and one option is to switch to tirzepatide which has fewer side effects compared to semaglutide as seen in independent studies below.

Pancreatitis

Also a known rare side effect. These medications, even when approved for type 2 diabetes work to stimulate or enhance insulin secretion from a “burned out” pancreas in a type 2 diabetic state. They work for weight loss by stimulating the pancreas to release insulin which contributes to a feeling of satiety (less hungry, eat less). Out of 2,116 patients studied in the Wegovy trial that was ultimately submitted to the FDA for approval, 4 patients taking the active ingredient semaglutide and 1 patient taking the placebo or inactive ingredient for comparison had pancreatitis. So the risk isn’t high in developing pancreatitis in general, but can still occur, even in a patient not taking the medication (placebo)!

Medullary thyroid cancer

When these medications were first being studied on lab rats in the lab, some rats contracted a rare form of thyroid cancer, medullary thyroid cancer. But even some of the rats taking the placebo, the nonactive medication, developed medullary thyroid cancer. So it’s not clear what that association is and the FDA even states they’re not sure of the significance in humans. Even though the incidence of medullary thyroid cancer in humans has been rare and unchanged for the last 30+ years despite these medications being available on the market for human use since 2005, we still recommend our patients examine the middle of their neck to ensure there are no lumps and bumps around the neck that weren’t there the month before.

Suicidal ideations

There is a risk of suicide with all weight loss medications. This isn’t specific to Ozempic, Wegovy or Mounjaro. It’s not clear yet what the association is, possibly pre-existing depression, but patients on weight loss medications are known to consider suicide. There’s no evidence this is specific to or worse for patients on Ozempic or Wegovy. But the drug manufacturer isn’t attempting to hide this. It was in the FDA application for approval.

This won’t be all. The media will look at other side effects and act like they’re new or riskier than they are. For the next trending risk, my money is on alopecia. 3% of patients taking the medication had some alopecia but the placebo group still had 1% incidence of alopecia. This isn’t specific to the medication. Any stressor, like weight loss, can lead to hair loss. It’s called telogen effluvium.

Nothing new here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyHealth.

The post Ozempic is safe. How fake news wants you to believe otherwise. first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Antibiotics

While not based on personal experience, one of the more common infections on a trip is a skin infection from a scratch or a urinary tract infection (UTI). You can’t bring a whole pharmacy with you but there’s a group of antibiotics that can cover many potential infections. They’re called fluroquinolones.

You may know them better as Cipro or Levaquin. They also go by the generic names of ciprofloxacin and levofloxacin, respectively. The reason I go into such detail about their trade and generic names is because all of the drugs in this class have ‘flox’ in the name. So regardless of what country you’re in, and if you forgot to bring your own Cipro or Levaquin with you, you’ll know you’re getting the right medication because ‘flox’ will be part of the name on the bottle, even if the rest of name doesn’t look familiar.

DripDrop for Dehydration

If it was realistic to bring a bag of IV fluids along with your own IV tubing and needle, I would. But since this is difficult for a host of reasons – such as you may not be a nurse or a doctor and the TSA would probably question you – DripDrop is the next best thing. It’s a powder formulation that you add to a bottle of water to replace lost sodium and potassium and other essentials elements that you need in addition to water. It won’t treat your diarrhea but it’ll keep your diarrhea from leading to your dehydration! DripDrop is available without a prescription.

Nausea

I’ve got one word for you: Zofran. This is the greatest anti-nausea medication ever created. It comes in a dissolvable tablet. So even if you’re vomiting, this will be absorbed under your tongue. No need to swallow. It’s available in a generic form as ondansetron.

Enjoy your next trip abroad. And the best way to guarantee it is to bring along this trusty pack of meds.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Medications to pack when traveling abroad first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.