GLP-1 Safety

Disclaimer:

Ozempic® (semaglutide), Wegovy® (semaglutide), Mounjaro® (tirzepatide), Zepbound® (tirzepatide), Saxenda® (liraglutide), and Generic Liraglutide are not compounded. Ozempic®, Mounjaro®, and Generic Liraglutide are FDA-approved for type 2 diabetes treatment but may be prescribed off-label for weight loss at a healthcare provider's discretion. Wegovy®, Saxenda®, and Zepbound® are FDA-approved for weight loss. Ozempic®, Saxenda®, and Wegovy® are the registered trademarks of Novo Nordisk A/S. Mounjaro® and Zepbound® are registered trademarks of Eli Lilly and Company. Twentyeight Health is not affiliated with or endorsed by Novo Nordisk A/S or Eli Lilly and Company.

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Prescription products require an online consultation with a healthcare provider who will determine if a prescription is appropriate for you.

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Important safety and prescribing information:

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Side effects:

Many people experience no side effects while taking semaglutide. Some of the most common or potential side effects include:

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Nausea

Constipation

Vomiting

Diarrhea

Abdominal pain

Headache

Gastroesophageal reflux disease/Indigestion (Heart burn)

Injection site reactions

Dizziness

Back pain

Increased lipase or amylase (found during a blood test for pancreatic concerns)

Altered taste

Nasopharyngitis (common cold)

Passing gas

Bloating

Belching

Gastroenteritis (inflammation of the stomach/intestines)

Decreased appetite

Fatigue

Low blood sugar (hypoglycemia) in those with type 2 diabetes

Upset stomach

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These symptoms often subside as your body adjusts to the medications. Please notify your provider if side effects persist. For a complete list of side effects, review the medication packaging inserts.

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Please contact your doctor ASAP and seek in-person care immediately if a side effect becomes problematic or you experience:

Severe nausea and/or vomiting resulting in dehydration: It is important to stay well hydrated and drink plenty of fluids while on this medication.
Kidney problems/kidney failure: Vomiting, nausea, diarrhea can cause dehydration and kidney issues and make kidney problems worse in individuals who have pre-existing kidney conditions; may sometimes lead to the need for hemodialysis.
Thyroid C-Cell Tumor: Trouble swallowing, hoarseness, a lump or swelling in your neck, or shortness of breath (see “Black Box Warning” in the prescribing information).
Pancreatitis: Severe pain in your abdomen or back that will not go away.
Acute gallbladder disease: Pain in the middle or right upper stomach, fever, white parts of your eyes turn yellow or skin turns yellow, nausea/vomiting. If gallstones or inflammation of the gallbladder is suspected further studies are needed.
Hepatitis, elevated liver enzymes, or jaundice.
Diabetic retinopathy problems: Changes in vision in those with type 2 diabetes, particularly vision problems may worsen in those with a history of diabetic retinopathy.
Severe gastrointestinal disease: May cause gastrointestinal disease; do not use if you have a history of severe gastrointestinal disease.
Signs of low blood sugar (for example, dizziness, weakness, shakiness, jitteriness, headache, anxiety/mood changes, rapid heartbeat, confusion, slurred speech, sweating, or lightheadedness): While this is rare with semaglutide, if it occurs, please seek in-person care immediately. If you have these symptoms, try having liquid or food containing sugar (around 15-20 grams)—drink juice or regular soda, or eat some hard candies right away, as this will help raise your blood sugar quickly. If taken with insulin or an insulin secretagogue (ie sulfonylureas), it is best to talk to your health care provider about possibly lowering the dose of these medications to lower the risk of hypoglycemia.
If you are going under general anesthesia or deep sedation, GLP-1s may make you accidentally breathe food or liquid into your lungs (pulmonary aspiration). Tell the providers who will be performing the procedure that you’re taking a GLP-1 so they can give you instructions to avoid this.
Increasing heart rate.
Worsening depression, behavior changes, or suicidality.
Never reuse or share needles, syringes, or vials.

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Drug interactions:

As with other medications, semaglutide can interact with alcohol and certain prescription and non-prescription medications and herbal products. The risk of hypoglycemia is increased when combined with other drugs that may lower blood sugar, such as insulin or insulin secretagogues such as sulfonylureas. Semaglutide delays gastric emptying and may impact the absorption of oral medications. If you are on thyroid hormone medication, prior to starting semaglutide, please review the timing of taking your thyroid hormone medication with the doctor who prescribes it as it may need to be adjusted. The drug levels of medications with narrow therapeutic windows (i.e., warfarin) should be monitored closely while on semaglutide. Talk to your health care provider if you are taking levothyroxine before taking semaglutide.

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Please consult the pharmaceutical packaging for a full list of side effects, warnings, interactions and additional information.

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To report suspected adverse reactions to any of these prescription products, contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

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In case of emergencies, please call 911 or go to the nearest emergency room.

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Contraindications:

Do not use Wegovy if you have any of the below conditions. If anything changes and you develop one of these conditions, please stop taking this medication and contact your provider immediately. This list may not be all inclusive, reach out to your provider with any questions.

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Pregnancy
Breastfeeding
BMI less than 27
Personal or Family History of Medullary Thyroid Carcinoma
Personal or Family History of Multiple Endocrine Neoplasia Type 2
History or Active Renal disease
Type I Diabetes
Poorly controlled Type II Diabetes
History of Pancreatitis
Elevated Triglycerides
Significant Alcohol Use
Gallbladder disease without surgical removal
History of Retinopathy
History of a bowel obstruction
History of eating disorders
History of gastroparesis
History of Suicidal Ideation in the past
Recent bariatric surgery
Known allergy to semaglutide, tirzepatide, liraglutide, any other GLP-1 drug or any of the inactive ingredients in Ozempic®, Wegovy®, Mounjaro®, Zepbound®, or Saxenda®

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Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

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Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.

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If you are pregnant: weight loss medications should not be used during pregnancy. There is no benefit to weight loss during pregnancy and it may cause fetal harm.
If you are a female or male of reproductive potential: Discontinue weight loss medications at least 2 months before a planned pregnancy as these drugs can stay in the bloodstream for a long time.
If you are breastfeeding: Tell your Twentyeight Health provider if you are breastfeeding before you start any weight loss medications.

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Treatment Failure

This treatment is not guaranteed to be effective. It may not work or may only partially resolve the condition for which you are seeking treatment. In some cases, you may need to seek alternative treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, reach out to your Twentyeight Health provider for support. If it is an emergency, call 911 or seek immediate medical help in person.

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