Add a new side effect to the GLP-1 agonists already substantial list of adverse gastrointestinal reactions. Don’t recognize the name glucagon-like peptide-1 (GLP-1) agonists? How about the super popular brand names Ozempic and Wegovy, aka semaglutide? They have been in short supply for many months because of their reputation as weight loss miracles. In addition to stomach paralysis with Ozempic and Wegovy, there is now a new complication: ILEUS! The FDA has just added ileus to the official prescribing information for semaglutide. More about that momentarily.
What the Heck Is ILEUS?
When your digestive tract stops functioning, it can lead to ileus. That means some portion of your intestines stops contracting and moving digestive material along lower part of the food tube.
Symptoms can include substantial abdominal pain and cramping, nausea, vomiting, bloating and inability to poop. This could turn into a life-threatening complication. Ileus sometimes occurs after abdominal surgery. It usually resolves within a few days. Drug-induced ileus may be more complicated.
Ileus was added as a potential adverse reaction to the official prescribing information for a similar medication, tirzepetide (Mounjaro), last July. By now, it should not come as a surprise that GLP-1 agonists like semaglutide and tirzepetide could do this. That’s because stomach paralysis with Ozempic and Wegovy is a growing concern, as you will shortly discover.
A Short History of GLP-1 Agonists:
Liraglutide:
These drugs were originally developed to treat type 2 diabetes. Liraglutide (Victoza) was approved by the FDA in 2010. Four years later, the agency approved the same drug under the name Saxenda to treat obesity. Although people taking this drug lost 12 pounds more over the course of a year than those on placebo, nobody got very excited.
Semaglutide:
Semaglutide was approved by the FDA for type 2 diabetes in 2017. It was first marketed as Ozempic. Then, in 2021, the agency approved this medication for weight loss under the name Wegovy. Because it appeared more effective than prior anti-obesity drugs, it began to attract attention.
Soon thereafter, social media picked up the story. Elon Musk contributed to the frenzy when he was asked how he lost weight. At first, he said “Fasting.” Then he added “And Wegovy.”
That little comment made headlines. Before long, both Ozempic and Wegovy were in short supply.
Tirzepatide:
The most recent addition to the weight loss bandwagon involves a similar diabetes drug. Tirzepatide (Mounjaro) has not yet been approved for obesity control, but the manufacturer has recently bragged about the results of two clinical trials. The drug works through two pathways. Like semaglutide, it mimics GLP-1. In addition, the drug stimulates “glucose-dependent insulinotropic polypeptide” (GIP) receptors.
This double action appears to make tirzepatide even more powerful. Two studies suggest that the drug can help people lose as much as one fourth of their body weight over about 88 weeks. This will doubtless add fuel to the enthusiasm about self-injected weight loss drugs.
The Hottest Drugs In America:
Why are the GLP-1 agonists becoming so successful? A lot of people want a quick weight loss solution so they look good.
Others, who have struggled with their weight for decades, are seeking a successful strategy to shed excess pounds. Drug companies are offering pharmaceuticals that will make people feel full after just a few bites. These medications seem to reduce food cravings and hunger pangs.
The drugs are called GLP-1 receptor agonists or GLP-1 analogs. Another name for them are incretin mimetics. That means they mimic natural “incretin” hormones made in the body. These compounds stimulate the secretion of insulin after the body senses glucose (sugar).
In reality they do a lot more. They reduce hemoglobin A1c (HbA1c) and help control blood glucose for people with diabetes. They also create a sense of satiety in the brain, thereby reducing appetite and food intake and changing the internal set point for weight management. More recently, semaglutide (Ozempic, Wegovy) has been shown to reduce major adverse cardiovascular events (MACE) by 20% in overweight adults.
Not Everyone Can Tolerate Ozempic:
Q. I have prediabetes and need to lose some weight to qualify for back surgery. That’s why my doctor prescribed Ozempic.
The first month, I was on a low dose and had minor nausea. After it was increased to 0.5 mg a week, I suffered persistent nausea and constipation. I could barely stand to look at food.
This drug limited my social interactions for fear of throwing up. I felt like I was in my first trimester of pregnancy, so I could not continue. What other options will help me control blood sugar levels?
A. Some people find the nausea, vomiting, diarrhea or constipation associated with semaglutide (Ozempic, Wegovy) intolerable. There are many other ways to manage blood sugar, though, including older medications such as metformin. You can learn about the pros and cons of diabetes drugs and non-drug approaches in our eGuide to Preventing and Treating Diabetes.
A Serious Complication of GLP-1 Agonists:
Nausea, constipation and diarrhea are certainly unpleasant. More recently, anesthesiologists have been warning about a related complication that an be even more serious.
Q. You recently answered a letter from a woman whose daughter had a reaction after anesthesia while taking a type of diabetes medication. In your response, you referred to gastroparesis.
I am a recovery room nurse. While gastroparesis might be a concern, it is nothing compared to euglycemic ketoacidosis that has been associated with surgery and taking SGLT2 drugs.
At our hospital we won’t do surgery on anyone who has taken any medication in the GLP-1 or SGLT2 classes within 72 hours unless the condition is life threatening. We have cancelled many surgeries due to this. Please inform your readers of this risk, and suggest they follow instructions before surgery, or they might have their operation cancelled.
A. Thank you for a helpful warning. To help people understand it, we need to offer some explanations.
The original question centered on semaglutide (Ozempic, Wegovy), a GLP-1 agonist that helps manage insulin and appetite. SGLT2 medicines like empagliflozin (Jardiance) keep the kidneys from reabsorbing sugar from the blood stream, so that excess sugar is removed in the urine.
Gastroparesis is essentially stomach paralysis. (Keep reading to learn more about this problem.) Food retained in the stomach can be regurgitated under anesthesia, leading to life-threatening pneumonia.
The ketoacidosis you refer to occurs when the body uses fat rather than sugar as its fuel. In some cases, the blood becomes acidic, a life-threatening complication. Anyone using one of these medicines to control their blood sugar (or lose weight) must discuss it thoroughly with the anesthesiologist prior to surgery.
What About Stomach Paralysis with Ozempic and Wegovy?
Before you start begging your doctor for a prescription for one of the GLP-1 agonists, you need to know about the downsides of these self-injected medications.
First, when people stop these very expensive medications, the weight tends to return. You can read more about this boomerang effect at this link. There are also a number of worrisome side effects.
Thyroid cancer is a potential risk. So is pancreatitis. This inflammatory condition can be extremely painful. Gallbladder disease is another serious complication.
One of the problems is that symptoms of pancreatitis or gallbladder disease can be similar to the most common reactions to these medications. A reader has described the digestive side effects of these weight loss drugs as an “intestinal apocalypse.” Nausea, vomiting, diarrhea and abdominal pain can be incapacitating. You can read more about side effects of drugs like Ozempic and Wegovy at this link.
Gastroparesis = Stomach Paralysis with Ozempic and Wegovy:
Most people never think about what happens in their digestive tract once they eat. Food goes in one end and the left overs (poop) come out the other in about 2-5 days. But what happens in between is critically important to your overall health.
How long does it take food to move out of your stomach and into your small intestines? This is the first part of the journey. The general consensus is that food exits the stomach in about 2-4 hours. Of course that is highly variable. It depends on what you have eaten, the state of your overall health and what medications you are taking.
When food takes longer to exit the stomach than normal, doctors call the condition gastroparesis. It comes from the Ancient Greek words gaster (which means stomach) and paresis (which means no movement or partial paralysis). One unexpected but potentially very serious complication of the GLP-1 agonists may be gastroparesis.
Why Would People Experience Stomach Paralysis with Ozempic and Wegovy?
We found a fascinating article published in an unlikely journal, Frontiers in Psychiatry, March 18, 2020. It was titled: “The Role of GI Peptides in Functional Dyspepsia [indigestion] and Gastroparesis: A Systematic Review.” The authors discussed various factors that caused delayed stomach emptying. One of those factors may be GLP-1. Drugs that mimic GLP-1 just might have a similar effect.
An article in the Canadian Journal of Anaesthesia (June 6, 2023) raised a red flag. It was titled:
“Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report”
The authors describe what happened:
“We describe an unexpected case of regurgitation of a large volume of gastric contents upon induction of general anesthesia in a nondiabetic, nonobese patient despite a long preoperative fasting period (20 hr for solids and eight hours for clear fluids). This patient had no traditional risk factors for regurgitation or aspiration but was taking the GLP-1 RA [receptor agonist] semaglutide for weight loss and had last taken the medication two days before their scheduled procedure.”
The physicians conclude:
“Patients taking long-acting GLP-1 RAs such as semaglutide may be at risk of pulmonary aspiration under anesthesia. We propose strategies to mitigate this risk including holding the medication four weeks prior to a scheduled procedure when feasible and considering full stomach precautions.”
Breathing stomach contents (pulmonary aspiration) while anesthetized is very dangerous!
An editorial published in the same journal on July 19, 2023 was subtitled “proceed with caution!” It suggests that doctors tell patients to avoid semaglutide for weight loss three weeks prior to surgery. That’s to prevent aspiration of stomach contents.
Consider the Implications of Stomach Paralysis with Ozempic and Wegovy:
The Canadian anesthesiologists are suggesting that semaglutide needs to be discontinued at least 3 to 4 weeks prior to surgery. That is presumably to make sure that there is NO FOOD in the stomach at the time anesthesia is administered. That is a long time!
A Lawsuit Involving Regarding Stomach Paralysis with Ozempic and Mounjaro:
A Louisiana woman filed a lawsuit on August 2, 2023 alleging that using these diabetes drugs resulted in stomach paralysis. Most references consider gastroparesis a rare complication of drugs like Ozempic, Wegovy or Mounjaro. The lawsuit only has a chance if the woman’s attorney can prove that the drug companies failed to warn of the risk. See this article about lawsuits and drug companies to learn more about such issues.
How many more people have experienced stomach paralysis with Ozempic and Wegovy? As I write this, that is unclear.
A July 25, 2023 report from CNN quotes the FDA:
“The FDA has received reports of gastroparesis with semaglutide and liraglutide, some of which documented the adverse event as not recovered after discontinuation of the respective product at the time of the report.”
The law firm that filed the case for the Louisiana woman claims to have hundreds of inquiries from other people who have persistent GI problems related to GLP-1 agonists.
What Are the Symptoms of Gastroparesis?
Persistent nausea and vomiting can be a warning sign that the stomach is not emptying properly. The National Institute of Diabetes and Digestive and Kidney Diseases reports that:
The symptoms of gastroparesis may include
•feeling full soon after starting a meal•feeling full long after eating a meal•nausea•vomiting•too much bloating•too much belching•pain in your upper abdomen•heartburn•poor appetite
Final Words About Stomach Paralysis and Ileus with Ozempic and Wegovy:
There is much we do not know about gastroparesis and GLP-1 agonists. Is this a really rare complication of such drugs or surprisingly common.
If a “normal” person usually empties her stomach within 2-4 hours of eating, how long does it take for someone on liraglutide, semaglutide or tirzepatide? Is it hours or days or…?
If food remains in the stomach for long periods of time, what are the implications? Severe nausea and vomiting can be incredibly debilitating. Are there other complications associated with stomach paralysis?
Now we know that ileus is a lower abdominal complication that kind of resembles stomach paralysis, people taking Ozempic, Wegovy and Mounjaro should watch out for these complications:
Symptoms of Ileus:
• Abdominal pain
• Cramping, nausea, vomiting, bloating and inability to poopfeeling full soon
• Nausea
• Vomiting
• Bloating
• Delayed bowel movements or severe constipation
Please share your own experience with drugs like liraglutide, semaglutide and tirzepatide in the comment section below. Were such drugs miracle weight loss medications? Did you experience any adverse reactions. We would like to better understand the pros and cons of these GLP-1 agonists with your help.
Learn More:
People with type 2 diabetes can learn more about the medications used for blood sugar control in our eGuide to Preventing & Treating Diabetes. We have also done a two-part interview series for our podcast: Show 1361: The Lowdown on New Medicines for Treating Obesity–Part 1 and Show 1362: The Lowdown on New Medicines for Treating Obesity–Part 2. You will appreciate varied perspectives if you listen to both.
