These GLP-1 medications are generally well-tolerated but may cause fatigue, headaches, hair loss, and gastrointestinal side effects such as nausea, vomiting, acid reflux, diarrhea, upset stomach, abdominal pain, and/or constipation, especially when starting treatment. These side effects usually diminish over time as the body adjusts to the medication. There can also be injection-site reactions (such as redness, swelling, itching or rash, etc.).
Fatigue, Lack of Energy and Tiredness: These are common side effects with all of these drugs. There are several causes including skipping meals which often results in hypoglycemia late in the afternoon, too much food reduction, and/or vitamin deficiency from rapid weight loss. Much of the fatigue can be avoided by not skipping meals and eating plenty of protein.
Gastrointestinal Side Effects: GI side effects are common in people taking these drugs. They included nausea, diarrhea, vomiting, and constipation. Less common are heartburn, burping and nonspecific abdominal pain.
• Nausea: Nausea is clearly the most common GI side effect. It’s often seen in the very beginning and during dose escalation, but for most people it gets less and less significant as time passes. Studies have shown it’s due the delayed gastric emptying, direct effect of these drugs in the brain, eating too fast or eating large meals especially full of fat and carbs. The secret is to eat smaller meals, more frequently, and try to stop before you feel full. Treatments: OTC meds like Gas-X, Pepto-Bismol, Imodium and prescription medications like Zofran (ondansetron) can help.
• Vomiting: This less common side effect is usually transitory and occurs more in the initial phase rather than with higher doses. Often treatment for GERD-like symptoms can stop the vomiting. Treatments: OTC products: Dramamine, Bonine, Gravol (ginger), Pepto-Bismol, and prescription medications like Zofran (ondansetron).
• Constipation: Constipation may last longer than other GI side effects, consistent with the more chronic nature of this condition. It is often due to other factors like the marked reduction of intake of food, especially fatty foods, fiber, and fats/oils. Treatments: Fiber such as Metamucil capsules 2-3 twice a day with several glasses of water (or psyllium husk), stool softeners and/or MiraLAX. With fiber- start low and gradually increase. Some other options include a Magnesium supplement or MCT oil.
• GERD-Heartburn-Reflux: Gastro-esophageal reflux disease (GERD) a known complication of obesity and with these medications. Treatments: OTC: Omeprazole, Prilosec, Prevacid- once or even twice a day. For breakthrough pain H2- blockers such as Pepcid AC or Tagamet can help.
More severe side effects, although rare, could be serious:
• Thyroid cancer- The FDA has issued its most serious warning (boxed warning) that GLP-1s like semaglutide or tirzepatide may be associated with a type of thyroid cancer called medullary thyroid carcinoma (MTC). So far, this side effect has only been seen in laboratory studies using rodents, so the risk to humans has not been determined
• Pancreatitis
• Gallbladder disease
• Low blood sugar
• Kidney disease
• Severe allergies or allergic reaction
• Vision problems (diabetic retinopathy)
• Gastroparesis
• Rapid heartbeat
• Suicidal thoughts or behaviors
• Injection site reactions (itching, redness, swelling)
Please see the full Prescribing Information (Wegovy, Ozempic, Zepbound, including the BOXED WARNING, for complete safety information.
Other Ways to Avoid Side Effects
Avoid fatty, greasy, and sugary foods. Aim for smaller meals and focus on protein first. Not only will that help with weight loss but also to avoid stomach upset.
Avoid large meals. Eat smaller meals. Try to avoid getting too full to avoid side effects.
Eat slower and chew thoroughly. Delayed gastric emptying prevents food from leaving your stomach quickly and can cause vomiting, nausea, and abdominal pain. Take small bites of food and stop when only half full.
Avoid carbonated beverages: Carbonated drinks can cause stomach discomfort, bloating and increased acid reflux. This includes carbonated water, sodas and some alcohol (seltzers, beer).
Consider splitting or lower the dose. If the side effects are bothersome, try lowering the medication for a while then slowly titrate back up after the side effects have improved. You could also try splitting the dose up during the week. Take ½ the dose twice a week sometimes can minimize side effects.
May need to stop/switch the medication. If the side effects are, despite the best efforts to alleviate the symptoms, treatment should be stopped. You could also consider switching to a different weight loss medication (in a different class), if appropriate.
Drink plenty of water. This will help avoid dehydration, fatigue, and help with constipation.
GLP-1 medications are typically prescribed as part of a comprehensive weight management program that includes other lifestyle changes such as a healthy (reduced-calorie) diet and increased physical activity. Individuals should be committed to making these lifestyle changes in conjunction with medication therapy.
It’s important to note that the decision to prescribe any weight loss medication should be after a comprehensive evaluation from a healthcare provider. A healthcare provider can assess your medical history, current health status, and weight loss goals to determine if these medications are an appropriate treatment option.
GLP-1 medications may not be suitable for everyone, and there are certain contraindications and precautions to consider before beginning treatment.
Online Weight Loss Program
MD by the Sea offers an online medical weight loss program that is physician-led by our Board-Certified Internal Medicine physician, Dr. Jami Feltner.
We offer weight loss medications, including the newest GLP-1 medications (if appropriate), a nutrition and exercise plan as well as continued ongoing support by email, text, phone and/or video.
These medications when used in combination with other lifestyle including the support of a physician, can lead to dramatic weight loss and continued long term success.
Let MD by the Sea help you with your weight loss journey!
