Drug Interactions (general concern)
Users on Reddit have shared various experiences and concerns regarding drug interactions while using GLP-1 medications. These concerns span interactions with other prescribed medications, substances like alcohol, and implications for medical procedures, as well as how GLP-1s might interact with pre-existing conditions.
Experiences and Concerns with Drug Interactions:
Another user mentioned a case of "Pancreatitis after combining with mysimba. "[29]
The risk of hypoglycemia is a noted concern when GLP-1s are used with insulin secretagogues or insulin. The Wegovy (semaglutide) prescribing information, as cited by a user, states: "Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing the dose of insulin secretagogue or insulin may be necessary. "[22]
A user described a patient whose A1C was 13+ and their PCP put them on "full dose Metformin and a GLP1. 1 week later she gets admitted to ICU for DKA, so hypovolemic from GI side effects she needed a pressor, and pancreatitis presumably from GLP1. "[23]
However, one user mentioned a patient who developed Wernicke's encephalopathy due to thiamine deficiency, which was attributed to severe nausea and vomiting exacerbated by continued heavy alcohol consumption while on Ozempic, not a direct GLP-1 side effect but an interaction with behavior and substance use. [35]
Another reported, "Aspiration on induction of anesthesia, severe lung injury. "[30]
A user mentioned a case where a patient's first GLP-1 dose, combined with large dinners and untreated severe OSA, led to "microaspiration --> PNA --> sepsis --> ICU + almost ended up intubated. "[18]
Institutions are developing protocols, with one user stating, "I think we require two weeks from last GLP1 injection before any procedure. "[31] Another user mentioned, "We had an aspiration on a patient who was off for one week, so now we do two. "[39]
Pancreatitis: There's concern about GLP-1s in patients with a history of pancreatitis. One user shared, "I saw one of my attending’s patients who asked me to start him on ozempic for his DMII. He had hx of pancreatitis 2/2 to alcohol... The pcp said yes to starting, and boom he was hospitalized with pancreatitis again a few months later. "[34] Another user mentioned a case of "acute necrotizing pancreatitis leading to death in a patient switching from Liraglutide to Tirzepatide I believe. They didn’t titrate. "[16]
Bipolar Disorder: A psychiatrist reported, "It caused one of my patients with Bipolar Disorder to have a mixed episode (features of mania and depression) and caused suicidality, leading to psychiatric hospitalization. "[28]
Dysautonomia/POTS: Experiences are mixed. Some report worsening symptoms: "Definitely made my pots/dysautonomia symptoms worse. "[5] Others found it manageable or even beneficial for other aspects like blood sugar control, while acknowledging the need for careful management of hydration. [6, 7, 8]
Remedies and Preventions Recommended:
For patients with a history of pancreatitis (due to alcohol) who restarted GLP-1, one user noted the patient "was fine on 1 mg weekly, increased himself to 2 mg, felt pancreatitis abdominal pain, and is now back to 1 mg weekly and doing fine. "[33]
A user with dysautonomia mentioned their doctor wanting to try a "low dose... 'microdosing'" to mitigate side effects. [4]
Managing Hypoglycemia with Other Diabetes Medications:
"Reducing the dose of insulin secretagogue or insulin may be necessary. "[22]
Pre-Anesthesia Protocols:
Discontinuing GLP-1s for a period before procedures requiring anesthesia (e. g. , one to two weeks) is becoming common practice. [31, 39] One user mentioned their endocrinologist, surgeon, and oncologist advised discontinuing a few weeks before anesthesia for papillary thyroid cancer. [13]
Caution with Pre-existing Conditions:
For T1DM, careful monitoring and awareness of delayed gastric emptying's impact on treating lows are essential. [1]
For patients with a history of pancreatitis, especially alcohol-induced, extreme caution is advised, and some doctors avoid prescribing GLP-1s altogether. [33, 34] One user stated their doctor prescreens for gallbladder and pancreatitis history and won't prescribe if there is one. [32]
A user with dysautonomia emphasized being "very intentional about eating and drinking enough to combat the orthostatic hypotension. I lived off of protein shakes. "[9]
General Awareness and Communication:
Users advise telling your prescriber about side effects ASAP, especially if they are severe or prolonged. [19]
Documenting discussions about risks and benefits, especially with pre-existing conditions like pancreatitis, is highlighted by medical professionals. [32, 33]
It's important to note that many users and medical professionals also report significant benefits from GLP-1 medications, and serious complications are not universal. One user mentioned, "Overall the benefits have seem to far outweigh the risks. "[36] Another stated, "GLP-1s are great meds, but they do cause a lot of side effects that make people stop them. They’re not usually dangerous, but unpleasant enough that in all the studies I’ve read about them, the discontinuation rate is pretty large.
Experiences and Concerns with Drug Interactions:
- Interactions with Other Medications:
- One user reported a patient on valproate experiencing "sky rocketing tremors" and mania after starting semaglutide, which emerged as the valproate dose was reduced.
- Interactions with Alcohol:
- Some users report a decreased desire for alcohol or worsened nausea with alcohol intake.
- Interactions with Medical Procedures (Anesthesia):
- Delayed gastric emptying caused by GLP-1s is a significant concern for patients undergoing procedures requiring anesthesia.
- Interactions with Pre-existing Conditions:
- Type 1 Diabetes (T1DM): Using GLP-1s in T1DM is considered risky by some.
Remedies and Preventions Recommended:
- Titration and Dose Adjustment:
- When switching GLP-1 drugs, it's crucial to "start at the bottom...
It's important to note that many users and medical professionals also report significant benefits from GLP-1 medications, and serious complications are not universal. One user mentioned, "Overall the benefits have seem to far outweigh the risks. "[36] Another stated, "GLP-1s are great meds, but they do cause a lot of side effects that make people stop them. They’re not usually dangerous, but unpleasant enough that in all the studies I’ve read about them, the discontinuation rate is pretty large.