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Updated thoughts on weight loss injections (as of 2023)
Since initially writing about semaglutide (brand names: Ozempic/Wegovy) and tirzepatide, (brand name: Mounjaro) I have not only personally used semaglutide for a short period, but I have also have had hundreds of patients use it as well. From that experience, I have learned a few things that have revised how I recommend using these medicines. This information is subject to change and reflects my current understanding of these medications as of 2023. Any use of these medications should be done under the direction of your physician.
To review, these medicines should be taken seriously and can potentially increase the risk of cancer and pancreatitis. Consequently, they should only be used as a last resort when conventional diet and exercise programs have not been successful.
Common side effects that my patients report include nausea, vomiting, diarrhea, stomach cramps, acid reflux, belching, bitter taste, bloating, constipation, headache, fatigue, hair loss, muscle wasting, dry mouth, hormonal changes, and menstrual changes.
These medicines decrease blood sugar, lower appetite/hunger, slow intestinal motility, and increase fullness. It is not uncommon for people to experience significant abdominal cramping or other side effects after overeating. Some people notice altered taste which can help them eat less. Alcohol intake is often significantly decreased. I have also seen some people decrease other addictive behaviors on these medicines.
Long-term side effects could potentially include, not only an increased risk of cancer, but also lingering bowel habit changes acquired during taking this medicine. Patients can lose muscle mass. Weight regain is also definitely possible after stopping the medicine. I have observed no withdrawal side effects other than an increase in appetite/hunger. On a positive note, there appears to be some early indications that cardiovascular health may be improved after taking these medicines.
I recommend an initial consultation with proper screening and blood testing before starting this medicine. I recommend frequent follow-up every 1-2 months. Patients with a family or personal history of certain types of cancer, pancreatitis, or significant baseline bowel issues (especially constipation) should avoid this medicine. There are other contraindications to using these medicines which should be discussed with your physician. I recommend doing an initial test dose at a very low dosage (weight based) to gauge benefit and side effects. People with higher starting weights (especially greater than 250-300 lbs) or who have previously used appetite suppressants like caffeine tend to experience less appetite suppression and generally need higher dosages. The highest risk of significant side effects are with the initial dose (within the first 2-3 days) or with significant dosage changes. B-vitamins are often combined with the injection or separately to help ameliorate nausea. Anti-emetic medicines can also be prescribed if necessary.
The conventional Ozempic brand name protocol is to try the lowest dosage and maintain this dosage for 1 month and then make a subsequent dosage change every month until the top dosage is reached. I have personally found this strategy to be less than ideal. I recommend adjusting the dosage only if it is no longer effective, side-effects permitting. After the initial test shot, the dosage can in most cases be increased if the patient has both experienced no side effects or benefits from the initial injection. Waiting an entire month is generally not necessary. The dosage should not be increased in a patient experiencing anything more than mild side effects as they will likely worsen. I recommend using dosages in between the typical dosages if needed because typical dosage jumps are often too aggressive and will result in significant escalation of side effects.
In most cases, I have found these medicines have the best change of being successfully used for weight loss if they are continued until the weight loss goal is reached and then for a weaning period afterward. This period should often last a few months to ensure weight is maintained. The injection dosages or frequency should be decreased during this period if at all possible. It is sometimes necessary to restart this medicine for some patients who have experienced weight regain. Although it is controversial, in some rare circumstances, it may be required to continue these medicines for even longer periods of time.
To review, these medicines should be taken seriously and can potentially increase the risk of cancer and pancreatitis. Consequently, they should only be used as a last resort when conventional diet and exercise programs have not been successful.
Common side effects that my patients report include nausea, vomiting, diarrhea, stomach cramps, acid reflux, belching, bitter taste, bloating, constipation, headache, fatigue, hair loss, muscle wasting, dry mouth, hormonal changes, and menstrual changes.
These medicines decrease blood sugar, lower appetite/hunger, slow intestinal motility, and increase fullness. It is not uncommon for people to experience significant abdominal cramping or other side effects after overeating. Some people notice altered taste which can help them eat less. Alcohol intake is often significantly decreased. I have also seen some people decrease other addictive behaviors on these medicines.
Long-term side effects could potentially include, not only an increased risk of cancer, but also lingering bowel habit changes acquired during taking this medicine. Patients can lose muscle mass. Weight regain is also definitely possible after stopping the medicine. I have observed no withdrawal side effects other than an increase in appetite/hunger. On a positive note, there appears to be some early indications that cardiovascular health may be improved after taking these medicines.
I recommend an initial consultation with proper screening and blood testing before starting this medicine. I recommend frequent follow-up every 1-2 months. Patients with a family or personal history of certain types of cancer, pancreatitis, or significant baseline bowel issues (especially constipation) should avoid this medicine. There are other contraindications to using these medicines which should be discussed with your physician. I recommend doing an initial test dose at a very low dosage (weight based) to gauge benefit and side effects. People with higher starting weights (especially greater than 250-300 lbs) or who have previously used appetite suppressants like caffeine tend to experience less appetite suppression and generally need higher dosages. The highest risk of significant side effects are with the initial dose (within the first 2-3 days) or with significant dosage changes. B-vitamins are often combined with the injection or separately to help ameliorate nausea. Anti-emetic medicines can also be prescribed if necessary.
The conventional Ozempic brand name protocol is to try the lowest dosage and maintain this dosage for 1 month and then make a subsequent dosage change every month until the top dosage is reached. I have personally found this strategy to be less than ideal. I recommend adjusting the dosage only if it is no longer effective, side-effects permitting. After the initial test shot, the dosage can in most cases be increased if the patient has both experienced no side effects or benefits from the initial injection. Waiting an entire month is generally not necessary. The dosage should not be increased in a patient experiencing anything more than mild side effects as they will likely worsen. I recommend using dosages in between the typical dosages if needed because typical dosage jumps are often too aggressive and will result in significant escalation of side effects.
In most cases, I have found these medicines have the best change of being successfully used for weight loss if they are continued until the weight loss goal is reached and then for a weaning period afterward. This period should often last a few months to ensure weight is maintained. The injection dosages or frequency should be decreased during this period if at all possible. It is sometimes necessary to restart this medicine for some patients who have experienced weight regain. Although it is controversial, in some rare circumstances, it may be required to continue these medicines for even longer periods of time.