The number of Americans taking tirzepatide and semaglutide – the active ingredients in GLP-1 medications such as Wegovy, Zepbound, Mounjaro and Ozempic – has increased rapidly in just a few years. First approved to treat diabetes and now prescribed for obesity-related health complications, GLP-1 drugs mimic a natural hormone that controls appetite and feelings of fullness.
However, several factors may hinder successful medication results, said John Morton, MD, medical director of Bariatric Surgery, Yale New Haven Health, and professor of Surgery, Yale School of Medicine.
“Patients may have to stop taking GLP-1 medications because of side effects, affordability or lack of insurance coverage,” said Dr. Morton, who is also co-director of the YNHHS Center for Weight Management. “However, it’s not a good idea to stop suddenly.”
GLP-1 Side effects
GLP-1 side effects can include nausea, vomiting, stomach pain, bloating, diarrhea and constipation. For many people, these are temporary and improve over time, but in rare cases more serious side effects have been reported. Examples include gastroparesis (when the stomach takes longer to empty food than it should), gallbladder problems, bowel obstructions and pancreatitis.
Approximately 10 percent of patients don’t respond to GLP-1 medications at all.
“They get frustrated, blame themselves when the drugs don’t work and just stop taking them,” Dr. Morton said. “However, obesity is a difficult condition and not every treatment works for every patient.”
Why you shouldn’t suddenly stop taking GLP-1 medications
If you’re taking a GLP-1 medication for diabetes, stopping suddenly can be dangerous because it can cause issues with your blood sugars, Dr. Morton said.
When it comes to treatment for weight loss, there may be a “rebound effect” when the medications are stopped, causing people to regain weight they’ve lost – and more. “The weight regain often occurs faster than the weight loss,” Dr. Morton said. Patients may also experience significant gastrointestinal upset after a sudden halt.
The benefits of specialty pharmacists
So, if you experience side effects with GLP-1s or your insurance ceases coverage, what can you do? Dr. Morton recommends consulting with your doctor or pharmacist, who can help you de-escalate gradually or transition you to another medication. That’s why the team at the YNHHS Center for Weight Management includes clinical pharmacists.
“We can work with patients to find a dose they can tolerate without too many side effects,” said Veronica Arceri, PharmD, a YNHHS clinical pharmacist specializing in metabolic disorders. “Or if one particular brand of medication causes unpleasant side effects that can’t be resolved by adjusting the dosage, we can substitute another type or brand of medication.”
Special populations such as elderly patients, pregnant women and those trying to conceive may require additional support, which is a priority for YNHHS program pharmacists.
Arceri said it’s more likely that people are forced to stop taking GLP-1 medications due to a lack of insurance coverage. Outpatient Specialty Pharmacy Services has established a Center of Excellence for Metabolic Health and Weight Management to support patients on weight-management medication. As part of their comprehensive pharmacy services, the center team can help coordinate insurance and other administrative matters to ensure patient access to medications.
GLP-1 alternatives
For patients unable to take GLP-1 medications, the Center for Weight Management brings together experts in medical and surgical weight-loss, endocrinology, behavioral health, nutrition and exercise physiology to provide comprehensive care.
“We offer a number of safe and effective treatment options and services, including medications, endoscopic treatments, choices of surgery, support for lifestyle changes, behavioral health consultations, exercise classes and our state-of-the-art Teaching Kitchen,” Dr. Morton said. “Our specialists can help patients decide which interventions are best for them. The program is a lot like what we have for cancer or heart disease, where it's not one single therapy, but multiple therapies that we can combine – and that's really where you see a difference.”
