As Ozempic remains popular, patient reports and legal disputes highlight new concerns. Under the spotlight are risks of suicidal thoughts or self-harm, pending an investigation in Iceland, and risks of gastroparesis, pending a Louisianna lawsuit.

European Medicines Agency. EMA statement on ongoing review of GLP-1 receptor agonists. July 11, 2023.

 

For now, doctors say that potential risks should be addressed in patient-provider conversations but should not deter doctors from prescribing the medication to people who are in need.

“Any time people report any kind of side effect or complication [of] a medication, it has to be investigated,” says Dr. Mir Ali, MD, bariatric surgeon and Medical Director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “It's important to make people aware of these things and let them know that it is a potential risk but a very low risk.”

Barring these risk factors, patients most qualified for Ozempic include those with a body mass index (BMI) higher than 30 and those with type 2 diabetes, says Dr. Ali.

 

Ozempic and suicidal thoughts

 

Patient reports in Iceland suggest that some Ozempic users have been experiencing suicidal thoughts or may be engaging in self-injury. Specifically, Icelandic medical authorities are analyzing 150 reports of possible cases of suicidal thoughts or self-harm for patients prescribed GLP-1 receptor agonists. Ozempic falls into this category, as does antidiabetic medication Mounjaro.

European Medicines Agency. EMA statement on ongoing review of GLP-1 receptor agonists. July 11, 2023.

 

Doctors who are unsure about prescribing medication to someone based on mental health criteria may want to consult with or refer a patient to a mental health professional.

 

Ozempic and gastroparesis 

 

Gastroparesis, also known as delayed gastric emptying, can delay or stop food from moving from the stomach to the small intestine, even in the absence of a blockage in the stomach or intestines, according to the National Institute of Diabetes and Digestive and Kidney Diseases. This can induce symptoms like abdominal pain, nausea, vomiting, bloating, or feeling full quickly after meals. The most common underlying cause of gastroparesis is diabetes, but it may also be caused by medications that slow stomach emptying—like Ozempic.

National Institute of Diabetes and Digestive and Kidney Diseases. Gastroparesis.

 

Ozempic slows stomach emptying and calorie absorption, which can cause people to feel fuller for extended periods. This may result in decreased food intake and, as a result, weight loss.

Prior to prescribing Ozempic, providers should review patients’ medical histories to see whether they have previously experienced gastroparesis. To be safe, doctors should refrain from prescribing Ozempic to these individuals, Dr. Ali says.

 

What to do if a patient experiences an adverse reaction from Ozempic

 

If a patient experiences adverse severe reactions from Ozempic, doctors may want to intervene by stopping or temporarily discontinuing treatment. If doing so, it is important to follow up with the patient to see if their reactions—suicidal thoughts, gastroparesis, or others—subside in the absence of the drug. If they do, this may be a good reason to keep the patient off Ozempic. If symptoms persist, this could be a sign that the patient needs additional care to resolve such conditions.

 

The importance of acting responsible when prescribing Ozempic—and any drug

 

While some risks of these drugs are concerning, assessing side effects is not a new phenomenon in modern medicine. When starting a medication, it is always important to check in with patients about how their treatment affects them, says Dr. Ali.

Ideally, if doctors are acting responsibly and titrating patients from a low to higher dose, they should be able to assess side effects throughout the course of treatment and stop the medication if needed, he adds. Some less severe side effects, like nausea, constipation, or diarrhea, may be present when a patient begins Ozempic but can go away.

“No matter what medication is prescribed, there will be a serious side effect for somebody, somewhere,” Dr. Ali says. “We typically start at the lowest dose and increase over a period of time…allow[ing] patients to acclimate to the side effects or see [fewer] side effects over time,” he explains.