Wegovy
HOW WEGOVY WORKS
Wegovy is a medication that works by effectively increasing your levels of a hormone called GLP-1. GLP-1 is a hormone that is made in your intestines, and it reduces the amount of food that you eat by slowing down how fast food moves through your body, making you feel fuller for longer, and it also sends a direct message from your intestines to your brain telling you that you’re fuller than you are, and reducing food cravings.
MANAGING SIDE EFFECTS OF WEGOVY
As with any medication, Wegovy has potential side effects. Many people don’t experience any side effects at all, and most of those who do experience one or two mild side effects. It is possible that you may have worse side effects and want to stop the medication, but this is unusual. Most side effects can be managed by changing how you eat or taking simple over the counter remedies from the pharmacy, and most people who experience side effects are happy to do this because they are pleased with their weight loss.
Side effects tend to occur during the first few days after your injection and settle down or at least reduce by the end of the seven-day period. They are also stronger at the beginning of a new dose, so your first injection of a higher dose pen may bring a lot more in the way of side effects, but you may well find that by the time you’re reaching the end of the pen, so weeks three to four, your side effects have reduced considerably. If you do get really difficult side effects then it’s worth either reducing your dose back to your previous dose, or staying on this dose for a couple of months to see if things settle down.
Let’s have a look at some of the potential side effects and how to manage them:
Heartburn, Nausea, Vomiting
You can help to reduce this by drinking plenty of water, particularly if you’re vomiting as it’s important to avoid becoming dehydrated. Eating small, regular meals rather than larger meals can help. Sipping herbal teas can help. If heartburn is your main problem, then avoiding high fat or spicy foods can help.
You can also use medication to help with this. You can buy simple remedies for heartburn like Gaviscon and omeprazole over the counter. If you have nausea or vomiting, then you can buy some mild medication for travel sickness that may help. If that doesn’t help then you could ask your prescriber or your GP if they would be willing to prescribe some prescription strength anti-sickness medication for you.
Burping, Bloating
‘Eggy burps’ is one of the common side effects of Wegovy, as is bloating. Both are related to excess wind, and for this you could try some indigestion remedies from the pharmacy. My favourite is Rennie Deflatine (the clue is in the name, it deflates you!), but any medication that contains the active ingredient simeticone should help. Please ask your pharmacist for advice.
Constipation
Constipation is a common side effect, but usually easily managed. You can manage it by drinking plenty of clear fluids, increasing fibre in your diet by eating fruits, vegetables and bran, and getting plenty of physical activity as movement helps to propel your stool through your bowel more effectively. You can also take laxatives from the pharmacy if need be.
Diarrhoea
This is a common side effect and is often mild, but it also tends to be one that people worry about more than others, because it can affect your ability to leave your home, travel, go to work etc. If you do get diarrhoea it tends to be mild and it can usually be managed with over-the-counter medication.
Dizziness
If you do experience dizziness, then please don’t drive or operate machinery. In terms of managing it, drinking plenty of fluid and eating small regular meals can help. If you can, lie down for a while until the dizziness passes, which it should do.
Hair loss
Thankfully the type of hair loss you can experience with Wegovy is mild and temporary, and your hair does generally grow back. In the interim you can consider taking a vitamin/mineral supplement specifically formulated for people with concerns about their hair, or using Regaine, a hair growth stimulant available from the pharmacy.
Headache
If you do experience headaches then the advice is simple self-care; painkillers like paracetamol or ibuprofen, hot/cold compresses, relax, lie down in a dark room etc. Most Wegovy headaches will respond to these measures.
Fatigue
Fatigue is a tricky one! There’s no specific ‘treatment’ for fatigue, so it’s about managing it. Ensure that you get enough sleep, fuel yourself properly with good food so that you have more energy, and generally look after yourself.
Gall stones
Gall stones are a possibility with any effective weight loss programme, and the faster you lose the weight, the greater your risk of gall stones. If you do get gall stones then your symptoms are likely to be worsening heartburn or abdominal pain specifically affecting the upper right side, just under your ribs, and most likely after a fatty or spicy meal. If you start to develop these symptoms then please do inform your doctor.
Kidney or bladder stones
This is relatively rare. Signs of kidney or bladder stones may include back or lower abdomen pain, difficulty in urination or change in colour of your urine. If you develop these symptoms, please speak to a doctor urgently.
Low blood sugar (hypoglycaemia)
This medication lowers blood sugar. Taking diabetes medication with Wegovy might further increase the risk of getting low blood sugar levels. The warning signs of low blood sugar may come on suddenly. They can include cold sweats, cool pale skin, headache, fast heartbeat, feeling sick (nausea) or very hungry, changes in vision, feeling sleepy or weak, nervousness, anxiety or confusion, difficulty concentrating or shaking. You must speak to a doctor straight away if you are started on new diabetes medication, experience low blood sugar (whether you take diabetes medications or not) or are worried about low blood sugar.
Thyroid disorders –
Studies in rodents showed that semaglutide (the active ingredient in Wegovy), caused a type of tumour: thyroid C-cell tumour. The tumours were caused by a specific mechanism to which rodents are susceptible, so the relevance to humans is considered low. Whilst the relevance for humans is considered low, the risk cannot be completely excluded, so if any neck lumps develop during treatment, please seek urgent medical advice.
Inflammation of the pancreas (pancreatitis)
If you have severe and ongoing pain in the stomach area, see a doctor straight away as this could be a sign of an inflamed pancreas (acute pancreatitis). This is a very rare side effect of Wegovy but it needs medical attention if you do have it, and it would mean that your doctor would have to stop your prescription. Patients often ask me ‘how will I know if it’s pancreatitis?’ My simple answer is ‘don’t worry, you’ll know’. It’s typically severe abdominal pain that will prompt you to seek medical help.
Diabetic retinopathy
People with diabetes who have diabetic retinopathy as a result do have an increased risk of their retinopathy, and therefore their sight, worsening on this medication. I generally advise people to not use this medication if they have diabetic retinopathy.
Pregnancy and Breast Feeding
Wegovy is not recommended during pregnancy and breast feeding, so women of child bearing potential should use effective contraception during treatment and discontinue medication two months before a planned pregnancy.
WHERE SHOULD I INJECT WEGOVY
You can inject into your abdominal wall (tummy), thigh or upper arm. A top tip from my patients – if you get side effects then it’s worth changing your injection site, so if you normally inject in your abdomen, try your thigh instead. It makes absolutely no sense, but so many patients have told me that it works that it must be true!
WHAT DOSE OF WEGOVY SHOULD I TAKE?
You should always start on 0.25mg once a week. The higher strength pens are 0.5mg, 1mg, 1.7mg and 2.4mg.
When increasing a dose, you should always wait at least four weeks (so one pen) before increasing, and you should only increase by one strength at a time. If you increase your dose too quickly you can get much worse side effects. I’ve met a few people who have tried this, and it’s never ended well! Start low and go slow is the best advice here.
WHAT DO I DO IF I MISS A DOSE OF WEGOVY?
If you miss a dose of Wegovy and the next scheduled dose is more than 2 days away (48 hours), take the missed dose as soon as possible
If you miss a dose of Wegovy and the next scheduled dose is less than 2 days away (48 hours), do not administer the dose. Take your next dose on the regularly scheduled day
If you miss doses of Wegovy for more than 2 weeks, take the next dose on the regularly scheduled day or contact us to make an appointment so that you can discuss restarting your medication if need be.
HOW DO I STORE WEGOVY?
Wegovy needs to be stored in the refrigerator at a temperature between 2 and 8 degrees Celsius before it is opened. Once opened it can be stored at temperatures below 30 degrees Celsius for up to six weeks, after which it should be discarded. If you’re travelling with Wegovy then you can buy cooling bags designed for this purpose online.
IS WEGOVY SUITABLE FOR ME?
The Freedom Clinic will prescribe medications within MHRA licensing, so you need to have a body mass index (BMI) of at least 30kg/m2, or 27kg/m2 with at least one weight related health problem in order for us to prescribe.
We wouldn’t typically prescribe for people with a history of thyroid cancer, multiple endocrine neoplasia, gall stones, pancreatitis or diabetic retinopathy.
HOW MUCH DO YOU LOSE WHILE TAKING WEGOVY?
Predicted weight loss with Wegovy is 14% of your starting weight, on average.
DOES WEGOVY BURN FAT?
Wegovy isn’t a ‘fat burning’ medication in the conventional sense, which is a good thing as these types of medications are not recommended! It helps you to eat less and also experience fewer cravings, which means that you should naturally start to burn your own fat – which is recommended!
SWITCHING BETWEEN WEIGHT LOSS MEDICATION
If you want to change from Wegovy to Mounjaro, or vice versa, then you should have a period of at least a week with no medication, a ‘wash out’ period as part of that change. So you would stop whichever medication you were currently taking for a week, then start the new medication from the prescribed starting dose.
WHAT ARE THE ALTERNATIVES TO WEGOVY?
The three licensed medications in the UK currently are Wegovy, Mounjaro and Mysimba.