Though some information and advice applies to all medications in or adjacent to the GLP-1 family, other aspects of treatment are specific to a singular medication or a subset of GLP-1 drugs. The advice in this article pertains to weekly injectable GLP-1s in which the active ingredient is semaglutide — Wegovy, Ozempic and compounded semaglutide. Wegovy is FDA-approved specifically for weight loss, while Ozempic is approved for Type 2 diabetes and only prescribed off label for weight loss. Compounded semaglutide is a generic medication. Compounded medications aren’t evaluated by the FDA, so the specific formulation matters.
Here are answers to five questions Dr. Wu fields all the time (and believes all patients considering a semaglutide medication would benefit from understanding).
If I want to avoid feeling nauseated at work, when should I take my medication?
Dr. Wu: For a weekly GLP-1, it doesn’t really matter. If you’re going to feel nauseated, it’s usually going to be the day after the injection, not the day of. Nausea is most often experienced when you first start the medication or increase your dose, so I wouldn’t recommend taking it the day of or the day before something really important. But it can be hard to predict and every person is unique.
What’s most important is taking the medication the same day each week. For example, if you take your first injection on a Monday, try to inject on Monday every week. The time of day can change; it doesn’t matter as much. But being consistent about which day it’s taken helps to mitigate side effects. Taking a dose too early can increase side effects, and so can taking it late. That said, if you forget to inject on your normal day, it’s not the end of the world — just reach out to your provider for instructions on what to do.
Once I begin taking my medication, when can I expect to see results?
Everyone is different in how they respond to medications and when they might start to see results. It also depends on how optimized diet and exercise are. The medications will not work as well or as quickly (or possibly at all!) if lifestyle modifications are not also made.
Anecdotally, some people start to feel effects immediately — appetite suppression and reductions in cravings can start within hours. And most people notice appetite suppression going hand in hand with weight loss. But semaglutide is a long-acting medication and it takes time for it to build up in your system, so many people might not notice a change until week four, and still others might not see changes until the maximum dose is reached. It’s important to be patient, and not to be too concerned, if you do not see immediate results.
If you’re not seeing weight loss at three months, then it’s time to check in with your provider, if you haven’t already. We’ll figure out if the medication isn’t working, or if we need to make further changes to diet and exercise, or if we need to increase the dose or switch to a different medication.
What should I expect after my first dose?
After a day or two, you might notice that your appetite is reduced. But that doesn’t happen for everyone, so be patient.
You might also experience any of the most common side effects, which are typically mild in nature and not concerning. The most common are gastrointestinal: nausea, diarrhea, constipation, abdominal pain and acid reflux. They could happen anytime after your first dose — everyone is different. As long as the side effects are tolerable, which they are for most people, continue taking your medication. You can use Zofran if you’re feeling very nauseated or vomiting. If you have severe symptoms, including severe abdominal pain, or nausea and vomiting to the point where you can’t keep up with fluid intake, get in touch with your doctor or go to the nearest ER.
What foods or beverages should I eat or drink when I start taking my medication?
The best diet is one that you can follow long term, since you will need to stick with it even after you reach your goal weight. In terms of things to drink, avoid anything with calories in it. Alcohol can make people feel really sick, so I typically recommend reducing alcohol — especially if you’re having nausea or abdominal discomfort. But this is an anecdotal observation.
This class of drugs slows down the emptying of your stomach, which is partially how they reduce appetite. Fatty foods do that too, so I recommend cutting back on them because the combination might make you feel sick. I don’t necessarily tell patients to go on a low-fat diet, but cutting back on fatty foods and eating smaller meals can help. But there’s no food or drink in particular that you need to load up on.
If semaglutide doesn’t work for me, does that mean other GLP-1 medications won’t work either?
For better or worse, the way people respond to medication is really individualized. The vast majority of people tolerate GLP-1 medications very well and lose a significant amount of weight. But if you have side effects, there are things we can do to mitigate them, and we can also change the medication. For example, a lot of people who don’t tolerate semaglutide might tolerate tirzepatide (a similar drug to GLP-1s), and vice versa. Also, some people just don’t respond to certain medications, and that’s nothing to be alarmed about. At the end of the day, it’s important to know that not every medication works for everyone. Don’t panic. Don’t lose faith. We can try something else.