GLP-1 RA class of drugs interactions: food, diseases, and other medications
Key Takeaways
Glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, are medications that can help to control blood sugar and can also promote weight loss.
These medications are only available with a doctor’s prescription.
Certain other medications may interact with GLP-1 RAs to produce negative effects. In particular, in people taking insulin or oral medications for diabetes along with GLP-1 RA, the risk of hypoglycemia (low blood sugar) is increased.
People with certain medical conditions, including a history of pancreatitis, may not be good candidates for a GLP-1 RA, as these medications may increase the risk of this condition.
A class of drugs known as glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, have been attracting attention recently. These medications help to keep blood sugar under control, and they also promote weight loss. Some of the medications in this class include semaglutide (Wegovy, Ozempic, Rybelsus), liraglutide (Saxenda, Victoza), and dulaglutide (Trulicity).
Some GLP-1 RAs are approved for treating diabetes, including Ozempic, Rybelsus, Victoza, and Trulicity. Others are approved for weight loss, including Wegovy and Saxenda. Although all GLP-1 RAs work in essentially the same way, the dosing of the medication is different when it’s used for weight loss than when it’s used for treating diabetes.
It’s important to know that GLP-1 RAs are prescription medications. They can’t be obtained over the counter, but are only available with a doctor’s prescription. This is because, while the medications are generally considered to be safe overall, there are some potential side effects.
GLP-1 RAs can interact with other medications, and may have unwanted effects in people with certain medical conditions. Your doctor needs to assess the possibility of such interactions to ensure that a GLP-1 RA is safe for you, and will monitor you during your treatment to address any side effects that may occur.
GLP-1 RA drugs like semaglutide (Wegovy, Rybelsus, Ozempic): interactions with medications
For those who are already taking other medications, there are some potential interactions to be aware of when you start taking a GLP-1 RA. Many people who take GLP-1 RAs have diabetes, and may be using insulin and/or other medications to help manage this. GLP-1 RAs can interact with diabetes medications. There are also some potential interactions with other medications to be aware of.
Insulin. Taking a GLP-1 RA along with insulin can increase the risk of hypoglycemia, or low blood sugar. Because GLP-1 RAs increase the secretion of your body’s own insulin from the pancreas and also lower blood sugar in other ways, there’s a risk that your blood sugar will dip too low. This can lead to symptoms like shakiness and trouble concentrating, and if left untreated, can even be dangerous. It’s important to monitor your blood sugar carefully after you start taking a GLP-1 RA, and your dose of insulin may need to be adjusted to account for the effects of the medication. Using a continuous glucose monitor (CGM) can help to catch a trend towards low blood sugar early, so you can intervene.
Oral diabetes medications. Similarly, for people taking medications like metformin that act to lower blood sugar, adding a GLP-1 RA increases the risk of experiencing low blood sugar events. Make sure to watch for potential symptoms of low blood sugar, and to test whenever you think you might be experiencing hypoglycemia, so that you can address this as quickly as possible. Your dose of diabetes medications may need to be adjusted to reduce your risk of hypoglycemia.
Other oral medications. In general, GLP-1 RAs slow down the process of digestion. This can affect how other medications are absorbed in the digestive tract. So far, research has found that the absorption of many oral medications is affected to some degree by taking a GLP-1 RA. However, this effect is small, and dose adjustments are rarely necessary. However, it’s important to consider the possibility that the dose of your other medications may need to be adjusted while you’re taking a GLP-1 RA.
Food and Alcohol Interactions with Semaglutide and Other GLP-1 RAs
Besides other medications, there are also some lifestyle factors that may interact with semaglutide.
Alcohol. Drinking large quantities of alcohol can lead to low blood sugar. This risk is greater when you’re taking a GLP-1 RA. Make sure to monitor your alcohol intake while taking a GLP-1 RA. Some people may need to reduce the amount that they drink at one time, to avoid potential drops in blood sugar.
Exercise. During a period of intense and prolonged exercise, your muscle tissues use a lot of glucose. When you’re taking a GLP-1 RA, this can potentially lead to lower blood sugar, because the medication blocks your liver from releasing extra glucose to help fuel your muscles, making it hard to perform exercises well. Taking a snack before exercising can help to improve performance during your workout.
Food Intake. GLP-1 RAs will generally decrease the amount that you eat. This is how they lead to weight loss in many people. However, it’s important to make sure that you’re still eating enough to meet your body’s basic needs.
Diseases Interaction with Semaglutide and Other GLP-1 RAs
For certain medical conditions, semaglutide may interact with these in ways that could cause harm.
Diabetic retinopathy. This condition involves damage to the retina (the light-sensing tissue at the back of the eye) caused by high blood sugar. Diabetic retinopathy can cause vision loss in people with diabetes. When people who already have diabetic retinopathy start taking a GLP-1 RA (or any other medication for diabetes for that matter), their condition may temporarily get worse. Ultimately, improved blood sugar control after starting the GLP-1 RA will likely be beneficial for retinopathy, but there may first be a temporary worsening of symptoms. This is something for people with diabetic retinopathy to be aware of.
Pancreatitis. Pancreatitis refers to inflammation of the pancreas, which is the gland in the abdomen that secretes insulin. There has been some research reporting an increase in pancreatitis with GLP-1 RAs such as semaglutide. Although recent studies have shown that these medications do not cause an increase in the risk of pancreatitis, people with a history of this condition should use caution with these medications. If you’re taking a GLP-1 RA and you develop pancreatitis, your doctor will almost certainly direct you to stop taking the medication.
Thyroid cancer. Some studies have shown that GLP-1 RAs may be associated with a small increase in the risk of thyroid cancer. However, other studies have not found this association, and the European Medicines Agency (EMA) recently reviewed the evidence and concluded that there’s no evidence of that GLP-1 RAs cause an increase in thyroid cancer risk. However, as a precaution, it’s generally recommended that those who have experienced thyroid cancer in the past should avoid GLP-1 RAs.
There was a potential concern about an increase in suicidal thoughts in people who start taking a GLP-1 RA. Further investigation has revealed no increase in the risk of suicidal thoughts in people taking these drugs compared with the baseline risk, but it’s always important to seek help from a mental health professional if you or your loved one are having suicidal thoughts.
Taking semaglutide while pregnant / preparing to conceive
GLP-1 RAs like semaglutide are generally not recommended for women who are pregnant or who are preparing to become pregnant. This is for a few different reasons.
Birth defects. There may be a risk to the baby. Studies in monkeys and other animals have shown that semaglutide increases the risk of miscarriage and birth defects. We don’t currently have enough data to confirm that this risk also exists in humans, but it’s assumed that it does, and GLP-1 RAs are likely to cause risks during pregnancy.
Effects of weight loss. Intentional weight loss is not recommended during pregnancy. This is because a developing baby needs a lot of energy and nutrients from the mother’s food. Women who lose weight during pregnancy have an increased risk for delivering a baby with a low birth weight, which can be dangerous for the baby’s health. Because GLP-1 RAs can cause weight loss even if they’re not being taken specifically for this purpose, they generally aren’t recommended during pregnancy.
Although GLP-1 RAs generally are not recommended during pregnancy, it’s also well-known that high blood sugar can lead to pregnancy complications, including birth defects of the nervous system and heart. It’s important to keep blood sugar under control during pregnancy to help protect the baby. If a mother has very high blood sugar levels due to diabetes, it’s possible that the benefits of a GLP-1 RA could outweigh the risks. However, other diabetes medications, such as metformin, are likely to be a safer option.
Seek a doctor’s opinion if you’re considering a GLP-1 RA
If you’re interested in taking a GLP-1 RA, and you’re wondering whether it would be safe for you given your current medications and your medical history, you should consult a qualified healthcare professional for an evaluation.
Here in Singapore, our NOVI Optimum Plus program includes consultations with a specialist physician. This will give you an opportunity to learn about any potential interactions with any other medication or supplement that you may take, and any side effects that you should watch out for. If a GLP-1 RA is a safe option for you and you’re interested in trying it, then you’ll be able to get your prescription right away. You’ll then have support from your doctor along with a team of healthcare professionals, including nutritionists and health coaches, to help you along your weight loss journey.