Myths, Misinformation, and Misconceptions Associated with Obesity Drugs
The weight-loss drugs (liraglutide, semaglutide, and tirzepatide) are a popular topic in conversations, news articles, and social media. But are they too good to be true? Let’s sort out the fact versus fiction and learn more about these medications that are used to promote weight loss.
My insurance doesn’t cover these medications for weight loss, should I buy them from an online pharmacy or compounding pharmacy for less?
Without insurance, these drugs can cost around $1000 per month, so many people consider buying them at a lower price from an online pharmacy or compounding pharmacy.
The US Food and Drug Administration (FDA) has concerns about buying these medications from online pharmacies as they may be counterfeit, could contain the wrong ingredients or harmful ingredients, and could contain too little, too much or no active ingredient at all. Another concern is that your usual medical team is not involved in prescribing and monitoring your therapy.
You should be careful with buying medications online and only purchase from online pharmacies that are licensed by a state in the US.
Could I consider getting one of the drugs from a compounding pharmacy?
Shortages have occurred due to the demand for these medications which are used to manage diabetes and/or to promote weight loss. These shortages allowed the drugs to be made by licensed and approved facilities until the supply issues resolve. Compounding pharmacies make the drugs in a small setting and do not get them from a manufacturer. However, the FDA and medical professional groups have many safety, quality, and effectiveness concerns about compounding these medications. You should always verify that the compounding pharmacy is registered with the FDA.
I’ve seen ads for products that have a similar name to Ozempic or are called “natural Ozempic” – are these safe and effective to use?
Many people are looking for a cheaper product or oral formulation of these medications. Many over the counter and herbal products appear to mimic the weight-loss drugs by name but do not contain the actual medication. Since the actual ingredient is unknown it is risky to use these medications.
One popular herbal supplement to promote weight loss is berberine derived from the berberis shrub. It has been investigated to manage glucose levels in people with diabetes but has not had an appropriate clinical study to evaluate the use for the management of weight loss. There is the potential for drug interaction with this product with other drugs that are metabolized in the liver. Since berberine is an herbal product, it is not regulated by the FDA for safety, effectiveness, or accuracy of the labeled product. Talk with your doctor or pharmacist before considering the use of this product.
I think I am pregnant. Should I continue to use my weight loss medication?
Based on the manufacturer information approved by the FDA, these medications should NOT be used during pregnancy. Animal studies showed some risk of harm to the fetus. Some early reviews of use during early pregnancy have not shown an increased risk, but due to the potential for risks, the recommendation is to discontinue use at least 2 months prior to becoming pregnant.
In some women that previously had infertility issues, treatment with these drugs to improve glucose control and reduce weight improved fertility by regulating menstrual cycles and causing ovulation. Therefore, you should not assume that pregnancy cannot occur during treatment.
Lastly, you should know that tirzepatide may decrease effectiveness of oral contraceptives (birth control pills). Talk to your doctor about effective birth control methods to use during your treatment.
I’ve heard some positive things about microdosing - should I use a lower dose to make my medication go further?
No, you should not alter your dose without first talking with your healthcare provider. There may be a valid reason such as side effects or change to another similar medication, to adjust your dosage. Always follow the instructions for the appropriate dose that is provided by your doctor or pharmacist.
What are the risks? I’ve heard a lot about side effects with these medications, especially the risk of thyroid cancer.
The most common side effect for use of these drugs for weight loss are gastrointestinal related such as nausea, vomiting, diarrhea, constipation, acid reflux, and stomach pain or discomfort. About 5-10% of people in clinical trials stopped using the medications due to side effects.
A rare form of thyroid cancer was reported in animal studies, but it is not certain that there is an increased risk in humans. Be sure to talk with your doctor to see if you have any conditions that would increase risks before using these medications.
Do I need to use these medications forever?
Obesity is a chronic or ongoing condition, so most people will need to be treated to prevent weight gain. Many people reach a weight loss plateau after about 18 months of use and if they stop the drug find that they gain weight. Most healthcare providers recommend some type of ongoing treatment to maintain a healthy weight.
Summary
These are only a few of the many questions associated with the use of these new drugs to manage obesity. If you find information or have questions it is always best to ask your doctor or pharmacist for more information.
Provided by ASHP.
Supported by an educational grant from Novo Nordisk.