Managing the Side Effects of Ozempic and Mounjaro

I have seen firsthand the transformative effects that GLP-1 receptor agonists such as Ozempic® (GLP-1) and Mounjaro® (tirzepatide) can have on patients struggling with obesity and type 2 diabetes. These medications are powerful tools in our arsenal, helping patients achieve significant weight loss and improved glycemic control. However, like all medications, they come with potential side effects that need to be managed effectively to ensure patients can continue their treatment comfortably and successfully.

Three of the most common side effects associated with GLP-1 agonists are nausea/reflux, constipation and skipping protein.

I will share some strategies to help manage these side effects, allowing patients to stay on track with their treatment plans.

1. Managing Nausea and Reflux

Nausea is one of the most frequently reported side effects of GLP-1 agonists, especially when starting the medication or increasing the dose. These medications slow emptying of the stomach, helpful in reducing appetite. Those with a loose sphincter muscle between the stomach and esophagus frequently experience increased reflux on GLP-1 meds.

Here are some tips to help manage this:

Start Low and Go Slow: Initiate treatment at a low dose and gradually increase it. This allows the body to adjust to the medication more gently. If your nausea is moderate in severity, ask your clinician if you should maintain the dose rather than increasing to the next dose. Use the lowest dose that controls appetite.

Eat Smaller, More Frequent Meals: Large meals can exacerbate nausea. Eat small protein portions throughout the day to stay nourished and prevent overextension of the stomach.

Avoid fatty foods, alcohol, caffeine, and spicy foods: These can trigger or worsen nausea.

Stay Hydrated: Sipping water or clear fluids throughout the day can help alleviate nausea.

Over the counter acid reducers: Prilosec ®(omeprazole) or Pepcid®(famotidine) reduce the amount of acid produced by the stomach and can markedly improve symptoms. Advise your physician if you need to take these medications for more than two weeks.

2. Managing Constipation

Constipation can be a bothersome side effect of GLP-1 agonists. These meds decrease the motility of the intestine, leading to constipation.

Here are some strategies to alleviate it:

Increase fiber: Benefiber® (water soluble fiber powder) or Metamucil® 1-2 tbsp daily will help regulate and soften stools. Some patients require the addition of a motility agent to draw in more water. As a result, Miralax® or magnesium citrate 1-2 doses/day may be needed.

Increase fluids: Adequate hydration is crucial for preventing and relieving constipation. Patients should aim for at least 8 cups of water per day.

This is a good opportunity to encourage colon cancer screen based on the recommendations of the American Cancer Society. Patients with obesity are at much higher risk of colon cancer, so ask your primary care physician for a referral.

3. Skipping protein

Because these medications are so effective at appetite control, it’s tempting to skip meals. Lack of protein intake can lead to muscle and hair loss. It is critical to maintain adequate protein, which favors fat loss rather than lean body mass.

Eat protein often: Even if not hungry, it is important to eat a 4-6 oz serving of protein at least 4 times daily.

Eat high quality protein: white meat chicken or turkey, eggs, low fat cottage cheese or nonfat yogurt, fish, shrimp or other shellfish are all great sources of protein. Note that if eating plant-based proteins, you need to eat a larger portion to get enough essential amino acids.

Conclusion

GLP-1 receptor agonists like Ozempic and Mounjaro are highly effective in managing obesity and type 2 diabetes, but their side effects can sometimes be challenging. By implementing these strategies, you can manage nausea, reflux, constipation and meal-skipping more effectively, to continue benefiting from these medications.

As always, it’s crucial for patients to communicate openly with your healthcare providers about any side effects you experience. Together, we can tailor a management plan that maximizes the benefits of GLP-1 agonists while minimizing discomfort.

If you are struggling with side effects from your GLP-1 medication, don’t hesitate to reach out to your healthcare team. We’re here to help you navigate these challenges and achieve your health goals.