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When she meets a friend about to start a treatment with Ozempic, used diabetes medicine also for weight lossthe publicist Caroline Tchakerian25 years old, avoids telling about the side effects she had when using the injectable medicine.
“It was so nauseous. I woke up feeling sick, in a cold sweat, and couldn’t sleep anymore. Then came the stomach ache, which got so bad that I had to go to the emergency room”, reports the publicist. However, despite the side effects, she says she doesn’t want to discourage others interested in the drug.
“It’s a very complicated situation because, even with the side effects, I lost almost 10 kilos, and then everyone thinks it’s cool. [Para] several friends who start now I warn you that [elas] they may feel bad, but sometimes it seems that it’s because I’ve already ‘made it’ and I don’t want others to lose weight too”, says the publicist.
The publicist claims that she does not regret having used the medicine, prescribed by an endocrinologist because she was overweight and had hepatic steatosis, also known as fatty liver.
Even so, she reports being concerned about the indiscriminate use by colleagues and acquaintances, almost always without the same medical follow-up. “Everyone is using it”, completes the young woman.
High demand for the medicine
In São Paulo, pharmacies in the expanded center even reported difficulties in keeping the medicine, manufactured by the Danish laboratory, in stock. Novo Nordisk. The ‘fever’ of using Ozempic, however, is not exclusive to Brazil. In the United States and Australia, the unbridled search made the medicine disappear from the shelves and become a subject in the main newspapers.
The medicine has active ingredient semaglutide, a synthetic hormone that helps control blood glucose levels and signals the brain to feel full. This is because it simulates the effects of GLP-1 — a natural hormone that is produced in the gut.
Its intended use in the package insert is for the treatment of diabetes, but the medicine has been prescribed by doctors, in a off-label (which is not in the leaflet), for weight loss.
the endocrinologist Paulo Rosenbaum, from Hospital Israelita Albert Einstein, explains that the use of the drug against obesity is safe and has been extensively studied by scientists. However, the treatment needs medical supervision to be safe.
“If well indicated, medicines based on semaglutide are a revolution in the field of endocrinology. But this current demand for Ozempic is dangerous because, as much as it is a safe medicine, it cannot be used without follow-up”, says Rosenbaum.
transient side effects
The specialist explains that side effects such as those reported by the publicist are common at the beginning of the treatment, but usually improve after a few weeks. However, he recalls that, for about 10% of patients, the side effects do not cease, and it is necessary to look for other alternatives.
“Research shows that about 10% of patients may have more side effects and sometimes will not be able to tolerate the medicine. That’s why it’s important to have medical follow-up. The vast majority tolerates it well, has side effects, but they are transitory, which after one or two months decrease”, explains the endocrinologist.
The medical manager of the laboratory Novo Nordiskwhich manufactures the Ozempic, Tássia Gomide Bragaalso points out that side effects are more common at the beginning of treatment.
The endocrinologist recalls that, for the time being, the drug is approved by the National Health Surveillance Agency (Anvisa) only for diabetes – the prescription for weight loss is off-label, that is, made at the expense and risk of the doctor in charge.
“Most events are mild to moderate in severity and happen transiently, lasting a few days or a few weeks. The need to discontinue medication due to adverse events is low”, says Braga.
She also explains that adverse effects usually occur during the initiation of medication use or when there is an increase in the medication dose. “Patients should seek advice from their doctor to minimize them”, adds the company’s medical manager.
It is still not clear what is behind the side effects caused by semaglutide. According to the doctor of Novo Nordiskone of the mechanisms of action of analogues of GLP-1 – category that includes the Ozempic – is the “transient decrease in the speed at which the stomach empties after a meal, which may be related to some of these effects”.
In order to avoid adverse reactions, doctors usually prescribe the drug with escalating dosage. That is, the treatment begins with smaller doses, which are gradually increased until reaching what is considered ideal for each patient.
“The person can start using 0.25mg per week, when the dosage of one unit of the product is four times higher, 1mg per week. During this escalation period, it can either have a quick response or not notice any effect”, he explains. Rosenbauman endocrinologist at Einstein.
In addition, the doctor from the pharmaceutical industry says that obeying the escalation of doses correctly minimizes the risk of side effects and can be adapted to the patient’s tolerability.
Taking the medicine correctly is essential.
Escalation was the solution to the side effects felt by the executive Priscila Simões50 years old, who started treatment with Ozempic in April 2022. In the first three months, she found it very difficult to use the medication, prescribed by an endocrinologist to treat overweight and fat in the liver.
“I had a lot of nausea, diarrhea, stomach pain, it was horrible. I could see that it was a very gastrointestinal thing. At first, I said that we lose weight because we can’t eat because we’re so sick”, recalls Simões.
The situation improved after she made a new appointment with her doctor and was advised to reduce the dosage, increasing the amount each week until she reached the indicated dose.
“When I did that, it improved a lot. Now I can take the prescribed dosage and eat normally without feeling sick, but in much smaller amounts. I keep eating the things I used to eat, but reducing the portion size a lot”, explains the executive.
Diet during treatment
The reduction of portions is one of the indications of the manufacturer Novo Nordisk to reduce side effects during the Ozempic treatment. Avoiding fatty foods and alcoholic beverages can also help control the feeling of nausea caused by the medicine.
“In general, eating smaller portions at meals, stopping when you feel satisfied, avoiding fried and very fatty foods, keeping yourself well hydrated throughout the day and avoiding alcohol are attitudes that can minimize these side effects”, explains Braga.
Another alternative may be to prescribe medication against nausea, or gastric protectors for patients who experience gastrointestinal effects, according to the endocrinologist Rosenbaum.
“There are some possibilities, such as prescribing medication for nausea that the patient can consume before meals, or even prescribing gastric protectors to prevent reflux”, explains the doctor.
“People need to be well guided because otherwise we end up seeing patients who could benefit from the treatment, but end up giving up because they didn’t have guidance to avoid some effects”, evaluates the doctor.
Dangers of indiscriminate drug use
The use of Ozempic without medical supervision worries entities and specialists in the field. In January, the Brazilian Society of Endocrinology and Metabology (Sbem) issued a note warning that, like any other medicine, the semaglutide “it needs medical follow-up and should only be used under prescription”.
The unbridled demand has even affected patients with diabetes, who cannot find the drug in pharmacies in São Paulo. “There is a shortage of medicine for those who need it, for those with diabetes, and that is a pity. With this fashion of social networks, this madness has become. There are people who shouldn’t even use the Ozempic and it keeps using it with all these side effects, and it’s lacking for those who should take it”, evaluates Rosenbaum.
Even patients who used the medicine under professional guidance say they are worried about fever injectable semaglutide.
“I know a lot of people using it, but most of my friends don’t follow up with an endocrinologist. I see a lot of inconsequential posts on TikTok, teaching people how to use it, but nobody talks about the tests that need to be done before treatment”, says the publicist Tchakerian.
“I feel that there is this trend, a lot of people came to tell me that they were going to take it too, and I always tell them to ask for the doctor’s guidance. I did all this with a prescription, but it is a medicine that they are taking indiscriminately”, agrees executive Simões.
Drug causes rebound effect
One of the risks of indiscriminate use is the so-called rebound effect, which occurs when the weight lost during treatment is regained when the patient stops using the medicine. In some cases, the weight gain is even greater than what was previously lost.
“When you use it without guidance you can have a rebound effect, an unusual weight gain, especially when the use is stopped without a plan of action”, explains Rosenbaum. “If the person doesn’t change their lifestyle, doesn’t exercise, they’ll put on weight all over again when they stop taking the medication”, adds the endocrinologist.
To avoid putting on weight again, experts recommend discontinuing the medication gradually and, of course, accompanied by changes in diet and regular exercise.
“I have this concern with the rebound effect, because I don’t want to regain the weight I lost, but I also don’t intend to take the medicine for the rest of my life. I’m going to try to keep the weight off with other mechanisms, with physical activity and diet”, says Simões.
Thinking about it, her strategy is similar to that of the publicist, who suspended the use of the drug in December, after a series of side effects.
“When I stopped the medicine and my hunger returned to normal, I felt like a dragon’s hunger, because before I ate very little. O Ozempic made me create an important habit of eating less and exercising. Now, I still go to the gym and try to adjust my diet, but I’m much hungrier than before”, explains Tchakerian.
As the cost of the medication is high — at the dose indicated by endocrinologists, expenses can reach around R$ 1,000 per week — the alternative adopted by the publicist was to redirect the investment. “Now, the money I spent on the medication I am spending on a personal trainer. It’s not the same thing, but I’m trying to be more in control,” adds Tchakerian.