Nausea taking 2.4 mg of Wegovy (semaglutide). No issues before

@marushka9
Welcome to Mayo Connect. It must be frustrating to know there is a solution and then have to fight insurance company to continue. I hope you win your appeal with insurance company. If you do, definitely talk to your provider about the situation and if need to restart at lower dose.

We cannot provide medical advice on Mayo Connect only discuss our personal experience. I have never taken Wegovy, but @jc76 just posted about similar situation. He stopped for a while and then restarted at higher dosage and had terrible reaction. See his comment: https://connect.mayoclinic.org/comment/1251493/

Have you let your provider know about your situation and see if they have any advice on preventing the weight gain.

@marushka9
I want to make sure not giving you medical advice jjust what was told to me by my Mayo doctors that relate to your question and will pass what they told me.

My wife was having a lot of medical problems and I had just finished my 1.75 dosage. I was to start the 2.4 but I did not. I chose to wait a while and wound up waiting for over a month to start it.

This Monday took the 2.4 dose at night for first time. It was at least a month since finished 1.75. About 2 hours after taking I had nausea and headache. I had had NO side affects from lower dosages.

I could not sleep as the nausea and headache got worse. I got up at 4:30 a.m. on Tuesday and tried to take a medication pill I usually take when I get up with some food. I immediately felt extreme nausea and I vomited 3 times.

This went on again about 2 hours later. I portal messaged my Mayo doctor and was given a acute visit and here is what I learned.

You have to start with the lowest dosage to see what you side affects will be. You then go on to next dosage if needed and again see if side affects. This goes on until you reached the maximum dosage. You have to take your dosages per instruction and that is within 1-2 days of the last dosage.

I was told with a month of being off it my body eliminated the drug from my body and desensitized the drug in my body. So what I did was hit the body with the highest dose with no adaptation to medication required to have body adapt to medication. So NO if you have a break (per my doctors for me) that is extended and you want to start taking again you have to start at lowest dosage again and go through that process. If I want to start WEGOVY again I will have to start a lowest dosage and proceed each month to higher dose.

I was put on a clear fluid diet and told to drink full gator aide to get the sugar and electrolytes I need. They wanted to put me on a nausea pill but I have a heart condition and that medical affects my electrical issues. I am extremely afraid to eat anything of substance.

On Tuesday when I came home from my medical appointment it was less than 10 minutes and vomited again over and over. I was told each day after dosage my nausea and headache would decline and they are right. This is Thursday still have a slight headache. My stomach is still nauseated, bloated, constant burping but (knock on wood) have not vomited since Tuesday.

I wanted to pass on what was told to me reference if our insurance okays it can you start at 2.4 dosage again? You are at the same time frame I was having been off WEGOVY for about 5 weeks.

Maybe your case is different but wanted to pass on what I was protocol for prescibing the medicaions with any extended delay between dosage would have to start over. I am in misery and being on a clear liquid diet is horrible but at least I have not vomited.

The FDA recently approved generic liguratide, which is an older form of these drugs. I'm giving it some thought if my side effects don't come down enough from my switch from Zepbound to Ozempic. I entirely support a ramp-up, ramp-down approach. I'm now on a low maintenance dose of Ozempic because I hit my goal weight, and I know if I stop entirely all my bad habits and the food chatter in my head will restart. I especially like Ozempic (and will appreciate liguratide) because it uses a multi-pen instead of a single-use pen, which means I can click-count. There is only one manufacturer of the generic at this point, but I'm guessing the price may come down further later in the year when they have competition. So this is an option if insurance doesn't provide coverage.

In the meantime, if you haven't considered time-restricted eating, you might do so. I have found over the years that it has been a helpful form of control. Done perfectly, it focuses on avoiding eating between an early dinner and an early morning breakfast, so it reinforces (and is reinforced by) your circadian rhythms. I need to have a small amount of protein/fat before I go to bed to minimize migraines triggered overnight by low blood sugar, so I just avoid food from bedtime until lunchtime.

@projfan
Congratulations on meeting your weight goal. I and many others who did not have success on the new injections weight control drugs really envy those that had success.

What I have read about weight loss and weight control echos your comments and my own personal experience with weight reduction and weight maintenance. That is not eating after early evening, no snacking, driking sugar beverages. This explained to me was if you eat or drink when not active the calories will go immediately to fat storing.

With fasting for about 12 hours the body will burn off calories it has not taken in. I found this simple tactic does promote weight loss for me. I am a terrible snacker.

It is not that I eat much at meals but my love of snacks is my downfall. I love nuts, and dark chocolate covered nuts. Dips and chips come in second. Nuts are very high calorie and for 180 calories for 1/4 cub which is not even a handful just does not hack it. Then if you add dark choclaete (even with high cocoa factor) you are adding a lot of calories. If eating later in day is even worse as going no where but to fat.

Again you should be proud of yourself for reaching your weight goal and also finding a medication that helps you maintain it.

Thank you! I'm 72 and have been gaining and losing and gaining and losing weight since before I could walk, so my metabolism is probably permanently damaged. But the older I get, the more responsive I get to drugs, which is good, but also (side effect city) bad.

I am so impressed that you can resist snacks in the evening. I have zero willpower at night.

Honestly, it's one reason I'm a little hesitant to get rid entirely of my GI issues from the GLP-1 RAs -- I have a horrible feeling that if I felt entirely fine, I would start eating too much again. Although it's helpful to have an aura stage (a migraine term) -- when I start sneezing at a meal, I know the next step is going to be serious nausea, so the sneezing tells me to stop eating. (Probably the vagus nerve, I suspect, but who knows?)

I will say that starting these drugs kicked all my bariatric surgery training back in, which has been very helpful. It's kind of sad that they just throw us on the drugs with zero nutritional or psychological or exercise or lifestyle guidance or support. As far as I am concerned, this is irresponsible.

@projfan
Regarding being able to resist snacks in evenings. Don't want to imply is easy. I have constant debate with myself in evenings watching T.V. The inner voics eat it, don't eat it is constant.

Some times I lose the debate and snack. I did find a popcorn called Skinny Pop that was 39 calories per cup. But even with that once I succump to snacking I will overdue it. For me not snacking at all is easier than trying to eat just a little.

Not sure I know when my snacking kick in as was a slim teenager. It does seem though that taste of something brings joy so get a good feeling. However the weight gain is not good and I know must get off. My wife even though a diabetic loves choclate, chips, cookies, etc. So very hard for me to see them and not want them.

You mentioned sneezing at meal. I get this all the time at the end of it. Have you ever got information what causes this. I can sneeze a dozen times and can't find the trigger food. Would apprciate if you have gotten any information this and the cause.

I agree with you on the psychological, nutrition, exercise and lifestyle guidance not being stressed just as much as taking the drug. WEGOVY does offer a mentor and sent message but no answer. I think the prescriber should really develop a comprehensive information briefing before prescribing even if done by his/her nurse of P.A.

Oh, I totally hear you. And agree that it would not be a huge lift for an NP or PA or even MSW to lead an effort to provide guidance to folks about how to modify lifestyle to help the drugs work better. Gradually increase walking, focus on protein/fiber, encourage liquids but try to keep them separate from meals, etc. But no one is going to make money off providing that service, and if you can't figure out how to make a profit from it, it's not happening unless someone in government mandates it.

One of the reasons I found time-restricted eating so helpful is that my on/off switch doesn't have an in-between. Not just for food -- pretty much for everything behavioral. I'll work until I drop, and then I'll relax entirely. My husband is great about staying balanced, but I'm not. Prior to these drugs, my best weight loss experience was with a medically-supervised liquid product that allowed me to cut out all solid food. Just being able to say "no" to food was SO much easier than making individual, sensible decisions about it. I was on something like 500 calories a day, and could go to restaurants with people and not be tempted. The switch was just set to "off". If I could have stayed on it forever, I would have done so. It would be so much easier if food pills were real.

I'm not sure there is a consistent trigger for the sneezing. But..."The vagus nerve is responsible for the regulation of internal organ functions, such as digestion, heart rate, and respiratory rate, as well as vasomotor activity, and certain reflex actions, such as coughing, sneezing, swallowing, and vomiting" (https://pmc.ncbi.nlm.nih.gov/articles/PMC5859128/). In my case, I'm guessing it's something my central nervous system just "learned" how to do when it detected upcoming nausea. The nausea most commonly happens when I eat soft things made with flour, like bread or pancakes (toast and crackers are fine -- go figure), but it sometimes gets triggered by, say, brussel sprouts. At this point, when my system is feeling particularly sensitive, I can scan a menu and instantly feel whether anything on it is going to trigger the reaction -- I can literally pick out the individual items that I'm going to be able to eat more than a few bites of just by reading the menu. Most of my carbs at home are now cooked groats, which are non-triggering for me, as high fiber as it gets, healthy, and you can do a surprising variety of tasty things with.

My husband can eat, like, six potato chips. It's unnatural. Once I open the bag, I'm just cooked. We do keep his snacks in a separate location, so I'm not staring at them when he's not eating them. But I think he eats for flavor, and I'm eating out of habit and craving and soothing behavior. It helps to have something else to do with my hands that's mindless -- I live with a glass of (unsweetened) tea next to me most of the time, and I play solitaire with physical cards whenever I'm in front of a screen. I've recently learned how to spin with a drop spindle, for the same purpose.