@wlb2,
Weight loss drugs have side effects that may be temporary or last longer. Being nauseas is not why weight loss drugs work. The medications reduce appetite and increase feelings of fullness, some interfere with fat absorption in the intestines.,

This article may help with suggestions on side effects:
https://diet.mayoclinic.org/us/blog/2024/managing-common-side-effects-from-weight-loss-drugs/
If side affects do not reside, you should contact your provider about dosage adjustment.

Are you making lifestyle changes along with the weight loss drugs.

@wlb2
I see the mentor has reached out to you.

I assume by the mention of introductory dose you are talking about the .25 which is the dose most doctors will start you off on so they can see how you react to the medication.

I had no significant side effects from the .25, .50. 1.75 until I hit the highest dose 2.25. I may be off on the exact numbers but as you can see they usually double each time you are on the dosage for a month.

Some individuals handle WEGOVY and some do not. That is why most doctors start you off with the lowest dose. As I mentioned until I got to the highest dosage, I only had bowel movement delay and a slight decrease in dinner appetite. Now when I got the highest dosage, I had a severe reaction. I vomited 3 times the day I took the dose and felt nausea for weeks after. Of course, my doctors said come off it as you have had a significant reaction. It took about a month to return to normal.

Now my primary care doctor wante me to try ZEPBOUND. It has to agents that affect your appetite versus WEGOVY only one. And I was told less side affects. But then I have read some have significant side effects with ZEPBOUND too.

It really depends on the individual. What and how one will react to any medication will not be the same to another. You have mentioned side effects that are common with WEGOVY. Just know that WEGOVY is going to slow down your digestive system. That for some is not an issue and get along fine. Some cite side affect more intense and significant issues.

WEGOVY had a web site and also a program for a mentor and advisor. I would go on the web site and sign up for that. You can talk directly to a rep.

Am I going to go on ZEPBOUND? No. I just have to learn to get my weight down and know that these weight loss drugs do work and many have had great outcomes, but you must stay on them to continue to get the benefit. Thus, long term lifestyle for me is to find a way to get my weight down and stay there.

I have had to accept that my personal techniques are not going to have the same quick weight loss success that others have had on WEGOVY has provided. But I have used techniques I have learned from my primary care doctor and web sites like WEB MD and they are working just at a much slower and much lower loss of weight each week.

Mayo had an excellent diet program also and you can go on the web site for that, and I believe there is a book on it as well.

So, my advice to you based on my experience is that if the side effects are something you want to deal with to get the weight off then you have to make that decision yourself. I did not like the side effects so I have accepted my weight loss will be slow and much harder, but my weight loss will be lifetime lifestyle and diet changes.

Have you tried weight loss programs like NutriSystem? I loss 60 lbs on that plan. My problem is got sick with COVID in 2023 that then went into sinus infection and then into bronchitis. I was down and miserable for 3 months and ate every comfort food I could find to feel better. So that is the weight I am not dealing with
Good luck!

Welcome to Mayo Clinic Connect, @wlb2. Great to see you've connected with@roch and @jc76.

I personally took semaglutide (Wegovy) and really had the nausea you are mentioning at the two lowest doses. It was very much like morning sickness, and it would get so bad I'd have trouble focusing properly on my work. I ended up taking over-the-counter anti-nausea lozenges, which helped. Then my doctor prescribed prochlorperazine (Compazine), an anti-nausea medication. I know my doctor disliked prescribing one medication to deal with side effects from another, but taking it did help.

Overall, I had good weight loss with semaglutide, over 50 pounds down. However, I ultimately went off it and am taking another weight loss injection due to really severe side effects, especially as the dosage went up. I had basically chronic diarrhea, "death burps" that made my whole family roll down the windows in the car, intense abdominal cramping, and vomiting at random times so that my husband asked me to put "barf bags" in our cars. I even had some fecal incontinence one night at the highest dose when the semaglutide really did not seem to get along with what I ate and drank the evening before.

I look back at my time on semaglutide somewhat wistfully, due to the weight loss results. My husband also has taken it with zero side effects, by the way. So it became clear to me that the body's response to this medication is very individual.

How are you feeling today, wlb2?

I've had bariatric surgery, which led to severe nausea (called "dumping" if you decide to do a search for it); started tirzepatide last summer to get rid of the weight I had gained (to improve my knee arthritis), which led to a slew of GI side effects; and moved to semaglutide this year, largely to deal with the side effects.

One of the key reasons the weight went back on was that I eventually fell back on comfort food to assuage the dumping syndrome, so yeah, part of this is behavioral. However, I also devoted a lot of attention to figuring out my list of trigger foods, and that's what worked in the end.

This was a very useful experience when I started the GLP-1 RAs. I titrated up more slowly than they recommend, paused and stuck at a lower dosage than the maximum, and titrated down slowly. During this experience, I did make use of the controlled nausea as a tool to help manage my eating, but I also did a lot of tracking to figure out what made a difference, and also got a prescription for anti-nausea medication that I used sparingly. I found that the symptoms were worse with some foods than others, if I didn't stop eating immediately when I started to feel the first edge of nausea, and at meals later in the day (I used the medication to help me be able to go out to dinner for social occasions, since otherwise dinners were difficult for me). This may or may not be the same for you, but it's an example of sleuthing the issue out.

It's really important to prioritize protein and fiber when we eat so much less. Unfortunately, this has meant that I haven't been able to rely on plant proteins, where the protein requires eating more volume. In my case, vegetables are more triggering than fruit, especially cruciferous vegetables, so I'm skewing toward fruit.

My GI symptoms are only partially dose-related, meaning that dropping down to a lower dose helped a little but not a lot. That's why I switched to another drug in the family, which helped (as did the fact that I could get it as a multi-pen, which let me fine-tune dosages). Switching definitely helped, although it took a couple of months for my system to calm down.

This was not the only side effect I had, and I've systematically been going after each one. I don't think this is normal -- someone has to be a statistical outlier, and I guess I was elected -- and it really is normal for the nausea to be dose-dependent and to go away over time. But it does appear that the weight loss is not just a reaction to the nausea, and does not depend on that symptom. So if you can get the nausea under control, you may well see the weight loss still happen.

Oh, yeah. Missed one. Try not to drink at meals -- see if you can give it 30 min before and after eating. Drinking with food can be triggering. This is a significant behavioral change for some of us, and you need to be really careful not to dehydrate, especially if you also need to shift to multiple protein-rich snacks rather than eating three larger meals. In my case, I delay my first meal of the day and drink lots of fluids during that time, among other hacks.

I'd like to tag a few other Mayo Clinic Connect members who've talked about semaglutide (Wegovy) to see if they have had nausea and stomachache and if so, how to manage it @brianberchtold @jc76 @ami83 @isadora2021 @celia16. @predictable @neenagator64 @larry68 and @shiver may also have some input.

@wlb2, how have you felt in the last couple of days?

Mounjaro is what i am taking and no nausea or stomach aches.I had some about 2 months after i started taking it.

I feel like my situation is weird. I started out by taking one .25 shot in the doctor's office. Then my doctor gave me a .5 prescription for three or four months.

So I started about 2 1/2 months ago and was absolutely rocking it out, just amazing, on .5. Zero side effects, and the most wonderful results was the no sweet tooth, that things tasted differently and I didn't even realize that I had food noise but all of that food noise was blessedly silent. I did not spend all day thinking about food.

I was watching my macros and of course constipation is always an issue but things were amazing and I got greedy. So I talked to my doctor into sending me a 1 mg script after one month.

Here's where it gets weird. I was on this 1mg with just slight stomach upset and nausea every once in a while for 3 weeks. But after the third week, I have since had two weeks of horrible side effects. First, neuropathy issues. I found out through research on Reddit that your skin hurts. It's weird but it's like if you take prednisone at a high dose and then don't taper off, your skin will hurt to the touch. It's highly sensitive and sometimes burns. So only very specific spots on my sides and back would burn or hurt whenever my clothes would rub against my skin or I would sit back or next to something. It was so crazy but definitely something I could've tolerated.

But at the same time, overwhelming nausea and fatigue hit me. I thought I had a bug and then maybe Covid and I have been so sick, probably a scale of seven for the nausea, most every day for two weeks and it has drastically affected my life. I barely worked last week. I just don't understand why it took that long but then I imagine that maybe I got gastritis from it. It is horrible nausea but a bite of anything or even taking my morning medication meant extreme indigestion, constant burping and overwhelmingly violent hiccups over and over every day. I dreaded taking my meds in the morning or my supplements and sometimes I wouldn't even be able to eat and sometimes I could and that would help the nausea a little but that's if I could even get it down.

I did lose over 10 pounds in that two months but most of that was the first month on .5 because even worse than all these ridiculous side effects, is I've only lost 3 pounds all month. So I requested that my doctor move me back down to .5 again and I'm praying that the side effects go away or lessen. Especially considering I have had to pay $1000 for both medications when I only dosed once from the 1 mg box. So I've paid 1000 bucks for two prescriptions in the last two weeks. Wish me luck!

Just the food noise being absent is life-changing for me..