Wegovy (semaglutide) and Nausea

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.

@lisalucier
The short answer to the question is yes both nausea and stomachace with the 2.4 dosage.

I started per my Mayo PCP with lowest dose of Wegovy I think was .25 but those levels did not reduct my appetite. From .25 to before starting 2.4 I had very limited stomach upset. It was more bowel movement slow down that I noticed. I did not feel nausea. I did get a slight reduction at dinner in eating feeling a little full but only at that meal.

My wife got sick and I did not start the 2.4 level dose right away. When I did within 2 hours (was prior to bedtime) I could feel nausea and stomach discomfort.

When I woke up the next morning was quite frankly severe. I was really nauseated and had stomach pain. I vomited. I struggled and sent a message to my PCP about my symptoms. At lunch time I vomited again. I was given an acute visit to Mayo.

The doctor who saw me said no way to counter the drug it has to take is time to go through system and would take about 4-5 weeks to completely leave. I was told to eat very light and clear food. My doctor said I would normally prescribed a nausea pill for you but it would interfere with other medication you take.

Now what did I do to manage it. I tried eating mashed potatoes and let them dissolve in my mouth. This light and easy digetible food did not upset my stomach and I was able to keep it down. I chew a long time and ate very slow. I need to have protein but was not going to eat any meat. So I bought protein shakes. They were tasty and did not have an issue with them.

I drank gingerale. It seemed to quell stomach. I constantly felt nausea and was burping. I stayed with the mashed potatoes and protein drinks and did not vomit again. I watch not to lay down to soon after eating as would seem cause more nausea.

I don't want to put a negative on these medications. For some they have great success with them and minor side affects. For me none of the lower doses were working to reduce appetite and the highest one I got a severe reaction.

I wish it would have worked for me but I and others need to know once you stop them your appetite and stomach will eventually return to the way it was before. So you have to try to change you lifestyle and eating habits and not just count on being on a medication like Wegovy.

My PCP wanted me to consider Expound (spell?). He said it contained 2 recptors to lower appetite not just the one in Wegovy. But I have read on MCC others having issues with Expound as well. I was told we he would not even consider it for at least three months after I had the reaction to Wegovy.

I wish i could find something about Expound.I might would do a trade off now that i lost 45 lbs.

@lisalucier
Hi Lisa, I have never used Wegovy, but most likely referred to it when writing about gastroparesis. I remember stating that while gastroparesis has little recognition, I'll bet it will be getting a lot more recognition in the near future, becaue it is one of the side effects from using Wegovy and the other shots meant for diabetics, that everyone seemed to start using to lose weight. Gastroparesis hits each individual differently overall, but for the most part, hits most with feeling full before eating, and causes nausea and and in my case, when I get an attack, it starts with pain in my upper abdomen that feels like someone is cutting into it just under my ribcage. Then the nausea starts, and I have to recognize the pain across my abdomen quickly and take a Phenergan suppository, because if I don't and the vomiting and diarrhea starts, it's a 12-hour bout on the bathroom floor that ends in ungodly dry heaves that don't stop until I call an ambulance for treatment at the hospital. The last time I had to go in by ambulance they had to use two injections into the IV to keep them under control, and I'm only 10 minutes from the hospital. Then in the ER I had to receive two other kinds of IV drugs to get it to stop.
The key is to eat several meals in small amounts to not trigger the stomach spasms. Dependent upon how bad the gastroparesis is sometimes only protein shakes and bone broth are what's on my agenda, until my system quiets back down. But don't try to eat a larger meal, as the stomach can no longer digest the food in 30 minutes and it can sit in the stomach and upper bowel for 2-3 days causing toxins. Adding any food to that issue causes worsening of the gastroparesis.
I hope you are having far less problems with the Wegovy then gastroparesis, because it doesn't go away. You only learn foods that trigger it and stay away from them and not to get full. Fiber is no longer your friend because the body doesn't digest it well at all. I can get away with French style green beans and very small amounts of 3-bean salad for fiber, but that is it. Popcorn is a disaster, and so is lettuce and gaseous foods.
I hope the issue caused by Wegovy is short-lived for you, but, unfortunately if it is gastroparesis it's permanent.

@larry68
Go to their web site. Very helpful information there. They offer some cost savings for those with insurance and thos without but not federal ones like Medicare Part D and other federal programs.

My Mayo PCP was really up on Expound. He said had two receptor for appetite reduction where Wegovy only had one.

He also mentioned not so many side affects but I read on MCC posters having side affects to it.

WOW that is great you lost 45 lbs. You should be very proud of yourself!

Sorry about your problems. I had gastric bypass surgery 20 years ago. Even to this day, if I eat things I shouldn’t, I will dump. If I don’t chew my food completely, I’ll dump. Sugary foods will make me dump. Like I said, 20 years later. Sooner or later you need to realize that it’s what we put into our mouths we are responsible for. The doctors were certain that I understood the complications if I didn’t change my eating habits. Once you dump a couple of times, you know how to avoid it. I have kept off 100 pounds since then. Good luck.