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Semaglutide+B12 & Tirzepatide+B12
Side Effects and Management

Overview

Semaglutide (generic for Ozempic® - brand name for treating diabetes and Wegovy® - brand name for treating obesity), is an injectable medication used to help manage blood sugar, weight loss and it can also lower the risk of heart attack and stroke. Semaglutide works by mimicking a gut hormone that causes your pancreas to release insulin, blocks your liver from releasing sugar, and slows down how fast food leaves your stomach. The Semaglutide we utilize is compounded with Cyanocobalamin (B12).

 

Tirzepatide (generic for Monjaro® - brand name for treating Diabetes and Zepbound® - brand name for treating obesity), is an injectable medication with a dual action using both GLP-1 and GIP incretin hormones, which are hormones that are released after eating.  Tirzepatide works by mimicking their effects including telling the pancreas to release insulin after eating and signaling the liver to lower the amount of glucose it’s making, which helps lower blood sugar, and slows digestion. The Tirzepatide we utilize is compounded with Cyanocobalamin (B12).

 

Both drugs signal the brain to help slow gastric emptying, curb appetite, increased feeling of fullness, decreasing food intake and modulating fat utilization offering cardio protection and weight loss. While these actions can be beneficial for weight loss, they can also cause some side effects which can be bothersome and make the medication difficult to tolerate. The good news is that they usually subside over time.

Nausea and Vomiting

Nausea is the most common Semaglutide/Tirzepatide side effect. Vomiting tends to be less common than nausea. You are more likely to experience these side effects with higher doses of Semaglutide/Tirzepatide, which is why your healthcare provider will raise your dose slowly to minimize these effects. For most people, these side effects should improve over time as your body gets use to the medication. You might feel unwell for a short period at the beginning of the treatment or with increases in dosage but, for the vast majority of people, this feeling tends to go away within the first few days or weeks as your body adjusts to the medication.

Helpful tips if you experience nausea:

  • Take your injection in the evening such that you sleep through the onset of any nausea

  • Eat smaller more frequent meals, avoiding high-fat foods, and remaining upright for 1 hour after you eat

  • Move the injection site to your thigh may decrease nausea

  • Omit use of vitamins on the day of and the day after injection if you experience nausea

  • Eat several saltine crackers before bed on the night of your injection and when awaking in the morning following your injection

  • Drink 8 ounces of an electrolyte replacement drink before bed on night of your injection and when awaking in the morning following your injection

  • Get fresh air or turn on a fan

  • Drink peppermint tea or ginger ale (or eat foods containing ginger)

  • Avoid greasy, sugary foods or fruit juices with high acidity

  • Avoid caffeine and alcohol

  • Vomiting is usually short-lived and will likely make you feel better afterwards

  • Most patients report that they are unable to consume the same amount of alcohol they consumed prior to use of Semaglutide without experiencing nausea and vomiting

  • With severe nausea, take Zofran 4-8mg every 8 hours under the direction of a physician, not to exceed 48 hours of use

Constipation / Diarrhea / Stomach Pain/Bloating

As mentioned above, Weight Benefits or your personal doctor will slowly raise your dose over time to minimize these side effects.

Helpful tips if you experience constipation:

  • Use Magnesium Glycinate nightly 360-500mg (this can also assist with sleep)

  • Eat smaller meals

  • Maintain daily fiber intake (15 grams)

  • Eat apples, beans or dried fruits

  • Stay hydrated, drink plenty of water

Helpful tips if you experience diarrhea:

  • Eat smaller meals

  • Stay hydrated, drink plenty of water

  • Avoid caffeine and alcohol

  • Try saltine crackers, toast, eggs, rice or chicken

Helpful tips if you experience stomach pain:

  • This is likely due to constipation or diarrhea, refer to tips above

  • With severe pain, contact your medical provider

Fatigue

Fatigue is a common side effect…and, eating fewer calories may cause you to feel tired. Feelings of fatigue should subside as your body adjusts to potential changes in your diet. 

Helpful tips if you experience fatigue:

  • Increase protein intake

  • Drink and electrolyte replacement beverage

  • Take magnesium glycinate at night to assist with sleeping

  • Avoid lying around when fatigued, that will make you feel more fatigued, take a walk or stretch to increase oxygen flow and energy

Acid Reflux / Heartburn

Most side effects relate to your stomach and digestive system. These side effects are usually very mild and go away as you go through your treatment and your body adapts to the medication.

Helpful tips if you experience acid reflux and heartburn:

  • Eat smaller, bland meals

  • Stay hydrated

  • Try sleeping on your left side and elevating your head while sleeping to a min of 35 degrees

  • Take over the counter Antacids such as Tums or Mylanta

  • Take over the counter medication such as Zantac, Prilosec, etc. as directed

Burping / Gas /Flatulence

Burping, gas and flatulence are usually caused by small amounts of air that build up in your digestive system. This air build-up is a totally normal part of how your body digests food. As the medication slows the rate at which your stomach digests food, it may cause a small amount of additional gas build-up.

Helpful tips if you experience burping, gas/flatulence:

  • Avoid gassy foods such as lactose, beans, lentils, asparagus, broccoli, brussels sprouts, cabbage, fructose, artichokes, onions, pears, wheat, and soft drinks

  • Use over-the-counter anti-flatulents and antacids as needed

Muscle/Joint/Bone Pain

Muscle/Joint pain, also known as myalgia/arthralgia, is a common musculoskeletal side effect reported by some individuals taking Tirzepatide. It is characterized by discomfort or pain in the muscles/joints, which may range from mild to severe. Muscle/Joint pain can occur in various parts of the body and may be accompanied by stiffness or weakness This generally lasts less than 24 hours and will dissipate as your body gets used to the medication

Helpful tips if you experience muscle/joint pain:

  • Apply a cold or warm compress depending on the nature of the pain and what provides relief or take a warm bath to relax the muscles and alleviate discomfort

  • Engage in gentle stretching exercises or light physical activity to promote blood circulation and relieve muscle tension

  • Engage in gentle range-of-motion exercises or low-impact activities to maintain joint flexibility and reduce stiffness

  • Maintain a healthy lifestyle, including regular weight-bearing exercise and a balanced diet rich in calcium and Vitamin D to support bone health

Consider over-the-counter pain relievers or muscle relaxants after consulting with your healthcare provider

Blurred Vision

Blurred vision is a common side effect reported by some individuals. It refers to a loss of sharpness or clarity in vision, making objects appear hazy or out of focus. Blurred vision can occur in one or both eyes and is usually temporary. In rare cases of serious optic nerve injury (including NAION) and vision loss have been reported in association with semaglutide. If I develop sudden vision changes, I will seek urgent ophthalmologic evaluation.

If you experience blurred vision, it is important to discuss it with your healthcare provider.

Helpful tips if you experience blurred vision:

  • Avoid activities that require clear vision, such as driving or operating machinery, until your vision returns to normal

  • Keep your eyes well lubricated with artificial tears or prescribed eye drops to alleviate any discomfort associated with blurred vision

Visual Disturbances/Sensitivity to Light/Color Perception

Some individuals may experience increased sensitivity to light, known as photophobia. This sensitivity can cause discomfort or pain in the eyes when exposed to bright light or glare. If you notice that your eyes are more sensitive to light, it is important to take steps to protect your eyes and manage the symptoms. Some individuals have noticed changes in color perception. This can result in alterations in how colors appear or the inability to distinguish between certain shades. If changes in vision persist or have significant impact on your daily activities, consult your healthcare provider for further evaluation and guidance.

Helpful tips if you experience visual changes:

  • Wear sunglasses with UV protection when outdoors or in brightly lit environments.

  • Adjust the lighting in your surroundings by using shades, curtains, or dimmer switches to reduce glare.

  • Avoid prolonged exposure to screens or devices that emit bright light.

  • Inform others about your condition to ensure proper communication regarding color-dependent information.

Dizziness / Lightheaded

The medication can cause dizziness or lightheadedness and you may experience this when starting your medication. The good news is that it's rarely a major issue and usually only a short-term symptom. You should feel fine again once your body gets used to the medication.

Helpful tips if you experience Dizziness or Lightheadedness:

  • Lie down until the dizziness passes, then get up slowly

  • Check your blood sugar

  • Move slowly and carefully

  • Drink plenty of fluids, especially water. Drink orange juice to raise your blood sugar

  • Eat a snack containing sugar

  • Avoid coffee, cigarettes, alcohol and drugs

Headaches

Headaches usually pass very early after taking the first few doses and are often caused by dehydration.

Helpful tips if you experience headaches:

  • Stay hydrated by increasing your water intake — your goal should be at least 2 liters of fluid daily

  • Take an electrolyte replacement powder with water daily

  • Relax and take needed rest

  • Take over the counter headache medication as needed.

Rapid Weight Loss

Rapid weight loss may increase risk of gallstones, nutrient deficiencies, electrolyte imbalance, hair loss, hormonal fluctuation, loose skin, and loss of muscle/bone mass. Data also suggest possible bone density reduction with prolonged use. You should ensure adequate calcium and vitamin D intake and consider bone density monitoring if on long-term therapy. Typical safe rates of loss vary by individual and I should follow prescriber guidance.

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