“Oh, boy, my stomach hurts. I’ve just been really constipated. I took Ozempic. I can’t go to the bathroom and was up all night. Ozempic does that.” This confession of Macy Gray, the acclaimed American R&B and soul singer, on a show on MTV, once again sheds light on the side effects of the blockbuster diabetes and weight loss drug that many, like her, take to “lose weight really fast.” Ozempic, an injectable form of semaglutide, which was initially intended for managing Type 2 diabetes, has become popular for its secondary weight loss benefits. It works by mimicking a hormone that regulates blood sugar and appetite, leading to reduced food intake. It also slows down digestion and keeps hunger pangs away. CONSTIPATION IS THE MOST COMMON SIDE EFFECT “Clinical trials have shown how constipation is one of the most commonly reported side effects among Ozempic users. Most studies have shown that between five and 12 per cent people develop constipation after taking Ozempic. Similar complaints have also come for Rybelsus, which is an oral form of semaglutide available in India, and has been shown to contribute to weight loss with diet and exercise,” says Dr Richa Chaturvedi, endocrinologist, Indraprastha Apollo Hospitals, Delhi. She says about 50 per cent of those who use these blockbuster drugs experience symptoms of stomach ache and constipation. “Usually, the symptoms settle in weeks but in about five per cent of patients, the severity is such that they have no option but to give up,” She adds. HOW DOES OZEMPIC TRIGGER CONSTIPATION? “Food takes time to digest, the patient may feel less hungry as the food stays longer in the gut and hence may not be having enough fluids. So your stool hardens,” says Dr Chaturvedi. People taking Ozempic may also end up eating less fibre throughout the day because they tend to feel full. Besides, they may consciously avoid fibre because it can worsen other side effects like gas, bloating and nausea. “Yet fibre adds bulk to stool, making it easier to pass. Lack of it leads to constipation,” explains Dr Chaturvedi. WHY A GRADED APPROACH WORKS BEST? Dr Chaturvedi sees patients who cannot even tolerate Rybelsus and educates them about side effects for ten minutes after routine consultation. “Remember the absorption of semaglutide from tablets is much lower than subcutaneous injections. I have had patients who could not tolerate even an oral dose. Even for that, one has to start with a low dose of 3 mg per strip of 10 tablets, 7 mg, 15 mg. Neither doctors nor patients should be in a hurry,” says Dr Chaturvedi. Now the OASIS phase 3 clinical development programme with once-daily oral Semaglutide of a higher strength, between 25 mg and 50 mg, has shown a weight loss of 15 per cent. “These studies have also highlighted adverse gastro-intestinal reactions with dose escalation," she adds. HOW TO EASE CONSTIPATION WITH DRUG USE? Dr Chaturvedi advises those on semaglutide against fatty meals. “Take fibre-rich food, drink adequate liquids, use antiemetics for nausea besides stool softeners. Most importantly, educate yourself about side effects before committing yourself to a regime that’s very effective but may not work for you.”
