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TRENDS & DISRUPTIONS IMPACTING CUSTOMERS' CUSTOMERS Semaglutide and Tirzepatide have been a source of disruption in the overall healthcare market

hypertension, diabetes, hyperlipidemia) 15% reduction of weight over 1-2 years Contraindications Prior hypersensitivity reaction to a GLP-1 agonist Type 1 Diabetes Mellitus Pregnancy Personal or family history of MEN2A, MEN2B, medullary thyroid cancer (due to concern for long-term thyroid effects) Prior pancreatitis Inflammatory bowel disease or gastroparesis Complications General info: Typically most severe within 4 weeks of initiation of therapy or with sudden escalation of therapy Complications seem to be dose-dependent Gastrointestinal Complications 20-70% of patients experience these complications Most common: nausea, vomiting, diarrhea, decreased appetite, abdominal pain, dyspepsia, constipation Pancreatitis (increased islet beta cells and exocrine duct cells leading to smaller duct size and thus risk of distal occlusion) This is actually more of a theoretical risk and has been demonstrated in animal studies but there are conflicting results in human studies Gastroparesis Small bowel obstruction Biliary disease such as increased activity of cholangiocytes, increased bile acid secretion, suppression of cholecystokinin, and decreased gallbladder emptying Recommendations : for patients who present to the ED with minor symptoms and achieve symptom control in the ED, they can continue the GLP-1 agonist and follow-up with the prescribing physician Dermatologic Complications Pruritis at injection site, urticarcaria, angioedema Hyperhidrosis Rarely anaphylaxis or T-cell mediated delayed hypersensitivity reactions like pustular rash, vesicular eruption, and psoriasiform eruption Ozempic face - aging or wrinkling of the face due to rapid loss of fat, resulting in increased size of skin folds and sagging Recommendations : treat as an allergic reaction with epipen, benadryl, famotidine, and steroids as indicated based on severity of symptoms Renal Complications Pre-renal acute injury occurs mostly secondary to volume loss from nausea, vomiting, diarrhea More likely in patients with pre-existing risk factors such as chronic kidney disease, hypertension, coronary artery disease, and patients who use angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers The reason for this is activation of the renin-angiotensin-aldosterone system is an important homeostatic mechanism in states of volume depletion, and use of inhibitors blocks this natural response Few case reports of acute interstitial nephritis (recovered with prednisone) Recommendations : assess volume status and replete with fluids as necessary, consider need for dialysis Endocrine Complications Combination with insulin/sulfonylureas may be associated with hypoglycemia (doses may need to be reduced prior to initiation of GLP-1 agonists) May not be due to combination effect, but rather because sulfonylureas may uncouple GLP-1 from its glucose dependence Hypoglycemia does not occur in those on metformin Recommendations : prescribing physicians should manage dose changes, but consider consultation with endocrinology in cases of persistent hypoglycemia Ocular complications Increased risk of diabetic retinopathy and retinopathy complications (vitreous hemorrhage, blindness) Recommendations : anyone with vision changes or painless vision loss should be evaluated by ophthalmology Overdose Case reports have been primarily accidental overdoses (in the setting of accidentally injecting an incorrect dose, such as injecting a whole pen) Mostly develop severe nausea ,vomiting, but no abdominal pain, transaminitis, or pancreatitis Recommendations : mainstay is supportive care, contact poison control Other complications (usually do not lead to discontinuation) Mild infections: nasopharyngitis, influenza, cystitis, viral infections Headache References Long B, Pelletier J, Koyfman A, Bridwell R

Whilst Ozempic was initially devised for diabetes later on we realised it's a good weight loss medication

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Clinical Implications: How to Translate This in Practice For endocrinologists and metabolic specialists, the message is clear

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