Potential Downsides and Risks of Oral Semaglutide

Understanding Oral Semaglutide

Oral semaglutide is a prescription medication approved for the treatment of type 2 diabetes in adults. It is part of a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists that work by mimicking the effects of a hormone called GLP-1. This helps lower blood sugar levels by increasing insulin secretion and reducing glucagon secretion. Oral semaglutide may also promote weight loss by acting on receptors in the brain to increase feelings of fullness.

While oral semaglutide has demonstrated benefits for blood sugar control and weight management, it's important to understand the potential drawbacks and side effects before starting treatment. As with any medication, oral semaglutide carries certain risks that patients should carefully consider.

Common Side Effects

The most frequently reported side effects of oral semaglutide are gastrointestinal in nature. According to the FDA prescribing information, these may include:

"The most common adverse reactions reported in ≥5% of patients treated with RYBELSUS are nausea, abdominal pain, diarrhea, decreased appetite, vomiting and constipation."

Many patients experience nausea, vomiting, diarrhea, abdominal pain or discomfort when starting oral semaglutide. The MadeMed approach involves carefully monitoring side effects and adjusting dosages gradually to allow the body to adjust.

Other common side effects noted in clinical trials include fatigue, dizziness, and headaches. While generally mild, it's important to report any persistent or concerning symptoms to your healthcare provider.

At MadeMed, we take a personalized approach to treatment, tracking your experience closely and making adjustments as needed.

Serious Potential Risks

In addition to common side effects, there are some serious potential risks associated with oral semaglutide that require careful consideration and monitoring:

Pancreatitis: According to the FDA, oral semaglutide has a "WARNING" about the risk of pancreatitis (inflammation of the pancreas):

"Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists."

Patients with a history of pancreatitis are typically not recommended for GLP-1 agonists like oral semaglutide.

Diabetic Retinopathy: There is a potential increased risk of diabetic retinopathy (an eye condition caused by diabetes) with the use of semaglutide, as noted by the FDA:

"An increased risk of developing diabetic retinopathy complications has been reported with other GLP-1 receptor agonists used for treatment of diabetic retinopathy."

Careful eye monitoring is recommended for patients with diabetic retinopathy.

Thyroid Tumor Risk: Animal studies have indicated a possible risk of thyroid tumors with long-term use of semaglutide. The FDA states:

"In humans, there were cases of thyroid C-cell tumors...reported among the clinical trials in patients treated with RYBELSUS."

MadeMed ensures thorough thyroid monitoring and appropriate dosing based on individualized risk assessment.

Special Precautions

While oral semaglutide is approved for many adults with type 2 diabetes, there are certain populations who may need to use extra caution or avoid this medication altogether:

• Patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should not use oral semaglutide, according to the FDA prescribing information.

• Those with severe renal impairment (eGFR below 15 mL/min/1.73 m2) or end-stage renal disease should avoid oral semaglutide use, as the drug may not be adequately removed from the body.

• Caution is advised for patients with hepatic impairment, as studies are limited in this population.

During your MadeMed consultation, our providers will conduct a comprehensive medical review to identify any factors that may increase your risk, ensuring appropriate precautions are taken.

Comparing to Other Diabetes Medications

The side effect profile of oral semaglutide aligns with what is commonly seen across the GLP-1 receptor agonist class. Many of the gastrointestinal side effects like nausea and vomiting are experienced initially as the body adjusts.

Compared to older diabetes medications like sulfonylureas and insulin, oral semaglutide has a lower risk of hypoglycemia (low blood sugar levels). However, the FDA notes oral semaglutide does increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue.

During your MadeMed consultation, your provider will review your specific medical history and current treatments to determine if oral semaglutide is an appropriate addition to optimize your diabetes management while carefully considering potential side effects.

Expert Insight on Weighing Pros and Cons

According to Dr. Thai Pham, MadeMed's medical director, "Semaglutide has demonstrated benefits for improving blood sugar control and promoting weight loss in clinical trials. However, these advantages must be balanced against the potential side effects and risks on an individualized basis."

Dr. Pham emphasizes that oral semaglutide may be a good option for many type 2 diabetes patients struggling with elevated blood glucose and weight management. "But careful monitoring for side effects like nausea and potential complications is essential, especially in higher-risk populations."

Open communication between patients and providers is critical throughout treatment. "We have to weigh the clinical needs against quality of life factors," says Dr. Pham. "Our role is presenting all the evidence, addressing concerns, and supporting safe, effective treatment tailored to each patient's circumstances."

Conclusion: An Informed Treatment Journey

While oral semaglutide offers potential benefits for blood sugar control and weight loss, understanding the potential downsides allows for prevention and proactive management of side effects or complications. Open communication about your medical history, current treatments, and individual risk factors during your MadeMed consultation ensures your provider can determine if oral semaglutide is appropriate.

No treatment is entirely risk-free, which is why MadeMed's holistic, personalized approach is so valuable. Your care team guides you through an informed decision process, weighing the pros and cons in the context of your specific needs and goals. From there, comprehensive treatment protocols with ongoing monitoring support your safety and success every step of the way.

Take the first step towards better metabolic health management by scheduling your free MadeMed consultation today.