Melanie Cole, MS (Host): Ozempic has been in the news recently. It seems to be very popular among certain celebrities who may be using it off label, but what is it actually supposed to treat and is it safe? The best way to know is by listening here, so we can help you make informed decisions for yourself. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital.

I'm Melanie Cole. Joining me today is Courtney Mattley. She's the Henry Mayo Newhall Hospital Pharmacy Department Manager, and she's here to talk to us today about Ozempic. Courtney, thank you so much for joining us today. I love when we do these shows because, there seems to be a lot of misinformation out there that we are really happy that we're going get to clear up today. So first, tell us what is Ozempic? What is it supposed to treat?

Courtney Mattley, PharmD: Hi, Melanie. Thank you so much for having me. So this medication is from a class of medications called GLP 1 agonists. Now, what GLP 1 stands for is glucagon-like peptide. And what that does naturally in your body, is tell your brain that you're full, and that's naturally released from your stomach when it gets distended and when you're full. So that's something that naturally occurs to tell your brain, Hey, you're full. You don't need to eat anymore. But this medication, semaglutide, which is the generic name for Ozempic and Wegovy, it's doing essentially the exact same thing to signal your brain that you're full.

Another thing that it does is it slows your stomach's gastric emptying so that you delay motility and you feel full longer, but you're getting that feeling even without eating. It basically is suppressing the appetite.

Host: Wow. So thank you for explaining that. Tell us about the potential benefits for it as we're looking at it for what it's supposed to be intended for. Tell us about some of the potential benefits and side effects.

Courtney Mattley, PharmD: Yeah, of course. So, it has two uses actually right now. So the first use is what was approved in 2017 under the name Ozempic, and that is actually for diabetes because even though it's doing what we just said it does with suppressing the appetite, it also does something to the pancreas with stimulating insulin secretion, which is a problem with diabetes because there's a lack of that insulin.

 Its intention for diabetes is, is the first reason that we've used it. But the second reason was approved in 2021 under a different brand name called Wegovy, with a W Wegovy, it's the same, company that makes it, but under a different brand name. And that is really for the treatment of obesity, because of that appetite suppressant.

So the same drug, two different brand names. Two different reasons for using it. Now as far as side effects go, it does work on the gut like we said, it's signaling your brain that you're full by doing what it does in the gut and relaying that message to the brain. But the side effects are all in the stomach as well and in your gut.

So it can cause pain in the gut, it can cause constipation, diarrhea, and the number one reported side effect is some really intense nausea for some patients. And that's usually when it's just being started and during any dose titrations.

Host: Courtney, can it be used as you're telling us what it's used for, can it be used in combination with other diabetes medications or medications for another condition? Are there any interactions that we should be aware of at the start?

Courtney Mattley, PharmD: Overall, it's a very safe drug. It's a really great option for diabetics because it is so safe and it does, have that weight loss as a part of it, and it does increase the insulin production. The biggest risk is, if it's stimulating that insulin production, which is a good thing for diabetics, it can interact with other medications that also cause insulin production.

Like, there's a class of medications called sulfonylureas, and that's a, an example of that would be glipizide or glyburide. So those medications also stimulate insulin production. And if dose titrations are not done appropriately, then that can cause some hypoglycemia events in patients. But otherwise, there's very few interactions in general. But, the medications that have insulin production can definitely have some issues.

Host: So Courtney, the main topic here that we want to discuss is this off-label use that we're hearing about. Do you have any sense as to how widely Ozempic or Ozempic lookalikes are used for weight loss as an off-label medication. Tell us a little bit about what people are trying to use this for.

Courtney Mattley, PharmD: So it's obviously become a very hot topic on social media, and it's all over the news, which is why people are talking about it. In 2021, 2022, there was a pretty big shortage of semaglutide, the Wegovy one, which is the, for weight loss. So people started turning to Ozempic because that's the one that's approved for diabetes, but it's essentially the same medication and people who wanted to use it for weight loss ended up going to the other medication Ozempic for the same thing.

The problem was then there was a shortage, obviously, and that shortage actually lasted a pretty long time through the beginning of 2023. And I did a little digging on some numbers. In February of 2023, there was about almost 400,000 prescriptions filled in one week in the US for semaglutide.

Host: You're kidding.

Courtney Mattley, PharmD: I know, it's, it's some huge numbers. So what people were doing to get the medications after it was on shortage is going to other countries, which, I mean, I understand especially people who needed it for diabetes. They were, they were trying to get it any way they could. But that can lead to some pretty risky risks that they're putting themselves in because for example, a website might say, oh, we're a Canadian legitimate company, licensed pharmacy, but they can say whatever they want on their website. They can say they're from Canada. They can say they're legitimate, but are they really? That's a risk. There's no way to know. So people were buying it from Canada, they were buying it from Mexico, and just hoping it was actually the right medication and quality and regulated and nobody really knew what they were getting. It could have been a counterfeit drug. So it was a risk a lot of people were willing to take because it was widely, widely done that way for the last two years.

Host: So how do we know what's going on with those Ozempic lookalikes? Are they safe? What do you want people to know about the risks of trying something like this?

Courtney Mattley, PharmD: Yeah, I mean if someone's willing to use something that's not FDA approved it definitely comes from its own risks. I would caution people with going out of the country, because like I said, if it's saying it's from a legitimate company, there's really no way of doing it. And these medications are very expensive.

Just because it's from overseas doesn't mean it's less. It doesn't mean it's cheap. It's actually still really expensive, just maybe not as expensive. But, people are putting a lot of money into some of these things and the risk is that you're getting something that's completely different and maybe just a placebo or who knows what's actually being delivered to your house.

Host: What about people that might ask you, I would like to use Ozempic for weight loss, and it's not, maybe they don't have diabetes or another medical condition, they just want to use it as a weight loss drug. What do you say to them when they're asking you about this?

Courtney Mattley, PharmD: Yeah, I think it has a place in therapy. I think we need to look at obesity as a disease state as well, and obesity is, a big risk factor for cardiovascular disease, diabetes, hypertension. So when I talk to people who struggled with weight their entire life, and sometimes years and years of going up and down and many weight loss programs, this medication could be a really good option for them because obesity in itself is a risk.

And we need to think of that without the stigma of, oh, you're just, don't have enough self-control or something like that, you know, that's the stigma we're seeing with Ozempic, and Wegovy. But I think we need to also use it for what it's meant to be used for, which is true obesity.

We're talking like patients who have a BMI over 30, maybe some risk of cardiovascular disease. And this, losing weight can be really great step in making them healthier. I would caution people in jumping to this just to lose, you know, those last five pounds, those last 10 pounds, because that's not what the intention was for originally. But having something like this for patients who have struggled with weight their entire life, I do think it has a place in our therapy.

Host: You've told us what it's really used for and if people come up to you, and I imagine that they do with all this news in the media, about these Ozempic like drugs, what do you want them to know about how long it could be before they experience side effects or how dangerous it really could be? I'd like it to just expand and reiterate the safety issue on using something that's not for what it's intended or even something that's not the actual medication.

Courtney Mattley, PharmD: So there's two issues there. There's using medications that you're not sure what it is. That to me is a huge risk because you're injecting something into your body that is not regulated and could be essentially anything or nothing. And besides the financial impact of getting something that's not going to work that you paid for; there's obviously health issues with getting something that's maybe not safe. As far as the duration, so the side effects can happen really, really quickly. It can actually start after the first dose when it comes to the GI side effects. Now those GI side effects can be very mild and they can be pretty severe to the point where some patients cannot tolerate it.

But those side effects go away as soon as the medication is stopped usually. So I wouldn't say that that's a risk that's long-term. But it's something that is obviously going to affect somebody's life that they may not want to stay on the medication for. As far as long-term side effects, these medications were intended to be long-term. Like for diabetes, it might be something that somebody's on for years. And we don't really have the data for that yet. There is one risk that is considered a black box warning, and that's the risk of thyroid cancer with this medication. And currently, the only reason that that's on the label for a risk is because they did see that risk with rodents, specifically rats.

That has not translated yet into human cases, but obviously, the more widespread we use these medications, when we start having millions of people on something, you do end up seeing sometimes these rare situations. So, I wouldn't be surprised if some rare side effects do pop up or some long-term issues, the more widespread we use these medications over the years. So time will tell on that aspect.

Host: What should patients do if they experience side effects while they're taking it?

Courtney Mattley, PharmD: Well, the first thing they should do is definitely tell their doctor, hopefully they're getting it from a legitimate provider. The GI side effects sometimes, it's just a dose related issue and they need to go down on a lower dose. Sometimes it's not going to go away and they might need to get off of the medication. But that's a discussion with their provider regarding why they're using the medication, their dose, and possibly the duration.

Host: What an interesting topic we're discussing today. Courtney, I'd like you to wrap it up. What's your best advice about Ozempic for which it is intended and these Ozempic lookalikes that can be found on the internet and various places and that celebrities have been using and all that we're hearing in the media. And what do you want the key takeaway to be from this podcast today?

Courtney Mattley, PharmD: Yeah, I think that obviously these medications are very expensive, which is why some people are going to other providers, other, other resources to get them at a discounted price. Still high price, but it's a discounted price. One of the things that I hope changes in the near future is the insurance coverage with these medications when it is used for the intended weight loss for obesity, when it comes to somebody's health where they need to lose weight, and this is a good option for them. Some insurance companies don't even cover it because it's considered a cosmetic option, so it's covered with insurance companies many times for diabetes, but not for weight loss.

And that leads people to go to other places to get the medication. I really hope that insurance companies reevaluate that so that patients can get this medication safely from a provider with the correct insurance coverage. And also to think about the stigma associated with these medications for weight loss.

And I hope that we look at obesity more as a disease and not as something that's more cosmetic. And we can actually have people get these medications safely for the right reason.

Host: That's so important. What great information you've given us today, Courtney. Thank you so much for sharing your expertise with us today. And before taking any drug or supplement that alters your metabolism, you really should talk to your healthcare provider. So, they can help you make informed decisions about whether it's the right treatment for you.

That's always just a good word to live by. And thank you again, Courtney. And to learn more about Henry Mayo Primary Care, visit HenryMayoprimarycare.com. It's that simple. You can also visit the free health information library at library.henrymayo.com. There's so much great information there and you know that this is coming from the experts and specialists at Henry Mayo Newhall Hospital. So it is information that you absolutely can trust. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.