Introduction
Dealing with disease is never easy. Apart from difficult symptoms, you also need to worry about getting better and what the most cost-effective solution is. Thankfully, there are medications on the market that help make life easier. One life-changing drug is semaglutide, branded as Ozempic and Wegovy, which controls blood sugar and promotes weight loss.
As helpful as they may be, there comes a time when you want or need to stop your treatment. What happens when you stop semaglutide?
This article explores what occurs when people stop taking Ozempic or Wegovy, focusing on effects, risks, and maintaining weight loss.
Semaglutide: An overview
Before discussing withdrawal symptoms, it’s crucial to understand semaglutide, its workings, and potential side effects.
How semaglutide works
Semaglutide belongs to a class of medicines called glucagon-like peptide-1 receptor agonists, or GLP-1 Ras, for short. Basically, they mimic how gut-based hormone GLP-1 triggers insulin secretion for blood sugar regulation or when medicines can’t control it.
Another effect is delayed gastric emptying, causing you to feel fuller for longer, with less cravings and a weaker appetite. As a result, people on semaglutide lose weight.
Onset of semaglutide effect
Research shows that on average, it takes a person around four weeks on semaglutide to see some weight loss. However, the full effect can take some more time. In one study, participants lost as much as 35 pounds or 15.9 kilograms over a 68-week period.
With Wegovy, you may see weight loss within the first four weeks, but only see the full effects after months.
With Ozempic, meanwhile, blood sugar levels typically fully decline within the first week of use when taking the maintenance dose. But the full expect can take as long as eight weeks or even longer, given its once-weekly shots.
How long drugs stay in the body
To understand the effects of discontinuing semaglutide, let’s look at how long drugs stay in the body. Let’s also look at why some people choose to stop their medication.
Most drugs will get out of your system quickly, but their side effects’ symptoms may stay for a while. In most cases, it doesn’t take long for the kidneys and liver to clear prescription drugs out of the body. There will be traces of the drugs, but these are too miniscule in amount to have any significant effect.
Meanwhile, those with liver or kidney disease will have large amounts in their system even after they’ve stopped taking it.
Reasons behind discontinuing drugs
Some people may stop taking a certain medicine after experiencing unpleasant side effects, ranging from dizziness to heart palpitations.
One of semaglutide’s most common side effects, for instance, is nausea. The experience may be so uncomfortable that patients intentionally don’t tell their doctor that they’ve stopped the medication. They might feel relief, but without the drug to manage an existing problem, symptoms could get worse.
In some cases, some may need to temporarily stop taking a certain drug due to lack of physical capacity. For instance, they may not be able to swallow, which prevents them from taking oral medication. One of semaglutide’s brands, Rybelsus, used to treat type 2 diabetes, comes in tablet form.
Withdrawal from medicines
Withdrawal refers to the things someone experiences mentally and physically after stopping or reducing their intake of a certain medication. The higher the potential for dependency, the more severe and long-lasting the withdrawal symptoms can be.
Typically, people suffering from withdrawal will experience symptoms like changes in appetite and mood, irritability, nausea, tremors, or vomiting. To prevent withdrawal symptoms, your doctor may have you slowly reduce your intake of a drug, a process called “tapering.”
Stopping semaglutide use
Earlier, we talked about how semaglutide works and how it regulates blood sugar levels and curbs appetite, promoting weight loss. In this section, we go into detail into how these effects are reversed, when you stop taking semaglutide.
Weight gain
Dr. Janice Jin Hwang, endocrinology and metabolism division chief at the University of North Carolina School of Medicine, says patients may start noticing the effects of stopping semaglutide use after a week or so.
“Like any medication, when you stop taking it, it stops working,” adds Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association.
When discontinuing semaglutide, the process stops by which semaglutide regulates blood sugar levels and curbs appetite. Many, in fact, regain the weight they had lost.
In a 2021 study by Dr. Domenica Rubino, director of the Washington Center for Weight Management & Research in Arlington, Virginia, she found that people actually gained two-thirds of the weight they had lost.
Patients may feel their old appetites coming back to the same level before they took semaglutide. In some cases, their appetites may even be larger than before. Some people described themselves as “insatiable” as they were so hungry all the time.
“When you’re at that max weight loss, your body’s hunger hormones are the highest,” Rubino notes. “So if you lose 50 pounds and regain 25, your hunger is the highest when you’ve lost the 50. And even when you regain the 25, it doesn’t go back to baseline; your hunger is higher than prior to losing weight.”
As obesity is a chronic illness, patients will need to keep treating themselves for it their whole lives, Rubino noted. Wegovy, for instance, has been found to help reduce body weight by approximately 15 percent.
Explains Rubino, “They are chronic medications, which means you basically take them just like you take blood pressure medicine or diabetes medicine.”
Elevated blood sugar levels
Discontinuing semaglutide may cause elevated blood sugar levels, leading to symptoms like blurred vision, fatigue, excessive thirst, and frequent urination. Some may even end up in the emergency room because of exhaustion and become more vulnerable to different infections.
“With the changes of active ingredient levels, you will likely feel the changes of the blood sugar as well which can affect the way you feel about cravings and have effects on your overall appetite,” says Amy Lee, MD, Chief Medical Officer at Lindora Clinic in California.
Cravings and extreme hunger pangs
Because of semaglutide’s delayed gastric emptying, people taking Ozempic, Wegovy, or Rybelsus feel fuller for longer. Once semaglutide is stopped, however, feelings of hunger and cravings come back.
Withdrawal symptoms can last from weeks to months as the body’s physiological baseline function is still kicking back into gear.
“Without the medication, your gastric empty time will return to baseline which results in food being metabolized quicker and can be a trigger for you to feel hungrier faster or even requiring more food volumes to reach satiety,” adds Lee.
Supply problems
While some patients stopped taking semaglutide due to unpleasant side effects, others had no choice given the shortage in supply. It’s an issue that will likely plague semaglutide manufacturer Novo Nordisk and its competitors for the longer term.
The Food and Drug Administration has listed Ozempic and Wegovy as “in shortage” for months. Doctors may prescribe other drugs like metformin or insulin to help diabetic patients control their blood sugar. However, it can be perplexing to come up with a new treatment plan.
The problem with restarting medication
Sometimes, people may need to go back to taking semaglutide to manage their weight, given the possibility of side effects. To manage this, patients start off with low doses which eventually reaches a maintenance dose after several weeks.
Should you go back to a full dose straight away, you may experience severe side effects in the beginning like diarrhea and vomiting, notes Dr. Kraftson, a clinical associate professor in the division of metabolism, endocrinology, and diabetes at Michigan Medicine. Kraftson also warns patients to chew food slowly and avoid heavy foods so they don’t feel sick.
Those working their way to a maintenance dose may lose weight more slowly, which might be concerning or frustrating.
Proper planning is key
Side effects and other unpleasant symptoms may be inevitable should you stop taking semaglutide. But with proper planning, these may be minimized.
For those who want to keep the pounds off, lifestyle changes will be key. They can reduce carbohydrates, opt for more filling foods, exercise regularly, and get enough sleep at the same time daily.
More importantly, they should stop fixating on weight loss by the number of pounds dropped. Instead, they must rather focus on positive health markers like good blood sugar levels, cholesterol, and liver enzymes.
Sure, staying on semaglutide may be a non-negotiable for people with chronic health conditions. But for others who may find it hard to start or keep taking the drugs, there are alternatives. Semaglutide may not be for you, but you can establish a nutritious and sustainable dietary pattern that works for you.
Conclusion
No matter how helpful a medication may be, you or your doctor may feel it may no longer be necessary.
Just as with any medication, though, the body will have to adjust to suddenly not interacting with a drug. With Ozempic and Wegovy, for instance, patients usually end up putting the weight they had lost back on. In addition, they may need todeal with elevated blood sugar levels and cravings.
Thankfully, there are ways to manage. Lifestyle changes play a big role in maintaining weight and other markers. From dietary choices, sufficient sleep, increasing exercise, to stopping weight loss fixation, life after semaglutide can be sustainable.
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