Tips & Safety

TIPS to diminish or avoid potential adverse reactions

Add some fiber supplement to avoid constipation and keep you regular with the diminished food intake. It is not uncommon to decrease the amount and/or frequency of your bowel movements. Your body’s natural gastrocolic reflex is diminished because of your decreased food intake. This is another reason to stay well hydrated.
Spread out your fluid intake throughout the day (recommended intake 64 ounces). Also drink slowly, large gulps may result in fullness or reflux.
Have over the counter (OTC) omeprazole on hand. It is an OTC reflux medication. Dissolving, under the tongue or pill form are available.
If real nausea occurs, call the office and we can prescribe a stronger anti-nausea medication.

VERY SAFE

This is a very safe medication. NO clinically relevant drug-drug interaction with semaglutide was observed. Therefore, NO dose adjustment of any medication is required. Also, NO apparent effect on the rate of gastric emptying was observed with semaglutide doses up to 2.4 mg weekly.
However, I suggest caution and/or an alternative protection when taking oral contraception to ensure maximum pregnancy prevention.

CONTRAINDICATIONS

A personal family history of medullary thyroid cancer. However, development of this cancer was only observed in mice.
MEN syndrome
Serious hypersensitivity reaction to semaglutide
Not pregnant
Not breastfeeding

Important Safety Information for GLP-1 injection

Warning: Risk of Thyroid C-Cell Tumors

In studies with mice and rats, semaglutide caused thyroid tumors, including thyroid cancer. It is not known if GLP-1 will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Dr. Giese if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
Do not use GLP-1 if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN

Limitations of Use:

GLP-1 has not been studied in patients with a history of pancreatitis.
GLP-1 is not for treatment of type 1 diabetes mellitus.

Who should not use GLP-1?

Do not use GLP-1 if:

You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
You have a known allergic reaction to semaglutide

How should GLP-1 be administered?

You can take GLP-1 with or without food. The injection should be administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Dr. Giese will guide you on a treatment regimen that may include an increase in dose weekly.

You should not change your dosing regimen or stop taking GLP-1 as prescribed without discussing with Dr. Giese first.

What should I tell Dr. Giese before using GLP-1

GLP-1 has certain drug interactions. It’s important to tell Dr. Giese all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

Some medications to watch out for include:

Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
Other GLP-1 medications, including Wegovy, Saxenda, Victoza, Byetta, or Bydureon
If you’re using other products for weight loss, including dietary supplements

It’s important to share your entire medical history with Dr. Giese. In particular, tell your her if you have a past history of:

Type 1 or type 2 diabetes
Thyroid cancer
Pancreatitis
Kidney disease
Diabetic retinopathy
Depression
Suicidal thoughts or behavior

Tell Dr. Giese if you are pregnant, planning to become pregnant, or breastfeeding.

If you are pregnant: GLP-1 should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to GLP-1 during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
If you are a female or male of reproductive potential: Discontinue GLP-1 at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.
If you are breastfeeding: GLP-1 was found in the milk of lactating rats. Tell Dr. Giese if you are breastfeeding before you start GLP-1.

Pregnancy registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to semaglutide during pregnancy. Pregnant women exposed to semaglutide and healthcare providers are encouraged to contact Novo Nordisk at 1-800-727-6500.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

What are the most serious side effects that I or a caregiver should monitor for when taking GLP-1?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention

These serious side effects can occur with GLP-1. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

Thyroid C-Cell Tumors: In mice and rats, semaglutide caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether GLP-1 causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza and Saxenda) after the drug was put on the market. GLP-1 is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Dr. Giese if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell Dr. Giese right away if you experience changes in vision.
Never Share a Pen: Pen-sharing poses a risk of infection.
Low Blood Sugar (hypoglycemia): GLP-1 lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.

Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.
Serious Allergic Reactions: Stop using GLP-1 right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
Acute Gallbladder Disease: GLP-1 may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell Dr. Giese right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
Increase in Heart Rate: Tell Dr. Giese right away if you have a racing heartbeat while at rest.
Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call Dr. Giese right away if you have any mental changes that are new, worse, or worry you.

What are the most common side effects of GLP-1?

Nausea
Vomiting
Diarrhea
Stomach pain
Constipation

You are encouraged to report negative side effects of prescription products:

Contact Novo Nordisk Inc. at 1-833-934-6891
Contact FDA MedWatch at 1-800-FDA-1088 or visit www.fda.gov/medwatch

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

What Not To Do

Do NOT Take the Injection Daily, or anytime you are feeling hungry, generally it is weekly

Do NOT throw you syringes in the trash

Do NOT Reuse the syringe

Do NOT Store the Vial in Freezer or anywhere besides the fridge

Do NOT Share Your Medication

Do NOT attempt to remove the medication with the vial upright. Must be tuned upside down to withdraw medication. See Here.

Do NOT Overeat “Because You’re Not Hungry”

Do NOT Ignore Dehydration

Do NOT Ignore Severe or Worsening Side Effects

Do NOT Use If Pregnant or Trying to Conceive

EWL Patient Registration Form

EWL Patient Consent Form

Dr. Sharon Giese and her staff are happy to schedule a consultation with you about Elective Weight Loss. For more information on plastic surgery, testosterone therapy in NYC and Dr. Sharon Giese, please email us at ewl@sharongiesemd.com or call us at 212.421.3400.