Managing Side Effects of GLP-1 Receptor Agonists Copy

By Rich Weil, M.Ed., CDE

February 5, 2025

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Written By Rich Weil, M.Ed., CDE

by Rich Weil, M.Ed., CDE
Founder and Director
Transformation Weight Control

I like to show the following slide when discussing side effects of GLP-1 receptor agonists. It shows the potential side effects of 12 of the most common prescription and over-the-counter medications in the U.S. The point is not that you should be able to read all the side-effects, but rather impress upon you that all medications have potential side effects, and many have lots of them!

The GLP-1 receptor agonists approved for weight loss include: Zepbound (tirzepatide), Saxenda (liraglutide), and Wegovy (semaglutide). All of them have similar side effects, the most common being nausea, diarrhea, vomiting, and constipation. More serious side effects include pancreatitis, changes in vision, low blood sugar (hypoglycemia), allergic reactions, acute kidney injury, and severe stomach problems. I’ll discuss the most common side effects in this blog.

Most Frequently Reported Side Effects

The most frequently reported side effects, by percent, for GLP-1s, was reported by Liu and colleagues in the journal Frontiers in Endocrinology in December 2022. They found that for FDA-approved GLP-1s for weight loss, liraglutide (Saxenda) and semaglutide (Wegovy), the percent of side effects reported was as follows:

Nausea: 42.2%
Diarrhea: 21.9%
Vomiting: 21.9%
Constipation: 8.4%

They report that although the incidence of side effects were similar among medications, semaglutide had the greatest risk of nausea, diarrhea, and vomiting, whereas liraglutide had the greatest risk of upper abdominal pain. This may be helpful information if you are having side effects and want to switch from one weight-loss approved GLP-1 to another.

Side Effects of Tirzepatide (Zepbound)

For tirzepatide (Zepbound), Jastreboff and colleagues reported in the New England Journal of Medicine in 2022 that at maximal doses, the percent of individuals reporting side effects were as follows:

Nausea: 31.0%
Diarrhea: 23.0%
Vomiting: 12.2%
Constipation: 11.7%

Managing Common Side Effects

Nausea

Stay hydrated (eight 8-ounce glasses of water a day).
Your doctor may recommend lowering the dose or prescribing anti-nausea medication.
Eat bland, low-fat foods like crackers, toast, and rice.
Avoid strong-smelling food.
Eat slowly and stop when satisfied.
Avoid alcohol and sugary foods.

Diarrhea

Avoid greasy, spicy, and high-fat foods.
Limit caffeine and alcohol.
Stay hydrated with water, fruit juices, and broth.
Your doctor may lower your dose or try a new GLP-1.

Vomiting

Stay hydrated.
Eat smaller, more frequent meals.
Avoid strong-smelling foods.
Eat slowly and pay attention to fullness.

Constipation

Drink plenty of fluids.
Eat fiber-rich foods.
Consider fiber supplements (after consulting your doctor).
Exercise regularly.

Thyroid Cancer

Much has been written about the potential risk for thyroid cancer in individuals taking GLP-1s. Most concerns are based on studies in rats, which may not translate to humans. Experts suggest that the benefits of GLP-1s outweigh potential risks for most people. Discuss any concerns with your doctor.

Final Thoughts

GLP-1 medications are effective for weight loss but come with side effects. If you’re experiencing discomfort, talk to your doctor about adjusting your dose or switching medications. Lifestyle adjustments like staying hydrated and eating smaller meals can also help.