Managing side effects from GLP-1 receptor agonists (GLP-1 RAs)—such as semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), liraglutide (Saxenda), and dulaglutide (Trulicity)—requires a comprehensive, patient-centered approach. The following protocol integrates clinical best practices and expert recommendations to minimize adverse effects and enhance treatment adherence.
Gastrointestinal side effects are relatively common when starting any of the GLP-1 medications. Tirzepatide is no exception but we have found it to be better tolerated by almost all patients who have used Semaglutide and Tirzepatide.Â
Side effects are more common in the initial weeks of treatment but should improve over time. Avoid or reduce side effects by following the guidelines in this plan about mindful eating, drinking water, and taking control over what you eat.
Possible side effects include, but are not limited to:Â
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Abdominal pain
- Headache
- Fatigue
- Dyspepsia
- Dizziness
- Abdominal distension
- Belching
- Hypoglycemia
- Flatulence
- Gastroenteritis
- Gastroesophageal reflux disease (GERD)
General Recommendations for Side Effects
Improve eating habits
- Eat slowly
- Eat only if you are really hungry
- Eat smaller portions
- Avoid lying down after having a meal
- Stop eating in case of feeling of fullness
- Increase meal frequency
- Avoid drinking through a straw
- Eat without distractions and enjoy savoring the food
- Try not to be too active after eating
- Avoid eating too close to bedtime
Adapt food composition to your requirements
- Choose easy-to-digest food, low fat diets (focus on bland foods)
- Use oven, cooking griddle, or boiling
- Increase fluid intake, especially clear, fresh drinks (in small sips) but not so much as to make you feel too full
- Health food that contain water (soups, liquid yogurt, gelatin, and others)
- Avoid sweet meals
- Avoid dressings, spicy foods, canned food, & sauces that are not home-cooked
Get some fresh air
Do some light exercise
Keep a food diary - it may be useful to identify foods or meal timings that make it worse.
Nausea
This is the most common side effect in all studies. Symptoms are usually moderate and disappear 8 days or less after they start. Be sure to follow ALL of the General Recommendations above.Â
- Provided that 30 minutes have passed since your last injection, eat foods able to ease the symptoms of nausea, such as crackers, apples, etc.
- Peppermint (tea, candies, essential oils, etc.)
- pH+ (supplement)
- Ginger (chews, fresh ginger, tea, gum, candy)
- Acupressure
- Avoid strong smells
- Move your injection site from abdomen (if that is where you are injecting) to your arm or leg
- Inject at night (you may sleep through the nausea)
- If your nausea started when moving up to a higher dose, go back to the lower one and stay on it for a few days. Then, increase the dose gradually.
- If needed, decrease your dose at your next injection or hold it altogether.
- Consider switching to a different GLP-1.
- Consider Metoclopramide 5-10mg 3 times daily as needed (prescription).
Vomiting
According to the literature, vomiting is less common than nausea. Symptoms typically resolve within 1-8 days.Â
- Maintaining hydration is particularly important
- Small amounts of food should be taken in more frequent meals
- Consider medications such as Reglan (metoclopramide) or Zofran - we may be able to prescribe these for you if needed.Â
- Avoid drinking during meals, rather have them, between 30-60 minutes before or after meals
- If your symptoms are severe or persistent, you may need to be seen (ER, Urgent Care, Primary Care)
Diarrhea
Diarrhea usually occurs during the first four weeks of treatment (if it is going to occur), after which the incidence notably decreases. Symptoms have been reported to last for about three days.
- Generous hydration: water, lemon, and a teaspoon of bicarbonate
- Avoid isotonic drinks intended to be used in the context of sport activities (e.g Gatorade)
- Avoid dairy products, laxative juices or meals, coffee, alcoholic drinks, soft drinks, very hot cold or very hot food, and products ending in "ol" (e.g sorbitol, xylitol, maltilol), including candy and gum.
- Avoid or temporarily reduce intake of food with high fiber content
- Eat chicken broth, rice, carrots, very ripe fruit without skin
- If your diarrhea is persistent, a probiotic or antidiarrheal supplements such as loperamide could be considered.Â
Constipation
Because the GLP-1 medications decrease peristalsis, constipation is a fairly common side effect. There are several options to get things moving again.
- EZ-Go
- Mag Citrate
- Powdered Vitamin C
- Increase physical activity
- Ensure diet is healthy, balanced and amount of fiber is adequate
- Drink generous amounts of water (or other sugar-free liquids)
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9821052/