So far in 2023, poison control centers across the country reported nearly three thousand calls related to semaglutide; an injectable drug used to treat diabetes and obesity. That is a 1,500 percent increase in calls since 2019, according to America’s Poison Centers. The drug has recently increased in popularity for its weight loss component.
FDA-approved sources of the medication include Ozempic and Wegovy, which patients must inject themselves with doses pre-measured in a pen. But compounded versions of the drug—which may be dispensed as needles, syringes and vials—may be more difficult to properly measure and self-administer.
Joseph Lambson, PharmD, DABAT is the Director of the UNM Health Poison Center in New Mexico. He also recently published a case series on administration errors of compounded semaglutide reported to the poison control center in Utah. He answered a series of questions on this topic that has gained national attention in recent weeks:
How many New Mexicans have called our local poison control center about semaglutide?
“Just looking at New Mexico data, our local poison center has managed 23 calls about semaglutide this year alone, compared to only 8 exposures in 2022. Seventy-eight percent of our calls this year involved incorrect dosing, and a lot of these were individuals giving themselves 10 times as much of the drug or double doses,” Lambson said. “I think having so many different formulations available, and not necessarily receiving instruction on how to use it, set people up to potentially have these medication errors.”
Why do you think poison control calls for this drug are increasing now?
“These medications have been around for a few years. They were originally used for diabetes and have recently received FDA approval for weight loss. This is what has spurred such interest in the drug, especially on social media,” Lambson said. “That has driven a lot of people to look for different sources of semaglutide where there has been such a high demand and a pretty low supply.”
What does it mean for a medication to be compounded?
“In situations where there are drug shortages, compounding pharmacies can provide compounded medication,” Lambson said. “A compounded medication uses the same active ingredient as a manufactured medication to make a personalized form of the drug for a patient, to help address their needs during a drug shortage. That is why we see a difference in how things are packaged.”
Would you warn against the use of compounded medications?
“With compounded formulations specifically, what contributes to worse side effects is that patients have to draw the medication out themselves with a syringe. If they’re unfamiliar with the techniques of how to do this, it can be very easy to give, for example, 0.1mL of a drug instead of 0.01mL. The FDA has additionally warned that some compounders may be using salt forms of semaglutide that are not currently FDA approved,” Lambson said. “I would urge those interested in semaglutide to discuss the different options available to them with their medical provider, to ensure they know how to take the medication and that they are receiving a drug that uses FDA approved ingredients. ”
What are the symptoms of a semaglutide overdose?
“Even at normal doses—when individuals are taking the medication appropriately—there are well-known side effects of an upset stomach, maybe some vomiting. The symptoms we noted at our poison control center are those same symptoms but often more heightened and exaggerated. So, patients complain of more severe nausea and more severe vomiting that lasts for a longer period of time.”
Has anyone died as a result of a semaglutide overdose in New Mexico?
“At the New Mexico Poison and Drug Information Center, we have had no reports of deaths or fatality, but to put things into perspective, this year, about 44 percent of our cases had severe enough symptoms that they required an emergency room visit.”
What should someone do if they start experiencing these symptoms while on this medication?
“If anyone exposed to semaglutide or other weight loss medications is experiencing symptoms, or if they have concerns of overdose, they should call the poison control center for immediate and confidential advice and guidance at 1-800-222-1222,” Lambson said. “They could very well have some very minimal nausea, maybe a few episodes of vomiting, but if their symptoms are beyond the side effects they are expecting, when discussing the medication with their provider, then that is an appropriate time to call the poison center. Based on how severe their symptoms are, a specialist at the poison center can help them decide if they are still safe to stay at home or if they need to go into the emergency room for evaluation.”
If you have one big takeaway for New Mexicans using this medication, what would you want them to know?
“My big take home for those in the state of New Mexico is that this is a very popular drug that does have evidence to support its use for diabetes and weight loss. So, if prescribed appropriately and dispensed appropriately, patients can feel empowered to take the medication safely, and may potentially have really good effects,” Lambson said. “But once we start looking for resources that don't follow FDA approved processes—or if we're receiving medications and not being counseled on how to appropriately dose those—that's when we start delving into the realm of possibility for worse side effects or harm.”
The Poison Hotline is available 24/7 and can be reached at 1-800-222-1222.