It was the tragic news that doctors feared would come at some point.
Last week it was revealed that a Scottish nurse had died after having just two weight-loss injections.
Susan McGowan, 58, started taking the appetite-suppressing drug tirzepatide, also known by the brand name Mounjaro, in August. However, by September 4 Susan had suffered multiple organ failure, septic shock and pancreatitis.
Her death certificate listed ‘the use of prescribed tirzepatide’ as a contributing factor, according to the BBC.
The heartbreaking story has ignited discussion about the safety of this new class of drugs.
Susan McGowan, 58, started taking Mounjaro in August – by early September she had died from multiple organ failure, septic shock and pancreatitis
Susan had worked as a nurse at University Hospital Monklands in Airdrie for more than 30 years
While Susan, who had worked at University Hospital Monklands in Airdrie for more than 30 years, is believed to be the first person in the UK to die with Mounjaro recorded as a contributing factor, there have already been some cases linked to other weight-loss medicines.
There have now been ten deaths in which the injections may have been a factor, which also include Ozempic and Wegovy, as well as 68 hospitalisations, according to the medicine safety watchdog, the Medicines and Healthcare Products Regulatory Agency (MHRA).
In just a few years, these drugs, known as Glucagon-like peptide-1 (GLP-1) injections, have gone from niche diabetes treatments to the most in-demand weight-loss treatments in the world.
Both Wegovy and Mounjaro have now been approved for treating obesity on the NHS, and the Government has announced ambitious plans to offer them to thousands of people who are unable to work with obesity-related disabilities in an effort to get them back into employment.
But are there some dangerous – even deadly – side effects?
To answer this question, we turned to some the top experts.
While all agree that GLP-1 injections are, for the vast majority, safe and effective, they acknowledge that severe side effects can – and will – happen.
The good news is that experts say there are steps that people considering taking these injections can take to limit the risk.
This includes being honest with your prescribing doctor about your medical history, carefully monitoring your diet and – if you decide to go private for a GLP-1 prescription – picking the right clinic or provider.
Read on to learn everything you need to know about how to safely begin taking a weight-loss injection.
SMOKERS AND DRINKERS BEWARE
Certain groups of people are more at risk of life-threatening side effects, experts warn.
The injections mimic the effects of GLP-1 – known as the ‘hunger hormone’ – which is released by the stomach in response to eating and tells the brain when it is full.
While they have been used to treat obesity for less than five years, GLP-1 drugs have been given to diabetes patients for nearly two decades to help control blood sugar levels.
‘This means we have long-term safety data on the jabs,’ says Dr David Strain, a diabetes expert at the University of Exeter. ‘We have a good understanding of what the side effects are and how often they occur.’
Some of the most common symptoms include nausea, vomiting and diarrhoea, which affect around a fifth of people who begin taking the injections. However, for most, these issues fade after several weeks.
Around one in 100 people experience a condition called gastroparesis (or stomach paralysis) where the stomach muscles seize up. This can be painful and also makes digestion difficult, sometimes leading to constipation.
Gallstones – tiny balls of cholesterol that form in the gallbladder – are an additional risk for anyone losing weight rapidly.
However, the side effect that doctors are most concerned about is pancreatitis.
This causes inflammation of the pancreas, an organ in the abdomen which produces digestive hormones. In some cases pancreatitis can be life-threatening, as it can trigger organ failure.
In trials, around 23 out of every 1,000 patients on Mounjaro developed pancreatitis. So too did Susan McGowan.
While it is impossible to predict exactly which patients will develop pancreatitis, experts say there are a number of factors which mean some patients are more at risk.
‘People who are obese or have diabetes are more prone to pancreatitis,’ says Prof Penny Ward, a pharmaceutical expert at King’s College London. ‘This is somewhat counterintuitive, given these are the conditions Mounjaro and other GLP-1 drugs are designed to treat.
‘However, pancreatitis can also run in the family, so it’s good to find out whether any of your close relatives have suffered with it before starting a GLP-1 drug.’
Heart disease is another factor which raises the risk of pancreatitis, as does excessive alcohol drinking and smoking.
‘People with an addiction to alcohol or smoking appear to be more likely to get pancreatitis, for reasons we still do not fully understand’ says Prof Ward.
‘This doesn’t mean that having a few glasses of wine a night will definitely trigger pancreatitis, but the more you drink, the greater the risk will be.
‘So it’s important that anyone considering GLP-1 injections cuts back on these habits.’
THINK CAREFULLY BEFORE BUYING ONLINE
Buying GLP-1 drugs from online pharmacies could increase the risk of life-threatening complications.
The NHS will prescribe Mounjaro only to those with a BMI score of more than 40 and at least three weight-related health problems, including diabetes, sleep apnoea and heart disease.
For this reason, a growing number of Britons are buying GLP-1 prescriptions via online pharmacies, which sell a month’s supply of the injections for about £200.
While the full details are unclear, reports suggest that Susan McGowan purchased Mounjaro via one of these firms.
These pharmacies are meant to prescribe the drugs only to people with a weight problem. However, experts say this does not always happen.
‘There has been a big rise in online companies offering these drugs through the post in the past few years,’ says Dr Charlotte Norton, chief medical officer at The Slimming Clinic. ‘The problem is that some allow patients to self-declare their own health through an online form. This relies on patients being honest about their medical history.
‘The risk is that patients who want to start this medication might report they are heavier in order to qualify, or they miss out crucial medical history such as previous pancreatitis or excessive alcohol use, for fear of being ruled unsuitable for the treatment.’
Experts say another reason to avoid online pharmacies is that patients need to be carefully monitored when they begin taking these drugs, and starting on a small dose which is gradually increased over several months.
‘If one of these early doses triggers serious side effects, then a doctor may advise that the patient does not increase the dose again or, in extreme situations, tell them to stop completely,’ says Prof Strain. ‘But some online pharmacies do not do these check-ins, which can put patients at greater risk of severe side effects.’
Experts also point out that, in some cases, online firms allow patients to buy large doses of GLP-1 drugs from the get-go, rather than limiting them to the smaller starting dose. This can also increase the risk of complications.
‘These are strong drugs which need the supervision of a doctor.’ says Dr Strain. ‘I don’t think buying them over the internet is a good idea.’
Mounjaro is a powerful weight-loss drug that can have serious side-effects so has to be closely monitored when prescribed – with patients starting on small doses and gradually building up
DECIDE WHICH JAB IS RIGHT FOR YOU
People looking to lose weight have essentially two options: Wegovy or Mounjaro.
Arguably the most well-known of these GLP-1 drugs, Ozempic, is, in fact, designed to treat diabetes. However, it does contain the same active ingredient as Wegovy – which is called semaglutide.
Experts say the impact of semaglutide on the body is better understood than Mounjaro, which only launched in the UK earlier this year.
‘Semaglutide has been on the market longer Mounjaro, which means we know more about the potential side effects,’ says Dr Norton.
The drug can help obese patients lose up to 15 per cent of their body weight.
Earlier this year, Wegovy was also licensed as a heart disease medicine, due to conclusive evidence that it cuts the risk of the life-threatening problem.
Mounjaro is even more potent, and can help patients shed more than 20 per cent of their body weight. It is such an effective treatment that experts have taken to calling it the ‘King Kong’ of weight-loss injections.
It is also less likely to trigger uncomfortable side effects.
‘It appears that patients on Mounjaro are less likely to experience nausea, vomiting or diarrhoea,’ says Dr Norton.
However, Mounjaro is more likely to trigger pancreatitis. Studies show that just one in 1,000 Wegovy patients develop the dangerous condition, compared to 23 out of 1,000 on Mounjaro.
Experts say this difference is likely due to the fact that Mounjaro doesn’t just mimic the hunger hormone GLP-1 – it also activates a receptor in the body called the glucose-dependent insulinotropic polypeptide (GIP), which helps bring blood sugar down.
‘Mounjaro activates twice as many receptors as Wegovy, which means it essentially packs twice as heavy a punch on the body,’ says Prof Strain. ‘However, the risk of pancreatitis is still very low.’
BE ALERT FOR THESE WORRYING SYMPTOMS
There are a number of symptoms that doctors tell new GLP-1 patients to look out for.
‘The key one is severe abdominal pain under the ribs,’ says Dr Norton. ‘This is where the pancreas is and might be an early sign of pancreatitis.’
Severe vomiting, to the point where the patient can’t keep fluids down, as well as fever are also red flags.’
Experts say that if someone experiences these symptoms while on a GLP-1 drug then they should immediately go to A&E.
‘I would also advise patients take the packaging the injections come in with them to hospital,’ says Dr Norton, ‘so doctors there know exactly what medicine and dose they’ve been taking.’
WEIGHT-LOSS JABS ARE NO EXCUSE FOR A BAD DIET
Anyone on weight-loss injections needs to carefully monitor their diet or risk severe malnutrition, experts say.
‘People taking Wegovy or Mounjaro eat much less than before starting treatment,’ says Dr Norton. ‘This is how the drugs help patients lose weight. However, this means it is crucial that each meal is nutrient-dense.’
Experts say it is easy to become malnourished on these injections, as people miss out on crucial vitamins and nutrients. This might include a lack of iron, vitamin B12 or vitamin D.
In the short-term this can lead to unpleasant side effects such as fatigue and headaches. In the long-term there can be more dangerous complications, including an increased risk of illness and infection.
‘One of the main things I advise patients is not to eat meals that are heavy in refined carbohydrates,’ says Dr Norton. ‘This is because these types of carbohydrates – like a bowl of pasta – take up more space in the stomach, making you feel uncomfortable and leaving less room for other important ingredients such as vegetables and pulses.’
Most in-person weight-loss clinics will offer GLP-1 diets which give advice on what to eat while taking the injections. However, some online pharmacists do not provide this service.
Experts add that poor nutrition can also lead to physical injuries such as bone breaks and muscle problems.
‘Without proper diet and exercise, patients can lose a lot of crucial muscle as well as fat,’ says Prof Strain. ‘I’m concerned that online clinics can’t provide this support that patients need.’
