Semaglutide and Severe Constipation

[Flip Troiano]

I have a CIRS patient who started at 270 lbs got down to 250 before we started semaglutide. In 4 weeks of of only .25 mg she lost 10 lbs but had such severe constipation (barely 1 stool a week) that she had to stop and is now back to 250 lbs. She has a severe lactose intolerance and can not tolerate lactulose. Any thoughts or experience on whether any of the other GLP1 peptides will have less constipation? or other thoughts?

Flip

 

[tim blend]

I believe most patients using semaglutide will have some gi effects especially reflux and or constipation. I don’t like the idea of adding medication to a treatment but I have added ducolax tabs daily or preferably 3-5 grams of vitamin c powder mixed with water. additionally encourage more fluid intake since the peptide inhibits appetite and even drinking!

 

[tim blend]

would love to hear other options

 

[Kristelle Reyes]

Hello @drkriswyahoo-com and @dr-siobhannewmangmail-com, we would love to have your insights here. Thank you! 🙂

[Kris Wusterhausen]

So Tim. I agree with your thoughts. Increase water intake is very important and placing on a daily Senokot. I have not noticed much a difference personally from GLP 1 agonist to GLP1 agonist. Hope this helps Flip

Kris

[Bruce Lowell]

I find that microdosing or splitting the dose over the week will help with the constipation in addition I have been using Lactulose. I also encourage exercise to help with the constipation

[Giovanni Silva]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806214/

Hey Cliff,

Great seeing you at A4M last weekend and all the other SSRP brilliant minds.

I’ve done oxytocin with my patients with great success. As you know, oxytocin is a contractile hormone and the whole GI tract is filled with oxytocin receptors. Also great for esophageal reflux.

Hey, can you message me your email, got a question for you. Have a wonderful day.

[Clyde Boswell]

I would personally stop using semaglutide with this patient. MOTS-C + tessamorelin could be a better option. My opinion, improve quality of life. A well intentioned and thought out intervention can sometimes lead to a worse outcome. I’ve also noticed the severely constipated patients often have a decreased pancreatic elastase. Be sure to check it.

[Xan Simonson]

Hello Giovanni,

Can you expand on using the oxytocin for constipation and esphageal reflux. What dose and frequency and is it injectable or intranasal?

Thank you,

Xan

[Mary Ann Butler]

Hi Flip,

The patients I have on Tirzepatide say it has less GI side effects than the Semaglutide.
In the case like you have I had them stop the Semaglutide. Start Miralax (not a stimulant) at bedtime. If that doesn’t do it then the Senakot until their going. Then either start the Semaglutide at 1/2 dose having her use Metamucil in the am and Miralax at bedtime. Or, switch to Tirzepatide, or suggested by Clyde go with a different direction.
good luck!

[Miguel Bertonatti]

Tirzepatide works 10X better than Semaglutide. Its like comparing an Iphone 8 to Iphone 14 Max Pro, Semaglutide is just simply old technology.

 

The GIP portion of Tirzepatide is what makes it incomparable and has much better results and way less side effects than Semaglutide.

[Giovanni Silva]

@drxansimonsongmail-com

Definitely intranasal works better. 30-60 IU daily. I usually start at 30 and if needed, start increasing dosage. Recently started another patient on Semaglutide and complained about “severe constipation”. Prescribed intranasal oxytocin and “it worked amazing”, per patient.

[Cara Lever]

I keep my clients on weekly check ins to monitor their digestive issues.  I start with a GI evaluation, check digestive enzymes and get them on DE’s with high doses of magnesium and vitamin C.  We don’t use any sort or medications or OTC drugs in our clinic so we focus on an anti-inflammatory diet, limiting foods that would cause gut inflammation and supporting them with binders, probiotics, magnesium and vitamin C.

 

Hope that helps!

 

[sangita patel]

we start semaglutide with colonx from xymogen and xymozyme from xymogen.

ColonX rejuvenates gut cells and keeps it moving. Xymozyme enzymes help break down food faster and move it out of the stomach. prevents them bloating.

 

[Mary Ann Butler]

Hi Flip.

I prescribe quite a bit of the GLP1-RA. I recommend Mag O7 Ozonated Magnesium available through Amazon. I prefer the powder so they have to drink water with it. I instruct them to take this at bedtime and Metamucil powder in the am. This regimen has been very effective. If they are more than 2 days backed up then I recommend Senakot to get going.

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