[VyseofArcadia]

> barring any life threatening long term side effects

There's the rub. We have not been prescribing semaglutide very long, and I won't trust it until we've had enough time to suss out long term side effects.

My father was on a long-term maintenance dose of immunosuppressant (I think prednisolone, but I could be misremembering) following his kidney transplant. When it was first prescribed to him, the long term side effects were either not known at all or not widely known. By the time these side effects were more widely known, it was too late, as he was already losing his vision (cataracts) and mobility (cartilage was being destroyed). He spent his last few years in pain.

I am very cautious about the potential for damaging long-term side effects.

[llamaimperative]

> There's the rub. We have not been prescribing semaglutide very long, and I won't trust it until we've had enough time to suss out long term side effects.

We've been prescribing GLP-1s for almost 20 years now. Not to say they all should behave identically, but from a Bayesian inference perspective these things really do appear to be quite safe.

[hollerith]

>We've been prescribing GLP-1s [for diabetes] for almost 20 years now

The dosage though for losing weight is 3 or 4 times the dosage for diabetes.

[VyseofArcadia]

https://www.drugwatch.com/legal/ozempic-lawsuit/

[cthalupa]

Risk factors for NAION are basically all the things that you go on these drugs to treat - type 2 diabetes, sleep apnea, cardiovascular disease, blood pressure, etc. One observational study that shows some correlation isn't enough for me to be particularly concerned about it.

> As of March 31, only 4 cases of gastroparesis were recorded for semaglutide—the active ingredient in Ozempic and Wegovy—in the FDA Adverse Event Reporting System (FAERS), a surveillance database updated by healthcare professionals, consumers, and manufacturers. For tirzepatide—the active ingredient in Mounjaro and Zepbound—there is just one case logged.

I don't have more recent numbers, but these seem pretty low.

I don't think anyone is saying that there is no chance of significant side effects in people, but when measured against the risks of being obese, they'd have to be very bad and impact a significant number of people taking the drug.

[llamaimperative]

Wow, someone experienced an adverse effect from a drug and are suing?

This adds literally zero information.

[VyseofArcadia]

Gastroparesis is a serious, life-threatening side effect.

It occurs in a small number of patients, sure, but maybe that just means I am more risk averse than you. My calculus is simple. I don't need wegovy. I can lose (and am losing) weight without it. Sure, it would be easier with wegovy, but it is not necessary. I am not going to take an unnecessary drug that has a nonzero chance of killing me.

[cthalupa]

>I can lose (and am losing) weight without it

Excellent! A huge chunk of people try and fail to do this for a wide variety of reasons.

If you can lose weight without the help of a GLP-1 drug, then yeah, that is likely the safest option. But most people aren't choosing between using a GLP-1 drug to lose weight or losing weight without it - they're choosing between staying fat and using the GLP-1.

[consteval]

We need to keep in mind that this drug address pretty much all of the biggest killers in the West. Not just one, but almost all of them. You name it - heart disease, obesity, alcoholism, smoking.

These things we already know are dangerous, and we also already know they're the most prevalent. We're not treating mesothelioma here.

[throwaway041207]

> I am very cautious about the potential for damaging long-term side effects.

This is fair. But I'll ask you this: how long would it take for you to trust it? Assuming there are no side effects beyond what we know now, which are:

* gastroparesis is a small number of patients

* elevated thyroid cancer risk in mice

* nausea and general uncomfortableness when taking it (some percentage, not all)

* muscle and bone loss which seems to be roughly on par with any rapid weight loss approach

* a small percentage of people develop malaise, anhedonia and suicidal ideation

* a propensity to gain some percentage of weight back and/or relapse in addictive behavior when going off the drug

These are the side effects we know about with over a decade of prescribing GLP-1 agonists. Assuming these continue to be the primary side effects, how long would you wait until you are comfortable in trusting they are the only ones?

[astrange]

We've been prescribing semaglutide since 2017 and the predecessor since 2010.

[aantix]

Exenatide, a GLP-1, was approved in 2005.