GLP-1s and Drugs

Ozempic, Wegovy, Mounajo, Zepbound, Victoza, Byretta

GLP-1 agonists are a monumental breakthrough in medicine. They have already shown significant results (and potential) for treating diabetes & pre-diabetes, aiding weight-loss, and preventing heart disease. 

They slow digestion to reduce appetite, and simultaneously stimulate insulin production while inhibit glucagon production. 

But that’s also where the risks come in.

Many sedatives (including alcohol, ketamine, and opioids) cause low-blood sugar by themselves, because they depress the brain’s and body’s processes that produce and release glucagon. 

So when these drugs and GLP-1s are taken in conjunction, risk for a “low blood-sugar attack” (hypoglycemia) jumps.

On the other hand, stimulants increase this risk as well, but in a different way. 

Because stim*lants suppress appetite, drugs such as cocaine and methamphetamine can make one more likely to under-eat when also taking a GLP-1. 

This seems to be the case for dopamine-releasing drugs generally, including Wellbutrin.

Also, because GLP-1s slow digestion down, stomach contents are retained for longer. This increases the risk for asphyxiation (choking) in the event of vomiting, especially if someone isn’t fully conscious. 

While data on this is scarce, there are medical case reports involving anesthetic ketamine and nitrous oxide in GLP-1 patients and asphyxiation resulting in paused procedures, lung injury, even death. 

For this reason, the American Society of Anesthesiologists (ASA) recommends skipping doses leading up to the week of a procedure.

In order to safely use drugs and GLP-1s at the same time:

• Use in lower-than-usual quantities once you begin using GLP-1s, to allow your body to adjust to the medication’s side effects and metabolic changes. 

• GLP-1s are known to increase risk of acute pancreatitis (pancreas inflammation), so limiting alcohol consumption during short time-spans is advisable. 

• Carry small sugary snacks and candies when going out.

• If diabetic, check blood sugar at least once (if feasible).

Works Cited:

Gariani K, Putzu A (2024) "Glucagon-like peptide-1 receptor agonists in the perioperative period: Implications for the anaesthesiologist." Eur J Anaesthesiol, 41, p. 245-6

Jones PM, Hobai IA, Murphy PM (2023) "Anesthesia and glucagon-like peptide-1 receptor agonists: proceed with caution!" Can J Anaesth, 70, p. 1281-6

ASA. American Society of Anesthesiologists (2024) American Society of Anesthesiologists Consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-soci

ISMP Canada. Institute for Safe Medication Practices Canada (2024) Glucagon-like peptide-1 (GLP-1) receptor agonists: risk of aspiration during anesthesia. https://ismpcanada.ca/wp-content/uploads/ISMPCSB2023-i9-GLP-1.pdf

Flory JH, Wiesenthal AC, Thaler HT, Koranteng L, Moryl N (2016) "Methadone Use and the Risk of Hypoglycemia for Inpatients with Cancer Pain" J Pain Symptom Manage, 51, p. 79-87

Malboosbaf R, Hatami N, Maghsoomi Z (2023) "Methadone-induced hypoglycemia: A case report" J Diabetes Investig, 14, p. 145-146

Chrétien B, Dolladille C, Hamel-Sénécal L, Sassier M, Faillie JL, Miremont-Salamé G, Lelong-Boulouard V, Le Boisselier R, Fedrizzi S, Alexandre J, Humbert X. Comparative study of hypoglycaemia induced by opioids. Is it a class effect? Expert Opin dr*g Saf. 2019 Oct;18(10):987-992. doi: 10.1080/14740338.2019.1646246. Epub 2019 Jul 24. PMID: 31317815.

Montero. “KFF Health Tracking Poll May 2024: The Public’s Use and Views of GLP-1 dr*gs.” KFF, Kaiser Family Foundation, 12 Aug. 2025, www.kff.org/health-costs/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-dr*gs/.