SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
8 likes 2y
Practice · Interactions · continued
Oral contraceptives and delayed emptying: what the data shows posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.
post #31 answers the question as asked. The question underneath it is different.
Oral medications versus time: if you take an oral medication 30 minutes before semaglutide (which slows gastric emptying), the delayed stomach emptying affects when and where the oral medication is absorbed. Separating by a larger interval (1 to 2 hours) usually resolves this.
2 likes 2y
Coming back to post #31, because the follow-up matters more than the original answer.
Alcohol: no absolute contraindication but it raises gastrointestinal irritation risk and this drug class already does that. The conservative position during titration is to limit it.
0 likes 2y
b.jansen, post #17: Metformin: commonly co-administered and relevant to gastrointestinal tolerability. Gastrointestinal side effects can overlap and additive. Taking them separately or adjusting one if tolerability is poor are reasonable approaches. Go to post
I disagree with the reply above, and I think the disagreement is substantive rather than terminological.
The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.
Worth separating two things that post #31 runs together.
Vitamins: most vitamins have no significant interaction. Fat-soluble vitamins (A, D, E, K) might be affected by the slowing of fat absorption during weight loss, but that is a nutritional consequence rather than an interaction.
13 likes 2y
post #35 is right about the mechanism and I think understates the practical bit.
Thyroid medications: semaglutide is associated with a slowing of gastric emptying, which might affect thyroid medication absorption if they are taken very close together. Separating them by a few hours is the conservative approach.
4 likes 2y
Separation timing versus clinically important interaction: a separation timing inconvenience (taking one medication 2 hours before or after another) is not the same as a clinically important interaction. Both can reduce absorption of one or the other, but only true interactions require active management.
0 likes 2y
e.pires, post #23: SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern. Go to post
Anticoagulants: no direct interaction with the compounds in this class. Weight loss and body composition changes might affect the clearance or effect of warfarin if you are on it; monitoring INR more frequently during weight loss is reasonable.
d.eriksen, post #3: Picking up post #2: that is the part I would want checked first. Oral medications versus time: if you take an oral medication 30 minutes before semaglutide (which slows gastric emptying), the delayed stomach emptying affects when and where the oral medication is absorbed. Separating by a larger interval (1 to 2 hours) usually resolves… Go to post
Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.
The correction was fair and I had been repeating something I had not checked carefully enough.
Supplements and herbs: many have no established interaction. Some do. If you are taking something unusual, checking a reference (like a pharmacist) is more useful than guessing from forum discussion.
16 likes 2y
f.amankwah, post #24: Two things before anyone answers the substance. First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound. Go to post
Picking up post #40: that is the part I would want checked first.
Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.
KStephanopoulos, post #35: Worth separating two things that post #31 runs together. Vitamins: most vitamins have no significant interaction. Fat-soluble vitamins (A, D, E, K) might be affected by the slowing of fat absorption during weight loss, but that is a nutritional consequence rather than an interaction. Go to post
Coming back to post #42, because the follow-up matters more than the original answer.
Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.
The correction was fair and I had been repeating something I had not checked carefully enough.
For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.
23 likes 2y
Collapsed as off-topic by two members at trust level 3 or above
Sulfonylureas and meglitinides: these agents stimulate insulin release and carry hypoglycemia risk. Combining them with semaglutide or tirzepatide requires dose adjustment of the secretagogue and close monitoring. The combination is not contraindicated but requires active management.
n.rowntree, post #31: SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern. Go to post
This follows post #44 rather than contradicting it.
Anticoagulants: no direct interaction with the compounds in this class. Weight loss and body composition changes might affect the clearance or effect of warfarin if you are on it; monitoring INR more frequently during weight loss is reasonable.
I read post #46 twice before replying, because I had assumed the opposite.
Separation timing versus clinically important interaction: a separation timing inconvenience (taking one medication 2 hours before or after another) is not the same as a clinically important interaction. Both can reduce absorption of one or the other, but only true interactions require active management.
6 likes 2y
Vitamins: most vitamins have no significant interaction. Fat-soluble vitamins (A, D, E, K) might be affected by the slowing of fat absorption during weight loss, but that is a nutritional consequence rather than an interaction.
17 likes 2y
I read post #49 twice before replying, because I had assumed the opposite.
Insulin interaction: semaglutide and tirzepatide are not contraindicated with insulin but the combination carries hypoglycemia risk if insulin doses are not adjusted. That is a reason for close monitoring, not for avoiding the combination.
10 likes 2y
b.vanhecke, post #5: Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well. Go to post
Metformin: commonly co-administered and relevant to gastrointestinal tolerability. Gastrointestinal side effects can overlap and additive. Taking them separately or adjusting one if tolerability is poor are reasonable approaches.
Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.
0 likes 2y
post #53 is right about the mechanism and I think understates the practical bit.
Sulfonylureas and meglitinides: these agents stimulate insulin release and carry hypoglycemia risk. Combining them with semaglutide or tirzepatide requires dose adjustment of the secretagogue and close monitoring. The combination is not contraindicated but requires active management.
30 likes 2y
e.pires, post #23: SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern. Go to post
Oral medications versus time: if you take an oral medication 30 minutes before semaglutide (which slows gastric emptying), the delayed stomach emptying affects when and where the oral medication is absorbed. Separating by a larger interval (1 to 2 hours) usually resolves this.
m.dumitru, post #11: Coming back to post #9, because the follow-up matters more than the original answer. Anticoagulants: no direct interaction with the compounds in this class. Weight loss and body composition changes might affect the clearance or effect of warfarin if you are on it; monitoring INR more frequently during weight loss is reasonable. Go to post
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
On post #53 — agreed on the reasoning, with one qualification.
Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.
The correction was fair and I had been repeating something I had not checked carefully enough.
1 like 2y
post #57 answers the question as asked. The question underneath it is different.
Supplements and herbs: many have no established interaction. Some do. If you are taking something unusual, checking a reference (like a pharmacist) is more useful than guessing from forum discussion.
0 likes 2y
Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.
0 likes 2y