Sara Kellner , 2025-04-24 11:00:00
April 24, 2025
2 min read
Key takeaways:
- Researchers estimated that nearly 25,000 ED visits were related to semaglutide adverse events.
- They were surprised to learn that 16% involved hypoglycemia.
An estimated 24,499 people visited the ED for adverse events related to semaglutide in the 2 years after its approval for weight loss, according to a study published in Annals of Internal Medicine.
The most common symptoms included nausea, vomiting and diarrhea, which had been previously documented in clinical trials. However, researchers also discovered that 16% of ED visits involved hypoglycemia.
“What I see in clinical practice is that some patients end up in the ED due to these severe symptoms from semaglutide, and it is not recognized in the ED,” Pieter Cohen, MD, associate professor of medicine at Harvard Medical School and internist at Cambridge Health Alliance, told Healio. “It is really important to make sure we are asking our patients about the use of semaglutide when they have these symptoms, particularly since use is so prevalent these days.”
Cohen and colleagues sought to characterize and quantify ED visits related to semaglutide adverse events in the U.S. as reported by the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project.
They identified 551 cases (73.2% women; mean age, 50.9 years) between Jan. 1, 2022, and Dec. 31, 2023, equating to a nationally weighted estimate of 24,499 (95% CI, 17,022-31,976) ED visits. Most visits (82.6%) occurred in 2023.
Results showed semaglutide was the only medication implicated in 81.7% of adverse events and was most often in injectable form (94%).
More than two-thirds (69.3%) of ED visits were due to gastrointestinal symptoms — 57.6% of patients reported nausea and vomiting, 25.1% reported abdominal pain and 12.2% reported diarrhea.
Cohen said he and colleagues were surprised to learn that 16.5% of visits involved hypoglycemia, 37.6% of which required hospitalization. In 18.9% of these cases, patients were not taking other antidiabetic medications.
“That was unexpected because that had not been seen in prior clinical trials, and we did not expect it to be the case, given what we know about how semaglutide works in the body,” Cohen said. “We need to try to drill down further … why is it that we are seeing these rather rare occurrences of semaglutide causing severe hypoglycemia?”
The researchers noted that 5 million people received semaglutide in 2023, so fewer than four out of every 1,000 patients who took the medication visited the ED for adverse events.
Cohen pointed out there was no way to distinguish whether the effects were caused by prescription or compounded semaglutide.
“We know that there was a lot of compounding in the years we looked at, so it is probably a combination,” he said. “Unfortunately, we do not have the details to separate the two.”
For more information:
Pieter Cohen, MD, can be reached at pcohen@challiance.org.
