Demand for Wegovy has soared, causing a global shortage that has yet to be fully resolved. - PHOTO: REUTERS
SINGAPORE (The Straits Times/ANN): Diabetes drug Ozempic is making waves again, this time for a side effect of causing unexpected pregnancies – even among women who are on birth control pills.
Ozempic – a brand name for semaglutide – is a prescription-only, once-weekly injectable medication from Denmark’s Novo Nordisk that has been around since the end of 2017 for the treatment of Type 2 diabetes. It made headlines several years ago for helping people to lose weight.
To take advantage of this rather popular side effect, the pharmaceutical giant launched another product called Wegovy to target weight loss in 2021. It is essentially the same medication, but given at a higher dosage.
Studies showed that among people taking Wegovy for 68 weeks, 83 per cent lost 5 per cent or more of their weight, while 48 per cent lost more than 15 per cent of their weight.
Demand for Wegovy soared, causing a global shortage that has yet to be fully resolved.
The shortage caused many, who wanted to lose weight, to turn to Ozempic. Although approved only for treating diabetes, the drug can be used off-label – meaning it can be used for something that it has not been approved for – in many countries, including Singapore.
Now, women in the US and Europe who had turned to Ozempic are saying the drug has caused them to become pregnant. Women who had been declared infertile were surprised they had become pregnant, while those who were on oral birth control pills were shocked to find themselves with child.
An article in Nature journal on June 26 quoted scientists saying that reports of pregnancies as a result of women taking Ozempic are plausible.
Dr Ee Tat Xin, a consultant at KK Women’s and Children’s Hospital’s (KKH) department of reproductive medicine, said a possible reason could be that the women may have regained or improved ovulatory function through rapid weight loss. It could also be caused by the regulation of certain hormones brought about by the drug.
“The exact mechanism by which Ozempic affects fertility is not clear. Together with the rest of the world, we are waiting for more evidence to validate this claim,” Dr Ee said.
He added that animal studies have shown that the drug may have an effect on gut microbiome, which may in turn improve ovarian function. The drug is also known to interfere with the effectiveness of contraceptive pills that some women may be taking.
Until more information is available, Dr Ee said KKH will not prescribe Ozempic to boost fertility. In fact, the medication comes with a warning for women to stop taking the drug two months before becoming pregnant, as risks to the pregnancy and foetus are not known.
Added Dr Ee: “In our practice, patients do conceive successfully when they manage to lose weight effectively, regardless of whether it is through diet, exercise, medication or bariatric surgery.”
Dr Khoo Chin Meng, who heads the division of endocrinology at National University Hospital, also does not recommend the use of Ozempic to boost fertility. He said women with excess body weight have subfertility or infertility issues due to a condition known as polycystic ovarian syndrome.
Ozempic can help to correct the condition through weight loss, but use of the drug should be discontinued when a woman is found to be pregnant.
Dr Jessie Phoon, an obstetrician and gynaecologist at Mount Elizabeth Fertility Centre, is also against using the drug to improve fertility.
She said: “Firstly, you are not supposed to get pregnant while on Ozempic. Secondly, the rebound effect after stopping Ozempic can be worse if long-term weight loss cannot be maintained.”
With the rebound effect, women could end up at a higher weight than before.
Because weight loss improves the chances of pregnancy, Dr Phoon suggested that overweight women who want to get pregnant “can be encouraged with the use of Ozempic under controlled environments, with a concurrent weight maintenance regime”. Once the woman achieves her weight-loss target, she should stop Ozempic and then “quickly try fertility options”.
The Health Sciences Authority (HSA), which regulates drugs here, said there must be a “rational basis” for a doctor to use drugs off-label. The doctor must be able to justify that it is in the patient’s best interest, and patients must have consented after being properly informed.
The HSA said it is illegal for Ozempic to be sold online. People doing so can be fined $50,000 and/or jailed for two years. This is because prescription drugs “contain potent active ingredients which could lead to serious adverse effects if taken without medical supervision”. In 2023, it removed 39 online listings for this drug.
Ozempic, and by extension Wegovy, are not the only drugs whereby pregnancy is an unexpected side effect.
Another injectable drug, tirzepatide – sold under the brand name Mounjaro for treating diabetes, and Zepbound for tackling obesity – appears to have similar fallouts. These drugs, by US pharmaceutical giant Eli Lilly, have been found to reduce the maximum concentration of contraceptive in the blood by up to 66 per cent after a single dose.
Because contraceptives are dose-dependent, taking tirzepatide could negate the effects of contraceptive pills.
Novo Nordisk has created a Wegovy pregnancy registry in the US to learn more about the safety of using Wegovy during pregnancy. - The Straits Times/ANN
