Who Should Not Take Semaglutide? Key Risks and Contraindications Explained

Semaglutide’s popularity as a weight loss and diabetes medication has skyrocketed lately and I get why—everyone wants a solution that works. But just because it’s effective doesn’t mean it’s right for everyone. Like any medication semaglutide comes with specific risks and isn’t a one-size-fits-all answer.

Before jumping on the semaglutide bandwagon it’s crucial to know if it’s safe for you. I’ve seen people overlook important health factors that could make this drug a risky choice. Let’s talk about who should steer clear of semaglutide and why paying attention to these details matters for your health.

Understanding Semaglutide

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for diabetes management and weight loss. I use the term "GLP-1 receptor agonist" because semaglutide mimics an incretin hormone that regulates insulin secretion and appetite. The FDA approved semaglutide in 2017 for type 2 diabetes and in 2021 for chronic weight management. Different brands offer semaglutide, including Ozempic, Wegovy, and Rybelsus, with injectable and oral formulations.

Table: Approved Semaglutide Brands in the US

Semaglutide lowers blood glucose by enhancing insulin release and suppressing glucagon after eating. I observe reduced appetite and delayed gastric emptying in users, which supports clinical weight loss results. Semaglutide’s effects on glycemic control and body weight make it a preferred option for adults diagnosed with type 2 diabetes or obesity, if other treatments have not given adequate results. I find the most common side effects include nausea, vomiting, diarrhea, and abdominal pain. Rare but serious risks, like pancreatitis and thyroid tumors, exist based on clinical studies and prescribing information.

Anyone considering semaglutide must understand these primary actions and risks before proceeding further.

Who Should Not Take Semaglutide: Key Contraindications

Certain health conditions and individual factors mean semaglutide isn't appropriate for everyone. Contraindications connect directly to personal or family medical history and specific risks from the drug's primary mechanisms.

Individuals With a History of Medullary Thyroid Carcinoma

Individuals with a personal or family history of medullary thyroid carcinoma should not use semaglutide, based on warnings in prescribing information from both Ozempic and Wegovy (FDA, 2021). Data from rodent studies show semaglutide can increase the risk of thyroid C-cell tumors. Any prior diagnosis of medullary thyroid carcinoma excludes use, as does a family history in first-degree relatives.

People With Multiple Endocrine Neoplasia Syndrome Type 2

People diagnosed with multiple endocrine neoplasia syndrome type 2 (MEN 2) must avoid semaglutide, given evidence that the medication increases the risk of developing malignant thyroid tumors in this population (Mayo Clinic, 2023). MEN 2, which includes medullary thyroid carcinoma as part of its clinical criteria, marks a strict exclusion for this drug.

Patients With A Serious Allergy to Semaglutide or Its Ingredients

Patients with a history of hypersensitivity reactions to semaglutide or any of its inactive ingredients must avoid its use due to the risk of severe allergic reactions, such as anaphylaxis and angioedema (MedlinePlus, 2023). Symptoms include difficulty breathing, swelling of the face, or severe skin rashes. Immediate discontinuation and medical attention are required with any suspected allergic response.

Groups Requiring Special Caution

Certain groups experience higher risks and require close evaluation before starting semaglutide. I focus on these groups to ensure safe and informed medication decisions.

Pregnant or Breastfeeding Women

Pregnant or breastfeeding women face significant safety concerns with semaglutide. Data from animal studies show fetal harm risks when exposed to semaglutide during pregnancy, according to FDA labeling. Lactating women may transfer semaglutide or its metabolites to infants through breast milk, even without direct evidence in humans. I avoid recommending semaglutide to these women except when no alternatives exist.

Individuals With Pancreatitis or Severe Gastrointestinal Disorders

Individuals with a history of pancreatitis, gastroparesis, or severe gastrointestinal diseases encounter a documented risk of symptom exacerbation with semaglutide. Reported cases of acute pancreatitis after GLP-1 receptor agonist use include semaglutide, as published in JAMA (2021, Vol 326, Issue 7: pp 597-608). I select alternative therapies for patients reporting chronic or recurrent abdominal pain or gastrointestinal dysfunction.

Patients With Diabetic Retinopathy

Patients with underlying diabetic retinopathy show increased risks of worsening eye disease when treated with semaglutide. The SUSTAIN-6 trial demonstrated a higher rate of diabetic retinopathy complications (3% with semaglutide vs 1.8% with placebo) among those with preexisting eye disease (NEJM, 2016, Vol 375, pp 1834-1844). I recommend frequent ophthalmic monitoring and caution in use for anyone with known diabetic retinal disorders.

Discussing Your Medical History With a Healthcare Provider

Bringing up my complete medical history with a healthcare provider ensures safe consideration of semaglutide. Mentioning every diagnosed condition like diabetes, thyroid disorders, or gastrointestinal disease helps the provider assess individual risk. Sharing details about past pancreatitis or diabetic retinopathy supports careful decision-making, using FDA guidance for contraindications.

Listing my current medications, supplements, and allergies allows the provider to identify possible drug interactions or allergic reactions. For example, combining semaglutide with insulin or sulfonylureas can raise the risk of hypoglycemia, according to the American Diabetes Association.

Informing the provider about pregnancy plans or breastfeeding status matters, since studies—such as those published by the National Institutes of Health—link semaglutide exposure to potential harm during pregnancy and lactation.

Mentioning family medical history, such as medullary thyroid carcinoma or MEN 2, is essential, since semaglutide elevates thyroid cancer risk in these cases per FDA warnings.

Answering provider questions honestly about habits like alcohol use and diet gives a full picture to guide safe therapy decisions. Providing complete and accurate information during these discussions maximizes the safety and efficacy of semaglutide treatment.

Conclusion

Choosing the right medication is never a decision to take lightly. I always recommend having open and honest conversations with your healthcare provider before starting something like semaglutide. Your unique health profile matters and so does your peace of mind.

If you’re considering semaglutide, take the time to evaluate your medical history and current medications. Staying informed and proactive helps you avoid unnecessary risks and ensures you’re making the best choice for your health.