Obesity as a Disease - Medication

farmerval

It would be lovely if the thread could get back to the couple of posters led by Apache who are willing to share their experiences in a new treatment for obesity.

Whether a pharmacist or doctor will or won't prescribe offer or whatever maybe can go to a separate thread? For whatever reason(s) the western world is experiencing an obesity epidemic as well as a diabetes epidemic. Ozempic or the proposed other treatments are of huge interest to so many people. That some posters are willing to share their experiences is very enlightening for many.

Diabetics are under medical care and supervision, with regular testing and monitoring to measure and adjust medications and dietary regimes to assist our treatment. The likely outcome if/when Wegovy is available here or Ozempic as it currently is, will be that many people will be taking it with minimal medical oversight so any experiences and benefits /downsides shared will help people in deciding to try this route as a solution to their weight problems.

LastApacheInjun

Thanks Farmerval.

Apologies if I have come across as flippant about diabetes, that was certainly not my intention and I do understand that it is a complex and debilitating disease. I don’t mean to turn this into an obesity vs diabetic debate. Not least because you are quite right that I am no expert on diabetes. Ideally everyone who needs this medication should have access to it and if there are shortages there are those who are way more qualified than me to decide who has the greatest medical need.

Had I been taken aside by a pharmacist when I went with my first prescription and explained that they couldn’t take on any more patients in order to keep supply for their current patients, I would have accepted it. Honestly I’m not sure I would have had the tenacity to try elsewhere- I probably would have chalked it up to just another failed attempt to lose weight. I just didn’t come across it.

Moving back to current experience, despite moving down to 0.4 ml last week I’m still getting side effects. Again for me it was the dreaded D, which led to me actually attempting to sleep on the bathroom floor on Friday night. While I stayed away from the takeaway I found I was eating beyond my fullness levels just because someone else had cooked it and I didn’t want to be rude and that’s what led to the side effects. It brought to the fore my people pleasing tendancies. Now that I have pretty immediate consequences if I slip up, I will have to prioritise my own physical wellbeing. This drug is like therapy.

Today I felt great. Full of energy, upbeat and very easy to stick to protein and fibre.

LastApacheInjun

Well here we are, Week 9 Day 2.

I didn't lose anything at all this week. It was bound to happen sometime, and if I am being very honest I don't think my diet was at all healthy over the past week. Even the stomach issues over the weekend couldn't rescue the week. It's disheartening, especially when I definitely still eating less than I did before, but I have to use it to look very honestly at what I'm eating, rather than how much.

I've found a certain pattern over the past three weeks, and many apologies for going into bowel movements in advance. But I have found that I can go days during the week without needing a No.2. It doesn't even feel like constipation, it's just like I completely forget about it. Then I eat something bad/high fat over the weekend, which obviously slows the movement of food even further. My body appears to get a shock, and decides to clear everything out quick smart (not pleasant). And then the cycle starts again.

I was very good in the first couple of weeks at tracking my fibre and protein, but I've fallen off the wagon somewhat as I had been blaming the clear out on the takeaway, rather than my whole week's choices. I also definitely have not been drinking enough water.

So back with a clean slate. I've eaten only whole foods and lots of fibre today. I took some psyllium husk last night and will do again tonight. I've drunk 3.5 pints of water, a coffee and a tumeric latte, so I'm hoping the fluids will help the movement. And home cooked dinners over the weekend, with lots of fibre. And we'll see how we go.

Someone on a US forum recommended nausea patches, like the ones you get for travelling, to help with the low level nausea. I have one on today - can't say if it's working or not but they last for three days so we'll see if it makes a difference.

Last thing to note: I got my 1mg pen at the pharmacy yesterday. I won't be on it for another three weeks but I thought it'd be better to get it early. Cost wise, the 0.25mg pen was €142, the 0.5mg pen was €145 and the 1 mg pen was €149. So barely a difference in price between the doses, which might be a relief to some people. I know the UK that the price can go up 30% between 0.25mg and 1mg.

Mellor

https://www.boards.ie/discussion/comment/122270040#Comment_122270040

I'm aware. But as above, it's a brand name. Semaglutide is the drug and is available so doctors are perscribing.
The claims that is reckless, untested, test dummy stuff is simply not true.

https://www.boards.ie/discussion/comment/122270078#Comment_122270078

Incorrect again. Semaglutide is approved in a range of doses for each. Each person is prescribed the appropriate dose for their treatment - which is the case for all medication.
Starting does for both are the same.

Semaglutide is licensed for both obesity and diabetes. The fact they are labelled separately is irrelevant medically. Besides, obesity treatment is the higher dose. So the claims that ozempic is unsafe to treat obesity is totally baseless.

Mellor

https://www.boards.ie/discussion/comment/122270575#Comment_122270575

The drug is approved here, as was already pointed out to you.

And for weight loss you don't just jump into the highest dose of 2.4mg. You titrate up, in all cases.

The starting dose in all cases is .25mg, then .5mg, then 1mg. It's only at higher doses that the to brands deviate.

https://www.boards.ie/discussion/comment/122270875#Comment_122270875

A pharmacist may legally be able to decline a prescription. That doesn't validate any decision they make.

If a patient has a prescription for say 1mg semaglutide, there are no valid grounds to refuse it.
Pharmacists are qualified to advise on medicine, they are got qualified to appraise a GP or other doctor's treatment that is medically approved.

Ezeoul

https://www.boards.ie/discussion/comment/122283389#Comment_122283389

The claims that is reckless, untested, test dummy stuff is simply not true.

So the claims that ozempic is unsafe to treat obesity is totally baseless.

Please quote the post where I made any of those claims. Please don't attribute another poster's words to me.

My only issue is about supplies, and it is my unchanged view that where there are limited supplies, the treatment of diabetes takes priority.

See the excellent post from @Goldengirl who put it better than I did. Also note the point made that Ozempic is often prescribed to diabetics who have stopped responding to other diabetes medications.

Contrary to what is posted above, there are still supply issues. If you would like to check out the living with diabetes threads, you will see recent posts from diabetics about difficulties in supplies as recently as this month.

Goldengirl

It still is not licensed here to treat obesity regardless of doctors prescribing it " off label " .Pharmacists are not making judgements, moral or otherwise , they are simply not allowed to order in drugs prescribed off label as they can be sanctioned .

Some seem to find ways around this , don't know how .

It is hoped that both Sandexa and Wegovy which come in dosages more suitable to treating obesity , will be available this year .

While I am commenting I make no judgements either as can totally understand people being desperate for this life changing treatment .

It's just coming in direct competition to some diabetics who can frankly become very seriously unwell and quickly if they cannot access their medication , hence the restrictions .

Good article here ..

https://www.independent.ie/irish-news/more-than-25000-irish-people-now-receiving-weight-loss-jab-ozempic-for-free-but-only-to-treat-diabetes/a7218535.html

ohnonotgmail

https://www.boards.ie/discussion/comment/122283560#Comment_122283560

If a patient has a prescription for say 1mg semaglutide, there are no valid grounds to refuse it.

If they have a diabetic patient that requires it then that is a valid ground to refuse.

they are got qualified to appraise a GP or other doctor's treatment that is medically approved

that is just plain incorrect.

Mellor

https://www.boards.ie/discussion/comment/122283565#Comment_122283565

Where did I attribute another posters words to you?

I said THE claims not YOUR claims. As in the claims in the thread, obviously you've seen them so should have know that. That second sentence you quoted wasn't even in response to you 🙄. That compliant is a bit of a reach.

My only issue is about supplies, and it is my unchanged view that where there are limited supplies, the treatment of diabetes takes priority.

And I previously said I understood pharmacies being selective when supplies are limited. I wouldn't want to see anybody unable to get a medically necessary medicine.

1mg appears to be more available now. Logically the 1mg is what the country needs to most of, so Novo are obviously making more of 1mg compared to .25mg.

FWIW it's probably incorrect to lump all diabetics in one equal category. T

See the excellent post from @Goldengirl who put it better than I did. Also note the point made that Ozempic is often prescribed to diabetics who have stopped responding to other diabetes medications.
Contrary to what is posted above, there are still supply issues. If you would like to check out the living with diabetes threads, you will see recent posts from diabetics about difficulties in supplies as recently as this month.

My post (that you replied to) had nothing to do supply. I was simply responding to the misinformation about the drug in question. Semaglutide is licensed for weight loss in ireland. It has been through extensive testing and studies, and it is an expected result not a wild uncharter side effect. The poster (that wasn't you 😉) that claimed that was grossly mistaken.

Ezeoul

https://www.boards.ie/discussion/comment/122283676#Comment_122283676

You attributed it to me by specifically quoting one of my posts, and then responding to it in a way that made it look to anyone reading like it was I who made those claims.

Please do not do that again.

Mellor

https://www.boards.ie/discussion/comment/122283650#Comment_122283650

Semaglutide is license or obesity treatment. You are mistaken. This has been explained multiple times.
I'm aware that has been reported in the paper. But that's simple a lazy reporter not knowing as much as say a medical professional.

https://www.boards.ie/discussion/comment/122283662#Comment_122283662

Sure, if they have very little supply, and a queue of diabetics waiting, then it could be valid. And for completeness that would also apply withhold from a single diabetic on maintenance in order to dispense to 4 others who need a starting dose.

But supply was not the context we were discussing was it?

You claimed it Doctors should not be prescribing the drug because it's not licensed. But that's was incorrect, as was explained, Semaglutide is license for both.

Then you claim that the dose was different. But as pointed out, that wasn't true either.
There further claims from other about being unsafe, untested etc. Nonsense.
Supply issues in the past do not justify peddling lies now.

If there was another shortage in future, a pharmacist could and should dispense wegovy pens to diabetics. I wonder would people cry about licensing then?
It would be far better off is prescriptions were generic. Branded drugs are simply another way pharma rips people off.

ohnonotgmail

https://www.boards.ie/discussion/comment/122283744#Comment_122283744

 And for completeness that would also apply withhold from a single diabetic on maintenance in order to dispense to 4 others who need a starting dose.

How, exactly, is that supposed to work? do the 4 who need the starting dose share the single 1mg pen?

Ezeoul

…

…

If this has changed in the last three months, please provide a link. Thanks.

Goldengirl

Ah look .I am not going to argue this further having basically been told I don't know my own business ! Wow !

https://www.boards.ie/discussion/comment/122283744#Comment_122283744

As @Ezeoul linked above it is not CURRENTLY licensed for treatment of Obesity , only for Diabetics in this country .

Doesn't mean it can't be used for obesity sure , but off label .

Hopefully changing in September.

Mellor

https://www.boards.ie/discussion/comment/122283805#Comment_122283805

Starting doses are .25ml-.5mg pens. I'm not sure what was confusing.
A person needing 1mg could use multiple starting dose pens or they could be allocated to people needing the lower dose. I think withholding in that case is fine too, as the starter pens are the ones really limited in supply.

https://www.boards.ie/discussion/comment/122283883#Comment_122283883

Ozempic is marketed for diabetes. Wegovy is marketed for weightloss. Same manufacturer, same dose, and same doses (currently, the 2mg ozempic is not licensed afaik).
Semaglutide is the actual drug in both cases. Semaglutide is currently licensed for weight loss in Ireland, and has been since the start of 2022.

This has been explained multiple times, in the thread. But if you want a link, see HSE: https://www2.hse.ie/conditions/obesity/medicines-and-surgery-for-obesity/ Or the links to the actual license below.
It's like getting a prescription for a particular brand, and the pharmacist giving you the generic form. Really common.
Or Neurofen vrs Ibuprofen, etc

https://www.boards.ie/discussion/comment/122284338#Comment_122284338

How is weight loss medicine "your business"? I understand you are diabetic, but didn't you also say you were not on ozempic.
I'm really sorry, but I fail to see how anything I have said is a comment on your business.

As was repeatedly explained, Ozempic is a brand name not an actual drug. The active drug, is Semaglutide, and also as explained above, Semaglutide IS licensed for both diabetes and weight loss. Links to misinformed articles are not helpful. Nor where the false claim about testing from others. See links below to the actual licenses.

http://www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine/results/item?pano=EU/1/17/1251/005-006&t=Ozempic

http://www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine/results/item?pano=EU/1/21/1608/002&t=Wegovy

Key point is the active ingredient is each list. Based on above licensing doctors can prescribe semaglutide for weight loss, pharmacists can dispense semaglutide for weight loss. They should do that subject to their own supply issues, obviously

ohnonotgmail

https://www.boards.ie/discussion/comment/122285831#Comment_122285831

I know what the starting doses are, thanks. Ive been on it 2 years. Why would someone on a 1mg even be considering getting 4 .25mg pens of a single 1mg pens? You're making no sense at all.

Ezeoul

https://www.boards.ie/discussion/comment/122285831#Comment_122285831

My last post on this, as you are literally trolling the thread at this point and I'm not indulging your nonsense beyond this.

Semaglutide / Ozempic is licensed in Ireland, but that licence extends to the treatment of diabetes ONLY.

You've already been provided with multiple links, including an Oireachtas report that confirm this, yet continue to insist they are "misinformed" and what matters is the active ingredient, and not the purpose it is licensed for.

So ask yourself this, if that were the case why do doctors have to prescribe it "off-label" for weight loss patients? Maybe you don't understand what prescribing off label means. It means prescribing a drug for a purpose other than it's approved for.

Note, the link you provided from the HSE website is a copy and paste job provided to the HSE by the NHS in the UK where Ozempic is also not licensed for for weight loss.

OP, good luck with the rest of your weight loss journey.

I do wish you the best and hope you achieve your goals, however you may get there.

ohnonotgmail

https://www.boards.ie/discussion/comment/122286050#Comment_122286050

i think their problem is that they see Ozempic being licenced in Ireland and assumed that semiglutides in general are licenced. It is specific formulation of drugs that are licenced, not their ingredients or active substance.

Mellor

https://www.boards.ie/discussion/comment/122285976#Comment_122285976

If there was no availability of 1mg pen, and you need to make it up. That’s really not hard to understand.

I wasn’t aware you were on it, but I explained the sides are you previously were mistaken about them in this thread.

https://www.boards.ie/discussion/comment/122286341#Comment_122286341

Semaglutide is licensed is multiple forms. I literally linked to the license above. You’ve gone from confidently incorrect to head in the sand ignorance.

Mellor

https://www.boards.ie/discussion/comment/122286050#Comment_122286050

The fact you can’t grasp really simple informat does not mean I’m trolling. It’s a reflection you alone.
Although the fact to ignore my last link suggest you do grasp it - but are salty you were proven wrong.

Semaglutide / Ozempic is licensed in Ireland, but that licence extends to the treatment of diabetes only.

Semaglutide not licensed other than ozempic/diabetes?
This HRPA license proves you are wrong. /thread

ohnonotgmail

https://www.boards.ie/discussion/comment/122287143#Comment_122287143

no pharmacist is giving out 4 .25mg pens in place of a 1mg pen. you're talking nonsense.

Mellor

https://www.boards.ie/discussion/comment/122287331#Comment_122287331

Did I say they were giving it out? The entire point was that they’d be entitled to withhold it from a diabetic in favour of somebody needing. LMFAO. You’ve just agreed with that.

ohnonotgmail

https://www.boards.ie/discussion/comment/122287362#Comment_122287362

Me:

I know what the starting doses are, thanks. Ive been on it 2 years. Why would someone on a 1mg even be considering getting 4 .25mg pens of a single 1mg pens? You're making no sense at all.

You:

If there was no availability of 1mg pen, and you need to make it up. That’s really not hard to understand.

you suggested they might. which is complete nonsense. no pharmacist would even consider that.

and this

they’d be entitled to withhold it from a diabetic in favour of somebody needing

Diabetics are the ones needing it. that is who it is for. you are very dismissive of the people like me that actually need it. i can only describe it as trolling. on the ignore list you go.

Ezeoul

https://www.boards.ie/discussion/comment/122287229#Comment_122287229

Just stop this now. I draw the line at you throwing personal insults around.

This is what you linked to and claims proves Ozempic is licensed for the treatment of weight loss in Ireland:

It is a licence, but the licence does not say what you claim. I also searched the EMA website. Nothing there that says it either.

We all know Ozempic is licenced in Ireland….FOR THE TREATMENT OF DIABETES.

I noticed you completely ignored what it means for a drug to be prescribed "off label".

So I'll leave readers of the thread to make their own conclusions, seeing as you're the sole poster on the thread who claims Ozempic is licensed for weight loss in Ireland, despite multiple sources that prove otherwise.

Have a nice day.

Goldengirl

https://www.boards.ie/discussion/comment/122287362#Comment_122287362

They have been advised to do so by the HPRA . As said before .

https://www.boards.ie/discussion/comment/122285831#Comment_122285831

No I am not on the drug .

I am a health professional . Semi retired but know my semaglutides from my dulaglutides , thank you .

I have no issue with you or anyone else using this medication as I have stated before , but trying to diss others as posting misinformation while you yourself are clearly posting incorrect information is a bit bizarre tbh.

Good luck to you if your doctor is prescribing it off label and you can get a pharmacy to supply it

I don't see anyone saying anything else .

The fact remains it is not licensed as yet here for use as a weightloss only drug because of specific supply issues for the target population , diabetics

Not that it doesn't work , not that it is unsafe , down to lack of supply for a vulnerable population only .

Both drugs you list from HPRA website ..those links do not refer to its uses . Which is the point we are discussing here .

The HPRA have been quite clear about this . This from last November .

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.hpra.ie/docs/default-source/Shortages-Docs/ema-mandated-victoza-amp-ozempic-direct-healthcare-professional-communication-(dhpc).pdf%3Fsfvrsn%3D2&ved=2ahUKEwiDrJev5uyGAxUFQkEAHQa_BvMQFnoECDEQAQ&usg=AOvVaw3KfDZDzRhxXbMh6ZvJR2w5

Mellor

https://www.boards.ie/discussion/comment/122287412#Comment_122287412

If a diabetic needed 1mg. And there were no 1mg pens available, it’s would be very reasonable to use two starter pens (contain 2mg total and up to .5mg doses), if they were were suitably available. It's not uncommon in medicine. (eg pharmacy fulfilling a 10mg script with 5mg tablets and instruction to take two).

How is that being dismissive if anybody? I'm sorry you feel like that. and I'm sorry you think i'm trolling. But the forum is based on factually and correct information being posted. And unfortunately many of the claims, although well intentioned, were incorrect. I've highlight were they were wrong. Labelling that “trolling”, is good counter argument. I think you've posts on the site to know I'm not trolling.

Mellor

https://www.boards.ie/discussion/comment/122287433#Comment_122287433

Are you really stooping to misrepresting/falsifying my posts. wow.

The above is NOT the link I provided in my last post (post #111). The fact you are screenshoting a different link is kinda sad. That's from post #106 - where I proved both licenses. Not you only screenshot one🙄
Here is the link from the last post https://www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine/results/item?pano=EU/1/21/1608/002&t=Wegovy . And before you say wegovy is not available, nobody said it was. We are talking about licensing.

A reminder what you said (as the above posts shows you're willing to twist things and lie).

It was explained that ozempic/wegovy are two brand names for the same drug (semaglutide) and are licensed separately. I literally linked to the license. And you still claimed semaglutide was not licensed for weightloss (in post #108). You used the word semaglutide. I posted the license three times now, that should be enough But as you've lied above, here is a screenshot

https://i.imgur.com/4LOXcro.png

It is a licence, but the licence does not say what you claim. I also searched the EMA website. Nothing there that says it either.

Did you really search the EMA website? I couldn't find anything to confirm my claims about semaglutide? I find that hard to believe, it's a very simple website. So really have to assume you are simply lying/misrepsenting my posts again. Which is weird. Anyway, here you go https://www.ema.europa.eu/en/search?search_api_fulltext=wegovy&f%5B0%5D=ema_search_categories%3A83&f%5B1%5D=ema_medicine_bundle%3Aema_medicine&f%5B2%5D=ema_med_status%3A100108&landing_from=73303 and a screenshot confirming what I've been saying.

Semaglutide, licensed for obesty treatment (under the brand name Wegovy), since jan 2002.

https://i.imgur.com/e8vdnzM.png

Your claim that semaglutide is not licensed for weight loss treatment is simply 100% false.

The distinction between ozempic/wegovy and the drug semaglutide has been explained multiple times. Please don't waste time with the strawman "but ozempic is not….yada yada". Nobody said it was. I've been very clear in my wording. Most peopel got that.

Ezeoul

How dare you, I falsified nothing. I screenshotted directly from YOUR link.

I'm not that pathetically desperate to win an argument when the facts speak for themselves.

Enough said. I refuse to engage with you any further.

When you have to resort to gaslighting, personal abuse and false accusations. you lose.

(OP, I apologise for my part in the ongoing derailment of your thread. It stops here.)

Mellor

https://www.boards.ie/discussion/comment/122287788#Comment_122287788

I think you may be mixing me up with OP or another poster. I'm not sure what my doctor "my doctor" refers to. As I haven't mentioned my doctor, nor am I on or need any medication. I'm simply providing information for others. Which is the point of the forum.

They have been advised to do so by the HPRA . As said before 

And as I have said, I've no issues with prescriptions being limited when supplies are limited. I've repeated that a few times.

The HRPA advise against starting diabetic patients on new treatments during shortages. Shortages of starter doses are and intentional supply action from NovoNordisk to avoid down chain pressure o namitenance doses.

The HRPA also recommend when supplies are limited to switch to another GLP-1 RA injectable. Which is what I referenced above - and was told was "nonsense".

I am a health professional . Semi retired but know my semaglutides from my dulaglutides , thank you .

I have no issue with you or anyone else using this medication as I have stated before , but trying to diss others as posting misinformation while you yourself are clearly posting incorrect information is a bit bizarre tbh.

If you are a health professional, and understand what semaglutide is (and dulaglutide, liraglutide, retratrutide, etc), then you understand its the active drug, available under multiple brand names. But I'm still unclear how I said "you don't know your own business".
I said you were mistaken about semaglutide licensing, and I provided the licence. I think that's reasonable. If you are retiring it's understandable if are not up to date on all brands of a drug.

I stand by my claim that the posts were misinformation (not necessarily intentional). And I believe I clearly proved that. For example.

A poster claimed Semaglutide was not designed and tested for weightloss. That is false. I said it was false, and I provided a link the the phase 3 study in 2021.

And above, a poster claimed Semaglutide was not licensed for weight loss. So I provided the license. Even though @LastApacheInjun clarified the licensing pages ago, poster where still repeating mistaken claims.

I'm not sure how providing that information, along with links to the study, licence approval etc is "dissing" posters. I think taking it as a diss is overly sensitive.

Good luck to you if your doctor is prescribing it off label and you can get a pharmacy to supply it

I don't see anyone saying anything else .

The fact remains it is not licensed as yet here for use as a weightloss only drug because of specific supply issues for the target population , diabetics

As I said, I think you've confused me with somebody else.

And many posters have made claims outside the supply issue. You literally just made one regarding licensing, as above that is incorrect.

Not that it doesn't work , not that it is unsafe , down to lack of supply for a vulnerable population only .

That's not quite correct. This whole conversation started when a posters claimed that semaglutide was safe or tested for weightloss, and it was simply a test dummy side effect. That is demonstrably false and has nothing to do with supply issues.

Both drugs you list from HPRA website ..those links do not refer to its uses . Which is the point we are discussing here .

Well sure, the HRPA link does not refer to it uses. Because that's not what the HRPA website lists directly, for that the HRPA links to the EMA (European medicines agency) website. I felt the HRPA website link was enough in that case as the intended use for other semaglutide labels was established in the thread.
I'm surprised the HRPA link confirming the license was not sufficient for you given your statements above. But for completeness, here's the EMA information. Confirming the authorised usage, and that it's been licensed for almost 2.5 years. Screenshot is in my previous post.

https://www.ema.europa.eu/en/search?search_api_fulltext=wegovy&f%5B0%5D=ema_search_categories%3A83&f%5B1%5D=ema_medicine_bundle%3Aema_medicine&f%5B2%5D=ema_med_status%3A100108&landing_from=73303  

Mellor

https://www.boards.ie/discussion/comment/122290378#Comment_122290378

The license I provided in post #111 was for the wegovy (weightloss) license. You replied with a screenshot to the ozempic diabetes license, not the one I linked to in my post. Everyone can click the link in my post and see that you are lying.

The facts do speak for themselves. I proved the correct screenshot that proved you were wrong (and suddenly you're no longer engaging, lol).

The one thing we are agree on is the intentionally screenshotting a different webpage is pathetically desperate.