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Obesity as a Disease - Medication

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    #62
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    https://www.boards.ie/discussion/comment/122268060#Comment_122268060

    Ozempic can be prescribed "off label" for non-diabetics, though its primary use is still for the treatment of diabetes. As I posted earlier, due to shortages pharmacies have been prioritising their diabetic clients for the available supplies.

    https://www.boards.ie/discussion/comment/122268044#Comment_122268044

    Not all diabetics are obese.

    Congrats on your progress. However, having read the thread, I do wonder how much of your progress is due to your changed habits, and how much is down to the medication.



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    #63
    Mellor
    Registered Users Posts: 39,376 ✭✭✭✭Mellor


    https://www.boards.ie/discussion/comment/122267234#Comment_122267234

    Why should it only be prescribed to diabetics? Silly attitude imo.

    If OP has paid for the medication, it is there property and they are entitled to use it.

    Who would be prescribing it if not their doctor.



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    #64
    Mellor
    Registered Users Posts: 39,376 ✭✭✭✭Mellor


    https://www.boards.ie/discussion/comment/122268118#Comment_122268118

    The shortage was a thing of the past afaik If doctors want to be selective with prescriptions, that's their choice. But I don't agree with pharmacists dictating who they dispense to. That sounds questionable, legally.



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    #65
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


    https://www.boards.ie/discussion/comment/122268118#Comment_122268118

    I do understand that Ezeoul. If someone develops Type 2 diabetes at a normal weight they are very unfortunate. But it is a fact that 90% of Type 2 diabetics are overweight or obese and the condition has developed because of their body weight.

    I have definitely changed habits. Ozempic isn’t some magic pill that allows me to continue to eat the way I did before and still lose weight. But the point is, I have been able to change my habits because of Ozempic. I no longer think about food all day. I can eat one biscuit and stop. This is a revelation to me. Even as a tiny child I was obsessed with cakes and sweets, more than the average child would. My mum did everything right - breastfed, cooked from scratch, limited treats. I was never overweight until my thirties so I had no hangups or anything, and no trauma to hang this food obsession on. I was born like this, I’m convinced of it.



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    #66
    ohnonotgmail
    Registered Users Posts: 40,457 ✭✭✭✭ohnonotgmail


    https://www.boards.ie/discussion/comment/122268060#Comment_122268060

    They are not meant to, it isn't approved for weight loss only diabetes.



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    #67
    ohnonotgmail
    Registered Users Posts: 40,457 ✭✭✭✭ohnonotgmail


    https://www.boards.ie/discussion/comment/122268306#Comment_122268306

    Because it is only approved for the treatment of diabetes



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    #68
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    My maternal grandmother, mother and I all developed diabetes in our late 40s and 50s without obesity as a factor. My daughter is pre-diabetes without obesity as a factor. We must be a very unfortunate family.



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    #69
    Jim2007
    Moderators, Business & Finance Moderators Posts: 10,306 Mod ✭✭✭✭Jim2007


    https://www.boards.ie/discussion/comment/122268306#Comment_122268306

    You might want to educate yourself on how medicines are approved before talking about silly attitudes….

    Taking medicines that were designed, tested and approved for a specific purpose in order to benefit from a side effect is an incredibly stupid idea. Because you have no idea of the consequences of taking the drug long term will have - you are basically the test dummy.



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    #70
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


    https://www.boards.ie/discussion/comment/122268610#Comment_122268610

    I am not sure that is quite right. Yes, Ozempic was originally designed for diabetics, and it is a very useful medication for them. But lots of medications end up showing other benefits that were not originally anticipated. Viagra was originally a blood pressure medication. Prednisone was originally developed for inflammatory diseases and is now used to treat Parkinsons. Ozempic itself has been shown to have benefits for those with heart conditions, and it is likely in the future that it will also be prescribed for people with heart issues, whether or not they are diabetic or overweight. They're called "repurposable" drugs in the pharmaceutical industry and it's a massive thing at the moment. AI can trawl through masses of data to see what drugs might also have a benefit on another disease, and it means that you don't have to go through years of safety trials as that data is already known.

    Semaglutide, the active ingredient in Ozempic, has been prescribed for nearly twenty years. If there were shocking unknown side effects to it, at least in the short to medium term, we'd already know about them. As Johann Hari put it, if Ozempic caused you to grow horns, the diabetics would have horns already.

    As to prescribing it off label, essentially you are correct, but it's a weak argument for preventing obese people from accessing the medicine. Irish GPs have no choice but to prescribe it off label. Wegovy, the drug approved in Ireland for weight loss, has yet to be launched here by Novo Nordisk. Wegovy is the EXACT same drug as Ozempic. It's like Opal Fruits and Starburst. Only the label on the pen is different. So GPs are essentially prescribing a drug that is approved and licensed for weight loss, with 20 years of safety information behind it, but the brand name is temporarily different. Wegovy is due to be launched at Halloween.



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    #71
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    I personally have no issue with non-diabetics being prescribed or using a drug licensed for diabetes off label, when supplies are plentiful. Have at it.

    But when supply is very limited (as it has been), then I do think that pharmacies are correct to prioritise supplies for patients with a condition the drug is actually licensed for.



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    #72
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


    In general, I agree with this. However, there are some people with morbid obesity who would have more immediate complications from obesity than someone who is Type 2 diabetic and may be able to control their condition through other available medications. It shouldn't just be a blanket ban. But I don't think that someone like me, who is only tipping into the obese category, should get priority over someone who is diabetic and can only control their condition with Ozempic.



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    #73
    taxAHcruel
    Registered Users Posts: 680 ✭✭✭taxAHcruel


    https://www.boards.ie/discussion/comment/122084689#Comment_122084689

    Just for info - since you enjoyed the previous podcast - another informative and relatively deep discussion about the drug came out today on the Andrew Hubermann podcast. The discussion is with one Dr. Zachary Knight under the title "The science of hunger".



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    #74
    Mellor
    Registered Users Posts: 39,376 ✭✭✭✭Mellor


    https://www.boards.ie/discussion/comment/122268488#Comment_122268488

    That's not really accurate though. Ozempic is a brand name. The actually drug is called Semaglutide. Semaglutide is licensed for weight loss in Ireland, and across Europe, under the label Wegovy (same manufacturer too).

    The brand name is irrelevant medical speaking. I find it kinda strange that we license the brand and not the drug. In the future there will be generic semaglutide (like neurofen vrs ibuprofen). But a GP, not being total misinformed like some here, is aware of that, so he safely prescribes Semaglutide for a usage that it is approved for.

    A pharmacist has no business interfering with peoples private prescriptions imo.



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    #75
    Mellor
    Registered Users Posts: 39,376 ✭✭✭✭Mellor


    https://www.boards.ie/discussion/comment/122268610#Comment_122268610

    Hilarious that you say I should educate myself, and then follow up with that ignorant nonsense.

    Semaglutide was designed as a longer acting GLP-1 receptor agonist. That's exactly the pathway that aids weight loss, there were existing GLP-1 weight loss drugs at the time. This is not some shocking side effect, where people taking risks with unknown consequences. It's was literally be designed, tested and approved as both an anti-diabetic and an anti-obesity medication used.

    Phase 3 testing for weight loss took place in 2021. https://www.nejm.org/doi/10.1056/NEJMoa2032183

    Taking a medicine that is tested and licensed for weight loss, prescribed by a medical professional is not being a test dummy. It's literally taking tested and approved medicine, that due to the brand name is considered off label.



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    #76
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    https://www.boards.ie/discussion/comment/122269686#Comment_122269686

    Wegovy is not available in Ireland at the moment.



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    #77
    ohnonotgmail
    Registered Users Posts: 40,457 ✭✭✭✭ohnonotgmail


    https://www.boards.ie/discussion/comment/122269686#Comment_122269686

    not just a brand name. a very different dose as well. Ozempic is only licenced for diabetes treatment in ireland.



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    #78
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


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

    I'm afraid I have to pull you up on this one too. The diabetic trials showed that a 1mg dose was the optimum dose to obtain blood sugar control benefits. The obesity trials showed that 2.4mg was the optimum dose for weight loss, where participants lost approx 15% of their body weight. However, weight loss also occurred at the 1mg dose, where participants lost approximately 10% of their body weight. At the moment, in Ireland, weight loss patients are restricted to taking a maximum of 1mg because the highest dose of Ozempic is 1mg. Of course you could buy two pens, or even three, in order to get up to the 2.4mg dose, and some GPs do prescribe that. But that makes the medication prohibitively expensive, apart from exacerbating the shortages of the 1mg pen, so most weight loss patients don't do that.

    The main point is, there is no downside for weight loss patients taking the 1mg dose (which they have to titrate upwards through anyway, in order to get to the 2.4mg dose) and staying on it for a length of time. In fact, losing 10% of your body weight has massive benefits for your health, including reducing the chances of developing Type 2 diabetes by over 80% and the chances of developing all types of cancer by 33%.

    It'd be different if it was the other way around - e.g. weight loss patients were only meant to take a 1mg dose and were taking the 2.4mg dose instead.



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    #79
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    https://www.boards.ie/discussion/comment/122270211#Comment_122270211

    According to my endocrinologist 1mg is not the optimum dose for diabetics, and has told me the max dosage they can prescribe will be increased, they're just waiting on whatever permissions are required.



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    #80
    ohnonotgmail
    Registered Users Posts: 40,457 ✭✭✭✭ohnonotgmail


    https://www.boards.ie/discussion/comment/122270211#Comment_122270211

    2.4mg is the dose used for weight loss. it isnt sold her because the drug is not approved for weight loss here. and if somebody brings in a prescription for multiple ozempic pens to a pharmacy the pharmacist should tell them to feck off.



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    #81
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


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

    But it isn't the only dose that is beneficial for weight loss, as explained above.

    It isn't sold here because Novo Nordisk have decided not to launch the 1.7mg and 2.4mg pens (branded as Wegovy) in smaller countries until they can guarantee supply. The 2.4mg dose is in fact licensed and approved here by the Irish Medicines Board. We are just waiting for NN to launch it.

     if somebody brings in a prescription for multiple ozempic pens to a pharmacy the pharmacist should tell them to feck off.

    What you should mean is doctors should not be prescribing it. A pharmacist should never have the power to decide what medication or what dosage is right for a stranger presenting themselves in their pharmacy, in circumstances where the person has attended a GP, who is qualified to make that decision.



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    #82
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


    https://www.boards.ie/discussion/comment/122270514#Comment_122270514

    That's really interesting Ezeoul. Have they done trials on the higher doses with diabetics? I hadn't read anything and I've been keeping a really close eye.

    By the way @taxAHcruel thank you for the heads up on the podcast. I'll start it on the way home. You are a mine of information!!



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    #83
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    https://www.boards.ie/discussion/comment/122270649#Comment_122270649

    So a supply issue does still exist.



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    #84
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


    https://www.boards.ie/discussion/comment/122270668#Comment_122270668

    Of Wegovy, yes.



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    #85
    ohnonotgmail
    Registered Users Posts: 40,457 ✭✭✭✭ohnonotgmail


    https://www.boards.ie/discussion/comment/122270649#Comment_122270649

    A pharmacist is more than qualified to make that decision. that IS their qualification.



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    #86
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


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

    Pharmacists should only refuse to fill a prescription where there is a medical reason that the medication is unsuitable or unsafe for the patient. They should not be making moral judgements on who should or shouldn't get medication. If that was the case, every pharmacist in the country could refuse to fill prescriptions for the pill.



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    #87
    ohnonotgmail
    Registered Users Posts: 40,457 ✭✭✭✭ohnonotgmail


    https://www.boards.ie/discussion/comment/122270937#Comment_122270937

    they are not obliged to fulfill any prescription. i'm sure there are some that wont fill a prescription for the pill. as for somebody coming in with a prescription for multiple ozempic pens, if they have to decide between filling that prescription or filling ozempic prescriptions for diabetic patients then I hope they would decide on the latter.



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    #88
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    https://www.boards.ie/discussion/comment/122270937#Comment_122270937

    You've tried to make this argument before, that pharmacists were making some kind of moral judgement on obese patients. That's in your head.

    And I'll say to you again, that is a very unfair accusation to make. Pharmacists are not in the business of making any moral judgements, (as you say, if they were they could refuse to dispense the pill or emergency contraception).

    What they are doing is prioritising limited supplies based on medical need. And they are qualified to make that judgement, even if there are some who think otherwise.

    I've often found the advice of an experienced pharmacist more helpful and knowledgeable than that of a GP.

    Post edited by Ezeoul on


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    #89
    LastApacheInjun
    Registered Users Posts: 97 ✭✭LastApacheInjun


    Look, I’m not saying pharmacists can’t prioritise limited supplies. I’m just saying that a blanket ban on weight loss prescriptions is inherently unfair. People with a bmi of 40+, or those with a bmi of 35+ and a heart condition may well be at a higher risk of serious complications than a diabetic who has been prescribed ozempic as their first port of call.

    It shouldn’t be an outright no without asking the patient further questions. Even where they present a prescription for two pens, rather then to be told to “feck off”.

    This is all rather moot though. 1mg ozempic has been taken off the IMB shortages list.



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    #90
    Ezeoul
    Registered Users Posts: 3,018 ✭✭✭Ezeoul


    https://www.boards.ie/discussion/comment/122271109#Comment_122271109

    Still shortages of the 0.25mg and 0.5mg Ozempic pens.

    https://www.hpra.ie/docs/default-source/clinical-trial---hpra-pilot-project/ie_shortage-comms_hcp_ozempic-0-25-mg---0-5-mg_june-2024_final.pdf?sfvrsn=2

    There is no blanket blanket "ban" on weight loss prescriptions and there never was. Doctors were still prescribing it, even when there were limited supplies available.

    Also Ozempic is not typically the first port of call for the treatment of diabetes. You may be knowledgeable about weight loss drugs, but not so much about the treatment (and complications) of diabetes, especially uncontrolled diabetes. It is an extremely complex condition which takes daily management and sometimes a cocktail of drugs to get, and keep it under control.

    I wonder if it was a cardiac or cancer treatment drug, and not just a diabetes one, would the attitude be the same.

    Post edited by Ezeoul on


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    #91
    Goldengirl
    Registered Users Posts: 13,751 ✭✭✭✭Goldengirl


    https://www.boards.ie/discussion/comment/122268366#Comment_122268366

    I think this is a really good thread and credit to you for it.

    However I have to disagree with your characterisation of diabetics with type 2 as due to obesity .

    Yes , a large proportion of diabetics are overweight hence the emphasis on weight loss to try to improve health and control blood sugar .

    But it is not as simple as that .

    It is a fact that many diabetics gain weight precisely because of their inability to metabolise sugars and carbs and not the other way round .

    I am lucky enough to be one of the skinny type 2 Diabetics as are my siblings and our disease is 100% genetic . ( Father ,grandparent )

    I had gestational diabetes on three pregnancies requiring insulin .

    Before I was diagnosed I gained weight over the course of a year just a couple of stone but uncharacteristic for me , felt very unwell and tired and craved carbs .

    I had always been slim , a healthy eater and physically active .Walking swimming cycling and worked in an active job .

    The diagnosis coincided with an inflammatory illness which the doctors think triggered my diabetes . which caused the weight gain

    That weight fell off quickly as soon as my blood sugars came under control but I felt unwell for a good few months after that until I got a handle on my diet and other complications .

    I still do whenever I get an infection which diabetics are more susceptible to or if I have any strain which triggers inflammation and high sugars . But that is daily life for most diabetics .

    I am on other meds , not on Ozempic but do agree that it should be widely available to those with high BMI over 30 if at all possible .

    But I can totally understand why its use presently is restricted to those with Diabetes who don't respond to other medications .

    Diabetics , even without high blood sugars can have a cascade of progressive illness (cardiac ,kidneys, nervous system, feet , eyes , high blood pressure and high cholesterol ) all of which are exacerbated by their diabetes which is a chronic inflammatory condition .

    Every effort has to be made to prevent all the other co-morbidities from developing .

    Obese people suffer some of these co- morbidities as well , but with all due respect it is incorrect to say it is the same as being a diabetic .It is not .

    If you are obese AND diabetic your risk factor is multiples for all the co morbidities mentioned above over a person who is just obese .

    On the Ozempic and it's side effects I have no issue with this discussion

    But it's not suitable to discuss a serious chronic and progressive illness as if it was just a matter of t2 diabetics " eating healthily and reversing it ". Once a diabetic , always diabetic whether under control or not .

    I am not sure if you meant to minimise Diabetes , but that is how it comes across ...

    I hope that Wegovy which has been recommended for treatment of obesity will soon be available in Ireland for those who want it .

    The more medication available so there is not such competition between those who would LIKE a medication to help them loose weight , impacting on the requirements of those who actually medically NEED it .



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