GLP-1 RAs for Weight Management: A Primary Care Approach to Risk and Monitoring

Gastrointestinal adverse effects and unanswered questions about longer-term or uncommon outcomes should be part of the prescribing conversation for obesity medications, Daniel J. Drucker, MD, told Patient Care Online in a recent interview. Asked about safety monitoring, he emphasized tolerability during dose escalation and the importance of assessing how a patient is eating and drinking. The Endocrine Society's recent scientific statement identified medication safety, adverse effects, and the effects of weight reduction itself as research priorities.¹

Drucker described a “start low and go slow” approach and says some patients respond while receiving relatively low doses. The FDA identifies nausea, diarrhea, vomiting, and constipation among common adverse effects of tirzepatide and warns about gallbladder problems, pancreatitis, and acute kidney injury.² Patients with persistent vomiting or poor fluid intake warrant attention to volume status and kidney risk.

He underscored rare reports of nonarteritic anterior ischemic optic neuropathy and uncertainty about causation and frequency. A separate issue is pregnancy planning. Drucker raised the possibility that metabolic health may worsen after an obesity medicine is stopped, while acknowledging inadequate pregnancy exposure data. Counseling must be drug-specific: National Library of Medicine drug information advises stopping semaglutide injection two months before a planned pregnancy.³ The same interval should not automatically be applied to other agents.

Relevant disclosures for Drucker include Amgen, Alnylam, AstraZeneca Inc, Crinetics, Eli Lilly, General Medicines Inc, Kallyope, Metsera, Pfizer Inc, Protagonist Therapeutics Inc, Roche, and Sanofi and speaking fees from Novo Nordisk Inc.

References

1. Jastreboff AM, Drucker DJ, Ard JD, et al. Obesity science, research gaps, and opportunities in the new era of obesity medicines: an Endocrine Society scientific statement. Endocr Rev. Published online September 9, 2026. doi:10.1210/endrev/bnag025
2. US Food and Drug Administration. FDA Approves New Medication for Chronic Weight Management. News release. Published November 8, 2023. Accessed September 24, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management
3. National Library of Medicine. Semaglutide injection drug information. Updated May 15, 2026. Accessed September 18, 2026. https://medlineplus.gov/druginfo/meds/a618008.html