Wegovy (semaglutide) is a widely prescribed glucagon-like peptide-1 (GLP-1) receptor agonist used for chronic weight management. This medication mimics an intestinal hormone to regulate appetite and slow gastric emptying. When facing an acute illness, such as COVID-19, patients must consider how the sickness interacts with their ongoing treatment. The primary concern is not a direct interaction with the virus, but the potential for the illness to compound the medication’s side effects, requiring a conversation with the prescribing clinician before the next dose.
General Guidelines for Taking Wegovy During Acute Illness
The most significant safety consideration when taking Wegovy during any acute illness is the heightened risk of dehydration and subsequent acute kidney injury (AKI). Wegovy commonly causes gastrointestinal side effects, including nausea, vomiting, and diarrhea, especially when starting the medication or increasing the dose. An illness involving fever, reduced oral intake, or increased fluid loss can severely worsen these pre-existing conditions.
The combination of the drug’s common side effects and the illness-related fluid loss can lead to what is known as volume depletion. In this state, the body has a low blood volume, which reduces blood flow to the kidneys, potentially leading to a rapid decline in kidney function. Post-marketing reports have highlighted cases of AKI in patients treated with semaglutide, with the majority of these events occurring in individuals who experienced gastrointestinal reactions that resulted in dehydration.
Wegovy also slows the movement of food through the stomach (delayed gastric emptying), which complicates hydration management. This slower process makes it harder to keep fluids down and can prolong illness-related nausea or vomiting. Patients must diligently monitor fluid intake and watch for signs of dehydration, such as excessive thirst, dizziness, or significantly reduced urination. If persistent vomiting or severe diarrhea prevents keeping liquids down for more than 24 hours, contact a healthcare provider immediately to discuss temporarily pausing the medication.
Specific Considerations During Active COVID-19 Infection
The decision to continue or pause Wegovy during COVID-19 infection depends largely on the severity of the illness and the presence of gastrointestinal symptoms. For a mild case resembling a common cold, with no significant fever or fluid loss, a healthcare provider may advise continuing the weekly injection while emphasizing rigorous hydration. Some studies suggest that patients with metabolic conditions taking GLP-1 receptor agonists may experience reduced risks of severe outcomes, such as hospitalization, if they contract COVID-19.
The situation changes if the COVID-19 infection is moderate to severe, involving high fever, respiratory distress, or significant gastrointestinal upset. COVID-19 itself can cause diarrhea and vomiting, and these symptoms overlap with the medication’s side effects, rapidly escalating the risk of dehydration. If the infection compromises a patient’s ability to tolerate oral intake or requires hospitalization, temporary discontinuation of the medication is usually necessary.
Consult the prescribing physician immediately if an active COVID-19 infection is confirmed. This allows the clinician to assess the overall risk, including potential drug interactions with specific COVID-19 treatments, such as antiviral medications. The physician tailors guidance based on the patient’s current Wegovy dose, pre-existing conditions, and the viral infection’s symptom profile. The focus shifts entirely to managing the acute illness and preventing dehydration to protect the kidneys.
Managing Missed Doses and Resuming Treatment
If a dose of Wegovy is missed due to acute illness, the appropriate action depends on the time elapsed since the scheduled injection.
Short-Term Missed Dose
If the next scheduled dose is more than two days (48 hours) away, the patient should take the missed dose as soon as possible. If the next scheduled dose is less than two days away, the patient should skip the missed injection and wait to take the next dose on the regularly scheduled day.
Prolonged Interruption
For a prolonged interruption of treatment, such as a pause lasting two weeks or more due to severe illness or hospitalization, the patient must contact their healthcare provider before resuming. Standard protocol often involves re-initiating the medication at a lower dose, potentially returning to the starting dose of 0.25 mg. This step-down approach mitigates the severe gastrointestinal side effects that occur when the body is reintroduced to a high dose of semaglutide after a long break.
Resuming the weekly injection should only occur once the patient is completely free of acute illness symptoms, especially those involving fluid loss. The patient must also be able to maintain adequate hydration consistently. The goal of re-titration is to allow the body to re-acclimate slowly to the drug, reducing the immediate risk of severe nausea, vomiting, and subsequent dehydration.