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GLP-1-related nausea associated with acid reflux medications
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Use of proton pump inhibitors and histamine-2 receptor antagonists to treat gastroesophageal reflux disease or to counter gastric effects of NSAIDs is a risk factor for nausea and vomiting in adults with type 2 diabetes prescribed GLP-1 receptor agonists, according to a retrospective study published in the Journal of Diabetes Investigation.
Researchers also identified female sex and presence of diabetic retinopathy as risk factors for gastrointestinal adverse events in these patients whether or not they used medications that affect the gastrointestinal tract.
Megumi Shiomi , of the department of clinical pharmacy and school of pharmacy at Kitasato University in Tokyo, and colleagues analyzed data from 130 adults with type 2 diabetes (mean age, 56.8 years; mean diabetes duration, 12.2 years) treated at Kitasato University Medical Center between 2010 and 2017. Participants were prescribed the GLP-1 receptor agonists lixisenatide (Adlyxin, Sanofi) or liraglutide (Victoza, Novo Nordisk). Of those, 14.6% were already using acid reflux medications, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), before initiating the GLP-1 receptor agonist. Analysis of the effects of the treatment were carried out during a median of 48 weeks, with medical records providing evidence of nausea and vomiting incidents.
After 8 weeks from beginning the GLP-1 receptor agonist, nearly all participants (90%) experienced nausea or vomiting. After 48 weeks, 52.6% of those also prescribed PPIs or H2RAs reported nausea or vomiting compared with 32.9% of those not taking antacids (P = .06). Incidents of nausea and vomiting were higher among women vs. men (P = .023) and among those with vs. without retinopathy (P = .009) regardless of the presence of PPIs or H2RAs. These findings were further supported by multivariate analysis, according to the researchers.
“The present study suggests that treatment with PPIs or H2RAs, female sex and diabetic retinopathy are risk factors for nausea/vomiting in patients with type 2 diabetes treated with GLP-1 [receptor agonists],” the researchers wrote. “In addition, female sex and diabetic retinopathy are recognized as risk factors in patients not treated with PPIs or H2RAs.”
Additional study with a larger sample size or a more exacting definition of what constitutes an event of nausea or vomiting is needed, according to the researchers. In addition, since this was a retrospective study, the reporting of nausea and vomiting was at the discretion of each physician. – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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