When a box containing my first pack of Wegovy pills arrived I was excited – until, that is, I spotted the stash of extra medication to help with side-effects tucked in beside them.
After 18 months of weekly Mounjaro jabs I was looking forward to swapping all the druggy paraphernalia (refrigerated syringe pen, spare needles, alcohol wipes, sharps bin) for the simplicity of swallowing a tiny tablet once a day.
I’d put my name on a waiting list and was one of the first in the UK to get my hands on the new pills when stocks were shipped out early last month.
So, it was rather a shock to receive four separate packs of tablets for diarrhoea, bloating, constipation and heartburn.
I’d happily lost 2st on Mounjaro (dropping from 13st 5lb to 11st 5lb) barely troubled by any of those ailments, so this got me wondering what hell I might be letting myself in for.
It turns out the stash was very much needed. Here’s my diary of my tumultuous first month on the new skinny pill.
Week one
After losing 2st on Mounjaro in 18 months, Louise Atkinson was looking forward to swapping the jabs for the simplicity of swallowing a tiny tablet once a day
UK pharmacies start shipping out their first packs of Wegovy pills on July 7. Only the two lowest doses have so far been supplied by manufacturer, Novo Nordisk – 1.5mg for complete beginners and 4mg for people like me moving over from a low dose of Wegovy or Mounjaro injections.
The pills are not likely to be available via the NHS for months (pending NICE approval) but all the online pharmacies are selling them privately, pitching their prices in line with the Wegovy jab (around £100 for a one month supply of the lowest dose) rather than more expensive Mounjaro (£150). Like the jabs, the cost goes up with the dose.
I go through a strict screening process with online provider shemed.co.uk, showing proof that I reached the criteria (BMI of 30 or, in my case, 27 with health concerns) at the start of my GLP-1 journey and convincing them of my commitment to continue on a low dose to maintain my weight loss and hopefully shift the last stubborn half stone that would take my weight into the ‘healthy’ category (BMI of 25 and under).
These tablets contain the same GLP-1 drug – semaglutide – as you find in the Wegovy syringe but the active ingredient is encased in a special coating which protects the peptides from stomach acids and digestive enzymes just long enough so it can dissolve and pass through the stomach lining to enter the bloodstream. There’s been a huge buzz of excitement surrounding the pills which many believe will revolutionise the medicated weight-loss market, driving costs down and opening up the GLP-1 world to a new needlephobic clientele and beyond.
Why am I switching? I am committed to being on a low dose of GLP-1 forever to keep my weight steady, my brain free from food noise and to reap the many emerging long-term health benefits (protecting me against heart disease, cancers and dementia), and I’m intrigued by the relative ‘normality’ of taking a pill each morning. My health is so much better already (blood pressure and cholesterol back in normal ranges), that my hope is this daily pill will take the place of the blood pressure tablet and statin I no longer need.
The active ingredient in the pill works just like the injection with the same impact on the body and brain, and the same potential side effect warnings (nausea, vomiting, diarrhoea, constipation). Studies for both show more than 70 per cent of users are affected by these ‘gastric issues’ but the pills were expected to hit the gut harder because it passes through the digestive tract every single day.
My ‘day one’ is timed exactly seven days after my last Mounjaro injection and I go to bed with the box by my pillow ready to take my first pill the moment I wake.
Your stomach must be empty (ideally after an eight-hour overnight fast), you can’t use more than 120ml of water (equivalent to a small glass of wine) to swallow it down and you absolutely must not eat or drink anything else or take any other tablets for at least 30 minutes so it has the perfect conditions in your stomach to dissolve and disseminate. It’s a hot and sweaty night and I wake up desperate for a large glass of water but that would over-dilute the pill and render it ineffectual so I ration myself to a few sips which barely disguise the bitter taste.
My second night is blighted by stress dreams in which I’m accidentally eating. Waking at intervals throughout the night I’m constantly checking the time and wondering if I should take my pill. Plus I really miss the early morning cup of tea that my husband Jon usually brings me in bed.
I’m eating healthily during the day but each evening I am hit by a strong drive to search out something sweet to eat. The sugar cravings are so strong I have to make a batch of biscuits because I want to lick the bowl so badly.
I’m concerned this 4mg dose is not going to be powerful enough to keep my evil eating demons in check. I needn’t have worried.
UK pharmacies started shipping out their first packs of Wegovy pills on July 7
On day four a wave of nausea hits. It’s not debilitating or vomit-inducing but more like the ‘yuk’ feeling you get if you try to read your phone when you’re a passenger in a car. It passes but I have to force myself to eat lunch with Jon. He has zero tolerance for nausea and is struggling to understand why I’m doing this to myself.
Rachael Joy, chief clinical officer at SheMed (and a registered nurse) tells me the semaglutide in my daily pill has been accumulating over the last four days. ‘Although you take the tablet every day, semaglutide has a long half-life [the time it takes to reduce to half its original quantity] of around seven days, so it is not flushed out of your system after 24 hours,’ she says.
‘Each daily tablet adds to the semaglutide that’s already in your body, gradually increasing the overall amount in your circulation until you reach steady state, which takes around four to five weeks of daily dosing.’
She reassures me that serious complications such as pancreatitis and gallbladder disease are uncommon and normally associated with rapid weight loss. ‘As oral Wegovy may produce more gradual weight loss, these complications are less likely on the pills, although more real world evidence is needed to understand this fully,’ she says.
The bowel perforation which led to the untimely death of a 73-year-old woman from Norfolk recently is so rare, she adds, that it is not even listed as a recognised side- effect of GLP-1 medicines.
But the next night my tummy pain keeps waking me up. I check the clock at 4am, then 5.30am worrying – now – whether the drug is too strong for me.
Week two
Louise suffered from feelings of nausea after beginning to take Wegovy pills. She is seen at the start of her weight loss journey prior to taking Mounjaro jabs
The scales tell me I’m 11st 6lb and I’m infuriated to see my weight slightly higher than when I started but I twisted my knee playing padel a few weeks ago which means I can’t walk the dog or do spin classes and my daily step count has plummeted.
And although I have all the self-control required to eat small, healthy meals during the day, I seem unable to resist nibbling and picking at food (or succumbing to a glass of wine) in the evening.
Mounjaro used to be strongest for the first days after the injection, before tailing off and the Wegovy pill seems to follow a similar but daily curve: waves of nausea in the morning which subside, then an infuriating ‘all bets are off’ blast of food noise in the evening.
Rachael Joy explains that peak blood concentrations are typically reached an hour after taking the tablet. ‘The concentration then gradually falls over the rest of the day,’ she says, ‘but the half-life means it won’t fall to zero and each day’s dose simply tops up the background level that’s already there.’
Levels of semaglutide in my system are clearly building but the daily dosage curve means it’s now far too easy to say ‘yes’ to a proffered glass of wine in the evening and the chemical cocktail seems to be ramping up a hangover.
After one ill-advised (but fun!) evening my body feels totally toxic and, bizarrely, I develop an itchy hives-like rash on the back of my neck/upper shoulders. I’m not a rashy person and I can’t work out what might have caused it. Possibly the Wegovy?
A series of bad nights follows with gastro discomfort and the itching rash keeping me awake. It means my days are spent feeling shattered with strong sensations of nausea interspersed with intermittent trips to the loo with diarrhoea.
I’m beginning to wonder if it’s worth it.
On the Facebook support groups I follow, pill-takers are starting to bail.
‘It’s been hard work living with this horrible yukky feeling all the time,’ says one, with another agreeing: ‘I can’t take any more of the sickness, headache, fatigue and generally feeling lousy.’
I could safely switch back to the Mounjaro jab 24 hours after taking my last pill but decide I need to push through with this. The expense of Mounjaro is so much more difficult to justify when you’re maintaining rather than losing weight and, despite the side- effects, as my body gets used to the drugs, I’m finding I need to deploy far less willpower to stay in ‘diet mode’.
The Wegovy pill might be hard work right now but the suppression I feel is impressive (like the first few months on Mounjaro) and steady every day. I’ve just got to hope the gastric side-effects diminish.
Week three
I’m relieved to find I’m 11st 5lb – just one pound down but I’m back on track.
Finally! No hunger all day, side-effects are less strong, no food noise, just measured healthy eating. Antihistamines clear the rash and the evening munchies (and wine craving) have disappeared.
I’ve stopped sleep-stressing about taking the tablet and it turns out it’s really not that hard to use up the required 30 minutes waiting time in the shower and getting dressed before the normal routines of daily life can resume. I still do get occasional waves of nausea but I find it strangely reassuring that the pill is working.
I’m eating so much less than I was before I started taking this pill. If only I wasn’t so sedentary I reckon the weight would be falling off now.
New week, new problem: constipation. I glug a fibre drink and spend the evening snacking on prunes (to me in this sugar-deprived state, they taste as delicious as Lindt balls). Disaster averted and I don’t need to dip into the constipation capsules in my ‘care’ package from SheMed.
Fatigue is also still bothersome. Mounjaro made me feel spritely and light but some days now I feel as if I could curl up and sleep, particularly during the afternoon.
I’m putting extra focus
on the quality of my nutrition but I wonder whether my poor microbiome (the population of good bacteria in my gut which influences digestion, mood and immunity) is having a tough time adjusting to swimming around in my GLP-1-infused intestinal soup.
Week four
On week four, Louise found that her weight began to drop more substantially, and side effects had subsided altogether
I’m 11st 4lb. Finally, after a 12-month plateau, the scales are moving down and I feel optimistic that I might reach my original weight-loss goal and get my BMI into the ‘healthy’ category for the first time in 30 years.
The side-effects have completely disappeared now my body has got used to the new GLP-1 regime and I’m falling into an easy rhythm of taking the pill each morning and being ‘good’ about what I eat and drink.
It’s so much easier to pop the pills in my wash bag for a big girlie weekend away – no more worrying about trying to micromanage the timing of a weekly jab – and the strong steady suppression really helps me resist the cocktails and pastries on offer.
Bonus: all the girls had hideous hangovers apart from me.
I celebrate by ordering my next month’s supply of pills. The predicted shortages haven’t happened – perhaps because the claimed loss (17 per cent of body weight) is less than Wegovy jabs (20 per cent) and Mounjaro (22.5 per cent) and the pills aren’t as cheap as expected – yet.
The protocol for those starting out on the Wegovy pill is to move up a dose each month if symptoms allow and the bigger doses (9mg and even 25mg) are now available but I definitely couldn’t handle a higher dose. This is plenty.
In fact, if I can get down to my goal weight I think I’ll drop to the 1.5mg ‘starter’ dose pill which should be just enough to keep that trickle of GLP-1 in my system long-term.
The second box of 4mg pills arrive without the side-effects care package which Rachael Joy tells me is sent out as a gesture of support to all SheMed GLP-1 users in their first delivery, regardless of pill or jab. Not just because they were expecting me to be blighted by symptoms.
I’m keen to keep going and I’m hoping the cost of the tablets will soon come down so they can be more widely available to everyone.
Maybe when the next GLP-1 pill – Foundayo – is approved for the UK market later this year, a price war might work in our favour.
But right now I figure I’m saving so much money on food, wine, the taxis we no longer need because I volunteer to drive, my daily magic skinny pill is virtually cost free.
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