During the holiday season, when many people are attending cocktail parties or enjoying festive family feasts, some adults who use popular diabetes or weight-loss medications such as Saxenda, Ozempic, and Wegovy consider skipping doses for one or two weeks. two weeks.
These medications can suppress appetite or sometimes cause uncomfortable side effects that some people may want to avoid during the festive season. And, some doctors say, some of their patients have said they want to fully enjoy their favorite foods or just want to save money during a high-spending season.
“People inevitably think about doing this,” said Dr. Judith Korner, professor of medicine in the Division of Endocrinology at New York Presbyterian/Columbia University Irving Medical Center in New York. “Sometimes they think about it when they go on a cruise or go on vacation,” she said. “I have patients who are in the opposite situation, where we have increased their medication and kept them on the current dose and we are not increasing it during the holidays.”
Dr. Alyssa Dominguez, an endocrinologist at Keck Medicine of USC in Los Angeles, says some of her patients also ask about pausing doses during the holidays. “Patients come to me asking about skipping doses of these medications during parties, during vacations. Another issue that frequently arises is delaying starting medication or increasing the dose,” said Dominguez.
“It’s not uncommon for someone to want to hold back their dose or delay a dose increase,” she said. “These medications have side effects such as nausea, stomach pain, constipation or diarrhea. So certainly if someone was thinking about starting medication or increasing their dose, it’s completely understandable why someone wouldn’t want to experience these symptoms if they’re going to be on a plane for a long time or in a foreign country.”
Different risks for different people
GLP-1 receptor agonists and dual agonists—such as Ozempic, Wegovy, Mounjaro, and Zepbound—are typically used as weekly injections. GLP-1 receptor agonists work by mimicking the hormone GLP-1 in the intestine, and dual agonists work by mimicking both the GLP-1 and GIP hormones, which regulate blood glucose and appetite.
In most cases, when people start on these medications, they are prescribed low doses that are gradually increased over the following weeks. But the effects a break may have on your body depend on why you’re taking the medication in the first place, Korner said.
“If you are taking medication to control your blood sugar because you have type 2 diabetes, you need to realize that if you miss a dose, your blood glucose will get higher,” she said. “But if you have very well-controlled type 2 diabetes and your blood sugar goes up a little bit, that may not be as clinically significant.”
Dominguez said the risk of high blood sugar would be a concern if someone with diabetes skipped a dose. But for other people who are using these medications specifically for weight loss, the risks would be different.
“We would expect a person to have less appetite suppression and faster stomach emptying, so they would probably be able to eat more, which may interfere with some weight loss efforts” increasing the risk of overeating, Dominguez said.
However, “these medications stay in your body for a while. So even if you skip a dose, it’s not like the drug levels drop to complete zero,” Korner said. “You will still have some medication in your system, so you can still have an effect on helping control your appetite. These are things to consider.”
The Ozempic package insert notes that if someone misses a dose, they should take it within five days. If more than five days have passed, the person should skip the missed dose and take the next dose on the regularly scheduled day.
It’s similar for Mounjaro and Zepbound. The leaflet recommends taking a missed dose within four days, but if more than four days pass, the missed dose should be skipped and the next dose administered on the regularly scheduled day.
The Wegovy leaflet indicates that if a dose is missed and the next dose is more than two days away, the patient should take the missed dose as soon as possible. But if the next dose is less than two days away, they should skip the missed dose and resume their regular schedule.
“For many of these medications, you can go up to two weeks off your medication without having to go back to a lower dose. So from a safety standpoint, it’s manageable,” said Dr. Deborah Horn, director of obesity medicine at UTHealth Houston in Texas.
“However, I wouldn’t recommend someone skip their dose just because they want to have a little extra for the holiday season,” she said. “We worry that after two weeks, you have a much higher risk of having side effects, even if you didn’t have them during the dose increase the first time,” such as nausea, constipation, diarrhea or vomiting.
“Parties aren’t always just about food”
For many patients, sticking to their dosing schedules is helpful during the holidays. “People, at least in my patient population, actually prefer to keep taking it because parties are hard, right?” said Dr. Eduardo Grunvald, medical director of the Center for Advanced Weight Management at the Bariatric and Metabolic Institute of UCSD.
Some providers said they counsel their patients on how to continue their medications and still enjoy their favorite treats, for example, by trying smaller portions.
“Keep meal size at a level you can tolerate. We know that if you eat too much on these GLP-1 medications, it can cause nausea or uncomfortable abdominal pain,” Horn said. “Just be careful with the volume.”
For some people, it helps to eat every four hours, which can reduce the risk of side effects, she said. “Some people may have problems with nausea and some of these gastrointestinal side effects if they go long periods without eating.”
Although it can be challenging during the holidays, try to be careful with foods high in fat and carbohydrates. “Some of these symptoms like nausea can be particularly aggravated especially by fatty or heavy foods,” Dominguez said. “So you shouldn’t deviate too much from what you’re used to eating. Otherwise, you may experience some unpleasant side effects.”
But “putting some nice fiber or protein alongside them will help avoid some of the associated gastrointestinal symptoms,” Horn said.
It may also be helpful to avoid alcohol during parties, Korner said. “Sometimes people really can’t tolerate having alcohol along with their medication. The other thing is that if you get a little tipsy from alcohol, you may find that your judgment isn’t as good as it normally is, and that can lead to eating things that you may not tolerate,” she said.
If you take a break from partying on your GLP-1 medication and notice side effects when resuming doses, Horn said, “consider contacting your healthcare provider because we may be able to offer anti-nausea medication in these scenarios.”
Finally, there are many ways to still enjoy the holiday season through activities or gatherings that aren’t tied to food: wrapping gifts, singing, or ice skating.
“Parties aren’t always just about the food,” Korner said. “While that’s certainly a very big part of it, we need to remember that it’s about family and friends and being together.”
*CNN’s Meg Tirrell contributed to this report
