Poison Control Calls for Semaglutide Weight-Loss Drugs Surge Due to Accidental Dosing Errors

Following the FDA's June 2021 approval of semaglutide for chronic weight management, U.S. poison control centers experienced a dramatic surge in calls, climbing from under 1,500 annually to over 8,000 in 2023. Research led by Jordan Miller at UT San Antonio reveals that the spike was driven by accidental dosing errors, primarily patients injecting the drug daily instead of weekly or skipping the titration schedule to start at the maximum dose. Compounded alternatives in multi-dose vials exacerbate these risks due to syringe-math confusion. While symptoms like hyperemesis, gastroparesis, and pancreatitis can occur, the errors are largely preventable through better patient education.

GLP-1 medication dosing errors

• ▪U.S. poison control centers recorded more than 8,000 GLP-1 receptor agonist related calls in 2023
• ▪The U.S. Food and Drug Administration approved semaglutide for chronic weight management in adults with obesity in June 2021
• ▪Semaglutide accounted for 64.2 percent of all GLP-1 receptor agonist related poison control calls in the study period following the 2021 FDA weight-loss approval
• ▪U.S. poison control centers handled between 1,000 and 1,500 GLP-1 receptor agonist cases annually before the middle of 2021
• ▪The two most common dosing errors driving the surge in poison control calls are injecting semaglutide daily instead of weekly and starting immediately at the maximum dose instead of following the titration schedule

Compounded semaglutide risks

• ▪Compounded semaglutide alternatives dispensed in multi-dose vials present a higher risk of dosing errors because patients must measure their own doses using a syringe
• ▪The Food and Drug Administration has reported cases where confusion between units, milligrams, and milliliters led patients to administer five to 20 times more than their intended dose of compounded GLP-1 medications

Overdose symptom recognition

• ▪Uncontrollable vomiting, or hyperemesis, is a primary warning sign of a GLP-1 overdose that can quickly escalate the risk of dehydration
• ▪The most commonly reported symptoms of a semaglutide overdose include nausea, vomiting, abdominal pain, dizziness, and diarrhea

Serious medical complications

• ▪While hypoglycemia is rare when GLP-1 medications are taken alone, the risk of low blood sugar rises significantly when they are combined with insulin or sulfonylureas
• ▪GLP-1 receptor agonists may increase the risk of pancreatitis, a serious inflammatory condition of the pancreas characterized by severe, persistent abdominal pain
• ▪A semaglutide overdose can cause gastroparesis, a condition where the stomach's emptying is severely slowed or almost paralyzed, potentially leading to dehydration, abnormal electrolytes, and kidney damage

Safe medication practices

• ▪There is no specific antidote for a semaglutide overdose, and medical treatment consists of supportive care including anti-nausea medications, intravenous fluids, and glucose or dextrose for low blood sugar
• ▪Obesity medicine physicians recommend a 'start low and go slow' titration protocol to find the lowest effective dose of GLP-1 medications while minimizing adverse side effects

Prevention strategies

• ▪Patients can prevent GLP-1 dosing errors by using FDA-approved brand-name products with pre-filled pens, confirming their dose with hands-on training, and setting weekly reminders to avoid double-dosing
• ▪Improving patient education at every step of the prescribing process, from the doctor's office to the pharmacy counter, is critical to preventing accidental medication errors