GLP-1 safety conversations

The safety points the MHRA sets out

The MHRA guidance applies across the GLP-1 class. The points below come from the MHRA guidance and from the NHS medicine pages.

• Stomach side effects and dehydration. Nausea, vomiting and diarrhoea are common. Occasionally the fluid loss is severe enough to need hospital treatment.
• Pancreatitis. Rare cases, some serious or fatal, have been reported. The key symptom is severe stomach pain spreading to the back which does not go away. The patient needs urgent medical help.
• Pregnancy and breastfeeding. GLP-1 medicines should not be used in pregnancy, while trying to conceive, or while breastfeeding, because safety data are lacking.
• Contraception. Tirzepatide can reduce the effect of the oral contraceptive pill, so extra barrier contraception is needed at set times.
• Anaesthesia and sedation. Slower stomach emptying raises the risk of aspiration under general anaesthesia or deep sedation. Patients should tell the surgical team and the anaesthetist, and keep taking the medicine unless told otherwise.
• Eyesight. A small number of cases of NAION, a type of optic nerve damage, have been linked to semaglutide. Sudden blindness or rapid loss of vision needs urgent help.
• Low blood sugar. The risk rises when a GLP-1 is used with insulin or a sulfonylurea.

On mental health, the MHRA completed a review and found no causal link between GLP-1 medicines and depression, suicidal thoughts or suicide. Monitoring continues, and staff should still report any concern through the Yellow Card scheme.

Stopping before pregnancy: the differences between medicines

For medicines licensed in 2026, check the Summary of Product Characteristics (SmPC) on the EMC for the product-specific advice. The Wegovy pill page and the medicine pages linked from the medicines hub give the licence details.

Fake products and unsafe supply

The MHRA warns against buying GLP-1 medicines from beauty salons, social media sellers or unregulated websites. Counterfeit pens can closely resemble genuine products. Powder vials sold for mixing are not authorised. Products sold as retatrutide are illegal in the UK, because retatrutide has no UK authorisation. The MHRA advice is to refuse any GLP-1 offered without a prescription.

When a patient shows you a product from one of these sources, advise against using the product, keep the packaging details if you can, and report the case to the MHRA.

Protecting time for a proper conversation

Each point above takes time to cover well, and many consultations run in short fixed slots. Say a service books GLP-1 reviews at five-minute intervals. A patient mentions a planned operation and trying for a baby. Covering both properly will overrun the slot. Cover the risks, book a follow-up, and record which parts of the consultation the slot length cut short.

A short written checklist helps teams cover the same ground every time: weight and height checked, pregnancy plans, contraception, past pancreatitis or gallbladder disease, other diabetes medicines, planned surgery, and where the medicine was obtained. If managers resist the time this takes, the workload guide and the guide to pressure to prescribe show how to raise the issue in writing. Persistent unsafe practice belongs in the guide to raising patient-safety concerns.

How to make a Yellow Card report

Report through the MHRA Yellow Card website (opens another website) or the Yellow Card app. Healthcare staff and patients can both report. The MHRA accepts reports of:

• suspected side effects, even when you are unsure the medicine was the cause
• suspected fake or non-genuine products
• misuse, including use for cosmetic weight loss

Include the brand, the batch number where known, the dates of starting and stopping, the reaction, and the outcome. Do not include information which identifies the patient beyond what the form asks for.

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