SHM Converge Scientific Abstract ePoster Gallery-GLP-1 Induced Anorexia - What to Do When the Medicine Works Too Well

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This case describes a 74-year-old man with type 2 diabetes who developed severe anorexia, weight loss, anuria, kidney failure, and refractory hypoglycemia after his oral semaglutide dose was increased to 14 mg daily. His other medications included glipizide and metformin. Despite supportive care and dialysis, he had no oral intake for several days after the last dose of semaglutide.<br /><br />The report highlights that GLP-1 agonists intentionally reduce appetite by slowing gastric emptying and affecting hypothalamic signaling, but these effects can become excessive and cause clinically significant anorexia. In this patient, the anorexia was severe enough to contribute to kidney failure. This appears to be the first reported case of GLP-1–induced anorexia leading to renal failure.<br /><br />Metoclopramide, a dopamine D2 antagonist and 5-HT4 agonist, was started at 5 mg three times daily. Within 24 hours, the patient’s appetite returned and oral intake normalized. As intake improved, urine output increased, creatinine stabilized, and dialysis was no longer needed. Glipizide, metformin, and semaglutide were discontinued at discharge.<br /><br />The case suggests that prokinetic agents such as metoclopramide may be useful when GLP-1 agonist-related anorexia is beyond the intended therapeutic effect. It also emphasizes the importance of prescribers recognizing and managing potential complications of GLP-1 therapy, especially in older patients with diabetes and other comorbidities.

Asset Subtitle

Eric Olausson

Meta Tag

Author List Eric Olausson, Magdalena Palac, Maxwell Bressman MD

Category Clinical Vignettes

Concept GLP-1 Receptor Agonist

Concept Anorexia

Concept Appetite

Concept Metoclopramide

Concept Dose-Dependent Effect

Distinguished Non-Finalist

Presenter Organization Greenwich Hospital - Yale New Haven Health

Presenting Author Eric Olausson

Track Adult

Keywords

oral semaglutide

GLP-1 agonist

anorexia

kidney failure

refractory hypoglycemia

type 2 diabetes

metoclopramide

anuria

dialysis

weight loss

GLP-1 Receptor Agonist

Anorexia

Appetite

Metoclopramide

Dose-Dependent Effect