Mounjaro, Ozempic, and Crohn’s Disease

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that affects the digestive tract, causing inflammation, ulcers, and other complications.

It is estimated that around 1.6 million Americans suffer from Crohn’s disease, with symptoms ranging from abdominal pain, diarrhea, fatigue, weight loss, and other gastrointestinal issues.

Ozempic is a commonly used diabetes medicine. Although it is administered as a subcutaneous injection, gastrointestinal symptoms are among the most common side effects of Ozempic.

Therefore, it is difficult to predict how a person with Crohn’s disease will respond to Ozempic treatment or for that sake any other GLP-1 analog and Tirzepatide (Mounjaro).

Ozempic works by mimicking the effects of the GLP-1 hormone, which helps to regulate blood sugar levels by increasing insulin secretion, reducing glucagon secretion, and slowing down gastric emptying.

This results in lower blood sugar levels and improved glycemic control in individuals with type 2 diabetes.

Among the side effects of Ozempic, the following are the most common:

• Nausea and vomiting
• Constipation
• Abdominal fullness
• Abdominal pain, and
• Diarrhea

These symptoms will likely be experienced by a patient with Crohn’s disease too. Since Crohn’s disease is an inflammatory disease of the bowels, most patients have gastrointestinal symptoms of presentation.

Other Interactions between Mounjaro, Ozempic, and Crohn’s Disease: 

Apart from a direct effect of Ozempic on changing bowel movements, it may also affect the bowels in other ways:

• Altered gut flora:

Ozempic use is associated with a change in bowel flora which can result in bloating, abdominal gases, swelling, pain, and spasms. Henceforth, Ozempic may lead to a flare in the symptoms of Crohn’s disease.

• Immuno-modulatory effects:

Since Crohn’s disease is an inflammatory disease, any drug that weakens or strengthens the immune system will have a direct effect on Crohn’s disease.

Ozempic is said to alter the immune system of the GI tract. It may result in flare-ups of symptoms, however, data is limited and the topic has not been well studied.

• Delayed gastric emptying:

Gastric emptying, when delayed has two effects:

1. The food enters the bowels slowly and it may affect its absorption,
2. Food and medicines remain in the stomach for a longer time and hence the efficacy of medications, especially enteric-coated pills, may be severely affected.

Ozempic causes delayed gastric emptying and it may affect the absorption of oral medicines, especially enteric-coated prednisolone, and aminosalicylates (mesalamine, olsalazine, sulfasalazine, and others).

• Effect on gut hormones:

Ozempic also affects the GI hormones. One of the most important here is the GLP-1 which is also involved in the gut-brain axis.

Other important hormones that may affect the absorption of food in patients with Crohn’s disease are pancreatic enzymes like trypsins and chymotrypsin, lipases, and amylase.

However, in clinical trials, it was observed that GLP-1 agonists are better tolerated than most diabetes medications by patients with Crohn’s disease and diabetes.

In one study, the author concluded that GLP-1 agonists may improve the disease course of Crohn’s disease as they reduced the need for hospitalization, corticosteroid use, TNF inhibitors, and surgery [Ref].

Below is a summary table outlining the impact of GLP-1 agonists on the progression of Crohn’s disease:

A hazard ratio of less than 1 means that the findings are in favor of GLP-1 agonists in Crohn’s disease.

Table summarizing individual Outcomes in Patients with IBD and Type 2 Diabetes Treated with GLP-1 Receptor Agonists and/or DPP-4 Inhibitors:

GLP-1 agonists were associated with a reduced risk of hospitalization, oral corticosteroid treatment, and surgery in patients with IBD and Type 2 Diabetes, as indicated by Hazard Ratios (HR) less than 1.

This suggests that GLP-1 agonists may have resulted in an improvement in these parameters.

Effect of Mounjaro and Ozempic on Medicines Used to Treat Crohn’s Disease:

The treatment of Crohn’s disease has changed significantly over the last few years. More patients are now using biological medicines to treat flares and maintain remissions.

Integrin inhibitors (Vedolizumab) and TNF inhibitors are widely used. Here is a list of medicines used to treat inflammatory bowel disease:

Ozempic may impair the immuno-modulatory effects of some of these drugs while it may also impair the absorption of some of these drugs.

• Aminosalicylates:

Aminosalicylates are medications that come in different brands, and each brand is absorbed in different parts of the stomach and at different acidity levels.

For example, Pentasa, when taken as a 1 g liquid suspension, is absorbed better compared to other forms, with 80% of the drug being absorbed. However, on average, only 20-30% of Pentasa is absorbed from the gastrointestinal tract [Ref]

It’s important to choose a brand of aminosalicylates that is easily absorbed, less affected by stomach acidity, and not affected by slow gastrointestinal transit.

Patients taking aminosalicylates should monitor their blood glucose levels regularly and adjust their diabetes medications as needed, as aminosalicylates may increase the risk of hypoglycemia (low blood sugar).

• Corticosteroids:

If you’re taking Ozempic and need to take corticosteroids like prednisolone, be aware that Ozempic may affect how well your body absorbs the corticosteroids.

Corticosteroids can also cause weight gain and affect your blood glucose levels. To avoid these issues, it’s better to take plain prednisolone instead of enteric-coated (delayed-release) prednisolone, as the enteric-coated form may not be absorbed properly in patients with slow gastric emptying caused by Ozempic [Ref].

It’s important to monitor your blood glucose levels frequently and adjust your diabetes medications as needed. Also, keep in mind that Ozempic is not likely to cause weight loss when used with corticosteroids.

• NSAIDs:

If you’re taking Ozempic and need pain relief, be cautious with NSAIDs (non-steroidal anti-inflammatory drugs) as they can make symptoms of gastritis and dyspepsia (upset stomach) caused by Ozempic worse.

Instead, consider using stomach-friendly NSAIDs like Celecoxib (Celebrex) for pain relief. While Ibuprofen (Advil) can be used for short-term pain relief, it’s better to avoid it if possible since alternatives like Tylenol and Celecoxib are available and may be safer for your stomach when taking Ozempic.

• Loperamide (Imodium):

If you’re taking Ozempic and experiencing constipation, be careful with using loperamide (Imodium) for diarrhea.

Loperamide (Imodium) can actually make constipation caused by Ozempic worse. If you need to treat diarrhea in patients with Crohn’s disease who are taking Ozempic, it’s best to use the lowest possible dose of loperamide.

• Antibiotics:

If you’re taking Ozempic and need to take antibiotics, be cautious with certain types of antibiotics, particularly quinolones, as they can increase the risk of hypoglycemia (low blood sugar) caused by Ozempic.

It’s safer to use antibiotics from the penicillin or cephalosporin families, as they are less likely to affect blood sugar levels when taken with Ozempic.

• TNF inhibitors:

TNF Inhibitors are usually given as subcutaneous injections, which means they are less likely to cause GI (gastrointestinal) side effects.

However, TNF inhibitors can cause weight gain, which may counteract the weight loss efforts of someone using Ozempic primarily for weight management.

On the positive side, TNF inhibitors may improve insulin sensitivity and help with diabetes control.

It’s important to monitor your blood glucose levels while using TNF inhibitors and be aware that the weight loss effects of Ozempic may not be as significant when combined with TNF inhibitors.

• Vedolizumab (Entyvio):

Vedolizumab may cause a small amount of weight gain, potentially impacting the weight loss efforts of someone using Ozempic for weight management.

• Tofacitinib (Xeljanz):

If you’re taking Tofacitinib along with Ozempic and have diabetes, be aware that Tofacitinib may reduce insulin resistance, which could increase the risk of hypoglycemia (low blood sugar).

It’s important to monitor your blood glucose levels regularly and work with your healthcare provider to adjust your doses of diabetes medications as needed.

Summary of the effect of Medicines used to treat Crohn’s Disease with Ozempic and Mounjaro:

In Conclusion:

Ozempic and Mounjaro may be used in patients with Crohn’s disease. Studies point towards favorable outcomes of GLP-1 agonists in patients with Crohn’s disease.

However, certain side effects and drug interactions must be kept in mind when using Ozempic or Mounjaro along with medicines used to treat Crohn’s disease.

In addition, the GI side effects of Ozempic and Mounjaro may be more severe in patients with Crohn’s disease. Hence, monitoring, dose adjustment, and early treatment may be necessary.