Ozempic and Gabapentin or Pregabalin for Diabetic Neuropathy

Diabetic Neuropathy is the most common and earliest complication of diabetes. Ozempic has been linked with diabetic neuropathy just like insulin.

Drugs that rapidly lower blood glucose, such as insulin and Ozempic may result in neuronal damage.

However, this is usually temporary and most studies have found a protective role of Ozempic in preventing neuropathy.

There are different types of diabetic neuropathies, however, the most common is peripheral sensory neuropathy which may present as tingling, numbness, pain, and paraesthesias.

The three commonly prescribed medicines for treating diabetic neuropathy are:

• Gabapentin
• Pregabalin, and
• Duloxetine.

Other treatments may include pain medicines, tricyclic antidepressants, and topical lotions containing capsaicin.

Ozempic and Gabapentin Vs Pregabalin:

Both Gabapentin and Pregabalin are drugs that are used to treat neuropathic pains in diabetic patients.

Most studies have found both drugs equally effective in relieving pain. However, there are some differences between the two drugs which may be clinically more relevant when these drugs are given in combination with Ozempic, (other brands of Semaglutide like Rybelsus and Wegovy, other GLP-1 analogs like Victoza and Trulicity, or with Mounjaro (Tirzepatide).

Ozempic, Mounjaro, and other GLP-1 analogs slow stomach motility, and hence the absorption of food, as well as drugs, may be delayed.

The delay in gastric emptying significantly affects the absorption of gabapentin to a greater extent compared to Pregabalin.

Thus, patients may have a suboptimal response to pain relief with Gabapentin compared to Pregabalin.

The table below compares the pharmacokinetics of Gabapentin Vs Pregabalin [Ref]:

Indications, dose, and side effects of gabapentin in diabetic patients:

Gabapentin is an anticonvulsant medication that acts on the GABA receptors to reduce the sensitivity of the nerves to pain signals.

It is commonly used to manage neuropathic pain in diabetic patients. The recommended starting dose of gabapentin for diabetic neuropathy is 300mg taken orally once a day.

The dosage can be increased to 900mg per day, depending on the patient’s response and tolerance. The daily dose should not exceed a maximum of 3600 mg (given in divided doses)

Gabapentin has several side effects that diabetic patients on Ozempic should be aware of. The most common side effects include dizziness, drowsiness, nausea, and headache.

Patients may also experience peripheral edema, dry mouth, and constipation. More severe side effects such as ataxia, tremors, and confusion are rare but may occur in some patients.

Here is a table summarizing the side effects of Gabapentin:

Few of these side effects are especially concerning as they are common with both Ozempic and Gabapentin. These include:

• Nausea
• Constipation
• Headache
• Fatigue
• Dizziness

When taking Ozempic and Gabapentin together, patients may experience these side effects more intensely.

Additionally, Gabapentin may reduce the weight loss effects of Ozempic, resulting in less weight loss compared to those who are not taking these medications together.

The Effect of Gabapentin on Body Weight in Diabetics Using Ozempic:

Several studies have examined the effect of gabapentin on weight and A1C in diabetic patients.

Gabapentin can cause slight weight gain, usually ranging from 1 to 5 kilograms per year, according to some studies [Ref].

While there are a few studies that report the opposite, most studies suggest that gabapentin may contribute to weight gain.

When combined with Ozempic, this weight gain from gabapentin may counteract the weight loss effects of Ozempic.

As a result, diabetic patients taking both Ozempic and gabapentin may not experience significant weight loss compared to those using Ozempic alone. It’s important to discuss any concerns about weight changes with your healthcare provider.

In conclusion, gabapentin may cause slight weight gain in diabetic patients. When combined with Ozempic, this may counteract Ozempic’s weight loss effects. Diabetic patients taking both medications may not experience significant weight loss compared to Ozempic alone

The effect of Gabapentin on A1C in Diabetics using Ozempic:

There is limited data on how Gabapentin affects blood glucose levels. However, most case reports, including those of both diabetic and non-diabetic individuals, suggest that Gabapentin use may lead to a decrease in plasma glucose levels.

In one case series that included six patients, severe hypoglycemia (low blood sugar) was reported in both diabetics and non-diabetic individuals who were taking Gabapentin [Ref]

However, there is also a case report that reported a mild increase in blood glucose levels with Gabapentin use [Ref].

In summary, Limited data suggests Gabapentin may lower blood glucose levels, but severe hypoglycemia has been reported in some cases. Further research is needed, and close glucose monitoring is important, especially in diabetic patients.

Comparing gabapentin vs pregabalin vs duloxetine for treating diabetic neuropathy:

Gabapentin, pregabalin, and duloxetine are commonly used to manage neuropathic pain in diabetic patients.

Gabapentin and pregabalin are recommended for patients with neuropathic pain and insomnia, while duloxetine is preferred for patients with neuropathic pain, depression, or fibromyalgia.

Both gabapentin and pregabalin may cause drowsiness and should be avoided in patients at risk of respiratory depression.

Duloxetine should be avoided in patients with hypertension or stomach problems, and it may cause dry mouth, abdominal pain, and insomnia.

The table below summarizes the effects of Gabapentin, Pregabalin, and Duloxetine on various clinical signs of Diabetic neuropathy:

It is important to note that the effectiveness of these medications may vary from person to person and depend on various factors such as the severity of the neuropathy, the dosage of the medication, and individual tolerance to the medication.

In Conclusion:

To sum up, gabapentin is a useful medication for treating neuropathic pain in diabetic patients, but it can cause some side effects that need to be considered.

Although there is no significant effect on weight or A1C levels, it is essential to consult a healthcare provider before taking gabapentin or any other medication while on Ozempic.

In comparison to duloxetine, gabapentin, and pregabalin were found to be more effective in managing pain intensity, but they also had a higher incidence of adverse effects.

Duloxetine may relieve pain along with symptoms of depression but can cause hypertension.

Therefore, healthcare providers should carefully evaluate and select the appropriate medication to manage diabetic neuropathy in patients taking Ozempic.