一文读懂！司美格鲁肽和替尔泊肽的副作用、禁忌，哪些人不能使用

Core Viewpoint - The article discusses the safety and efficacy of GLP-1 receptor agonists (GLP-1RA) in treating type 2 diabetes and obesity, highlighting their common side effects and contraindications, as well as the ongoing debate regarding their association with thyroid cancer risk [4][10][14]. Group 1: Safety and Side Effects - Common side effects of GLP-1RA include nausea, diarrhea, vomiting, constipation, abdominal pain, and gastroesophageal reflux disease, which tend to alleviate over time [4]. - Semaglutide shows good safety in diabetes treatment but can cause gastrointestinal issues, with 17% of patients reporting nausea even at low doses (0.5 mg), and higher rates of diarrhea (12.2%) and vomiting (6.4%) as doses increase [5]. - Approximately 80% of tirzepatide users report at least one side effect, with nausea (33%) and diarrhea (23%) being common, similar to semaglutide [7]. Group 2: Contraindications and Warnings - GLP-1RA medications carry a black box warning for potential increased risk of thyroid C-cell tumors, advising against use in patients with a history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 [10][11]. - Other warnings include risks of pancreatitis, hypoglycemia when used with certain diabetes medications, and potential kidney damage [10]. - Patients with a history of pancreatitis, severe gastrointestinal diseases, or those under 18 years old should use GLP-1RA cautiously [12]. Group 3: Thyroid Cancer Risk - Animal studies suggest a link between GLP-1RA and the development of medullary thyroid carcinoma (MTC), leading to black box warnings for at-risk patients [14]. - The European Medicines Agency (EMA) has evaluated the risk, concluding that current evidence does not support a causal relationship between GLP-1RA and thyroid cancer, despite some observational studies indicating increased risk [16][17].