Beware of the GLP-1 “Weight-Loss Syncope”

After losing 40 pounds on Ozempic in last 6 months, Jennifer could finally wear a dress she had always wanted. Eager to celebrate this milestone with her friends at a bar, she stood up to open the door as her Uber app alerted arrival. The next thing she knew she was waking up on the floor – her cellphone had 8 missed calls from her Uber driver & friends. She had lost conciousness…. and her Uber ride 🙁 [ This was my 3rd case of GLP-1 Syncope in 5 months – Name & story changed…coz’ HIPAA ! )

Everyone seems to know or at least suspect someone of being on GLP-1 agonist weight-loss drugs like Semaglutide & Tirzepatide. The magical speed & extent of weight loss has caused an explosion in demand & share prices of Novo Nordisk & Eli Lilly. Demand has caused scarcities & with scarcity came lucrative opportunities for compounding pharmacies that prescribe them to anyone wanting a quick weight fix.

On this post, I want to highlight the risk of syncope from weight-loss in people taking Blood Pressure (BP) medications. Body weight & Hypertension are strongly related – around 70% obese people have Hypertension. Weight loss is very effective in lowering BP ! Jennifer’s impressive weight loss essentially cured her Hypertension. Her Lisinopril was now dropping her BP too much & eventually led to passing out from Orthostatic Hypotension. Clinicians should be aware of this & note that even unintentional weight loss (from cancer, bowel surgery, dementia etc.) could do this. While the syncope itself is benign, they can cause head injuries, fractures and result in costly unecessary investigations. I feel “Weight-Loss Syncope” deserves it’s own sub-category!

Take-Home points 💡:

• Warn your weight-loss patients about expected BP drop, recommend a Home BP monitor device and advise keeping posture changes slow.
• Encourage adequate hydration, a simple way is to go by urine color – if darker than faint / pale yellow, they are falling behind on hydration
• If you suspect a weight-loss syncope & if EKG , Hemoglobin , Electrolytes are normal, then an Orthostatic BP check, hydration and holding BP meds & diurectics until clinic follow-up is all that is needed – no need for ECHO / Troponins / Head CTs !