Can you take Wegovy if you have glaucoma? This is an important question for patients considering this weight management medication whilst managing eye health. Wegovy (semaglutide 2.4 mg) is a GLP-1 receptor agonist licensed in the UK for obesity treatment, but understanding its safety profile in people with glaucoma requires careful consideration. Glaucoma is not listed as a contraindication to Wegovy, and current evidence does not suggest the medication worsens intraocular pressure or glaucoma progression. However, individual circumstances vary, and a thorough medical assessment involving both your prescribing clinician and ophthalmologist is essential before starting treatment.

Understanding Wegovy and Its Primary Uses

Wegovy (semaglutide 2.4 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity or those who are overweight with at least one weight-related comorbidity. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which were originally developed for type 2 diabetes management.

The mechanism of action involves mimicking the naturally occurring hormone GLP-1, which regulates appetite and food intake. Wegovy works by:

• Slowing gastric emptying, helping you feel fuller for longer after meals

• Acting on appetite centres in the brain to reduce hunger and cravings

• Improving insulin secretion in response to food intake

• Reducing glucagon release, which helps regulate blood glucose levels

Wegovy is administered as a once-weekly subcutaneous injection using a pre-filled pen device. Treatment begins with a lower dose that increases gradually over 16 weeks to improve tolerability. It should be combined with a reduced-calorie diet and increased physical activity for optimal results. According to NICE guidance (TA875), Wegovy may be considered for eligible patients as part of a specialist weight management service, with specific criteria for continuing treatment.

Common side effects include nausea, diarrhoea, vomiting, constipation, and abdominal pain, particularly during the initial dose escalation phase. Other adverse effects can include gallbladder problems, increased heart rate, and pancreatitis. Wegovy is contraindicated in patients with hypersensitivity to semaglutide or any of the excipients.

Wegovy should not be used during pregnancy or breastfeeding. Women of childbearing potential should use effective contraception when taking Wegovy and discontinue treatment at least two months before a planned pregnancy. Before starting Wegovy, a comprehensive medical assessment is essential to ensure the treatment is appropriate and safe for your individual circumstances.

Can You Take Wegovy If You Have Glaucoma?

Glaucoma is not listed as a contraindication to Wegovy in the current Summary of Product Characteristics (SmPC) approved by the MHRA. This means that having glaucoma does not automatically prevent you from being prescribed this medication. However, this does not mean the combination is entirely without consideration.

According to the available clinical data and regulatory information, there is no established link between semaglutide (the active ingredient in Wegovy) and worsening of glaucoma or increased intraocular pressure. The clinical trials that led to Wegovy's approval did not identify glaucoma as a specific concern, and the medication does not appear in standard ophthalmological lists of drugs known to adversely affect glaucoma.

That said, several important factors warrant careful consideration:

• Individual patient circumstances vary considerably, and what is safe for one person may require monitoring in another

• Type of glaucoma matters – there are different forms (open-angle, closed-angle, normal-tension) with varying sensitivities to systemic medications

• Other medications you may be taking for glaucoma or other conditions could potentially interact – though topical eye drops used for glaucoma typically have minimal systemic absorption and interaction risk

• Overall health status and the presence of other comorbidities (such as diabetes or cardiovascular disease) may influence treatment decisions

The decision to prescribe Wegovy to someone with glaucoma should be made on an individual basis following a thorough medical assessment. Your prescribing clinician will need to weigh the potential benefits of weight loss against any theoretical risks, taking into account your complete medical history, current glaucoma management, and overall treatment goals.

How Wegovy May Affect Eye Health and Glaucoma

Whilst Wegovy does not have a direct documented effect on intraocular pressure or glaucoma progression, it is important to understand the broader context of GLP-1 receptor agonists and eye health. The Wegovy SmPC includes a warning regarding diabetic retinopathy complications in patients with pre-existing diabetic eye disease, though this relates primarily to rapid glucose reduction rather than a direct drug effect.

Regarding glaucoma specifically, there is currently no robust clinical evidence suggesting that semaglutide worsens glaucoma or increases intraocular pressure. The medication's mechanism of action does not involve pathways typically associated with aqueous humour production or drainage, which are the key factors in glaucoma.

However, several indirect considerations are worth noting:

• Weight loss itself may have beneficial effects on intraocular pressure, with some studies suggesting modest reductions in pressure following significant weight reduction, though evidence is limited and varies between individuals

• Improved metabolic health from weight loss may benefit overall vascular health, potentially supporting optic nerve perfusion

• Gastrointestinal side effects (particularly vomiting) could theoretically cause transient pressure spikes due to straining, though this is a theoretical concern not specific to Wegovy or glaucoma patients

For patients with diabetic retinopathy, the Wegovy SmPC advises appropriate monitoring when initiating treatment, particularly if rapid glycaemic improvement is anticipated. This is because rapid improvement in glucose control has been associated with temporary worsening of diabetic retinopathy.

If you have glaucoma and are considering Wegovy, maintaining your regular ophthalmology appointments and continuing prescribed glaucoma treatments without interruption remains essential. Any changes to your vision should be reported promptly to your ophthalmologist.

Safety Precautions for Glaucoma Patients Considering Wegovy

If you have glaucoma and your healthcare provider is considering prescribing Wegovy, several safety precautions should be implemented to ensure optimal outcomes and minimise any potential risks.

Before starting treatment:

• Ensure your glaucoma is well-controlled with current treatment and that you attend regular monitoring appointments

• Provide your prescriber with a complete list of all medications, including eye drops, as drug interactions should be assessed

• Discuss your glaucoma type and severity with both your prescribing clinician and ophthalmologist

• Confirm that your most recent eye examination results are available to inform the treatment decision

• If you have diabetes and use insulin or sulfonylureas, discuss the potential risk of hypoglycaemia and whether dose adjustments may be needed

During treatment:

• Continue all prescribed glaucoma medications exactly as directed – do not stop or alter doses without consulting your ophthalmologist

• Maintain scheduled ophthalmology appointments for intraocular pressure monitoring and visual field assessments

• Report any visual changes immediately, including blurred vision, eye pain, halos around lights, or sudden vision loss

• Stay well-hydrated, especially if experiencing gastrointestinal side effects – persistent vomiting or diarrhoea can lead to dehydration and potential kidney problems

• Manage side effects carefully – if experiencing severe vomiting, seek medical advice promptly

• Monitor for signs of other Wegovy-related complications such as severe abdominal pain (potential pancreatitis) or rapid heart rate

• If you are of childbearing potential, use effective contraception during treatment and for at least two months after discontinuation

Additional considerations:

Patients with angle-closure glaucoma should be particularly vigilant about any medications that might affect pupil size, though Wegovy is not known to have such effects. Those with advanced glaucoma or significant visual field loss may require more frequent monitoring during the initial treatment period. Maintaining good communication between your GP, prescribing weight management service, and ophthalmologist ensures coordinated care and early identification of any concerns.

When to Consult Your GP or Ophthalmologist

Knowing when to seek medical advice is crucial for anyone taking Wegovy, particularly if you have pre-existing conditions like glaucoma. Prompt consultation can prevent complications and ensure your treatment remains safe and effective.

Seek emergency eye care immediately (same day/A&E/999 if severe) if you experience:

• Sudden vision changes including blurring, loss of vision, or new blind spots

• Eye pain or discomfort, particularly if accompanied by redness or light sensitivity

• Halos or rainbow-coloured rings around lights, especially at night

• Severe headache with eye pain or nausea (potential acute angle-closure attack requiring emergency treatment)

• Any new visual symptoms that concern you, even if seemingly minor

Contact your GP or prescribing clinician if you develop:

• Severe or persistent gastrointestinal symptoms (nausea, vomiting, diarrhoea) that interfere with daily activities or medication adherence

• Signs of pancreatitis – severe abdominal pain radiating to the back, often with vomiting

• Symptoms of gallbladder problems – pain in the upper right abdomen, fever, or jaundice

• Rapid or irregular heartbeat, chest pain, or shortness of breath

• Signs of allergic reaction – rash, swelling, or difficulty breathing

Routine consultations should include:

Schedule a medication review with your specialist weight management service as directed, typically at 3, 6 and 12 months after starting Wegovy, to assess efficacy, tolerability, and continued eligibility according to NICE guidance. Maintain your regular ophthalmology appointments as recommended for your glaucoma type – typically every 6–12 months for stable disease, more frequently if pressures are elevated or disease is progressing.

If you are considering starting Wegovy and have glaucoma, arrange a joint discussion involving your GP and ophthalmologist before commencing treatment. This collaborative approach ensures all aspects of your health are considered and appropriate monitoring plans are established.

If you experience any suspected side effects from Wegovy, you can report them directly to the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk). Remember, open communication with your healthcare team is essential for safe, effective treatment and optimal outcomes for both your weight management and eye health.

Frequently Asked Questions