Wegovy (semaglutide 2.4 mg) is a once-weekly GLP-1 receptor agonist licensed in the UK for weight management in adults with obesity or overweight with comorbidities. Many patients wonder: does Wegovy cause gout? Gout is a painful inflammatory arthritis caused by elevated uric acid levels, and individuals starting Wegovy often have obesity and metabolic conditions that already increase gout risk. Whilst gout is not listed as a recognised side effect of Wegovy, rapid weight loss and dehydration may transiently raise uric acid levels. This article examines the evidence, explores the relationship between weight loss and gout, and provides practical guidance for managing gout risk whilst taking Wegovy.

What Is Wegovy and How Does It Work?

Wegovy (semaglutide 2.4 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity (BMI ≥30 kg/m²) or those who are overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity, such as type 2 diabetes, hypertension, or obstructive sleep apnoea. It is administered as a once-weekly subcutaneous injection and is intended to be used alongside a reduced-calorie diet and increased physical activity.

Semaglutide belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs mimic the action of the naturally occurring hormone GLP-1, which is released by the intestines in response to food intake. By binding to GLP-1 receptors in the brain, particularly in areas that regulate appetite, Wegovy helps to reduce hunger and increase feelings of fullness. This leads to a decrease in calorie intake and, consequently, weight loss.

In addition to its effects on appetite, semaglutide slows gastric emptying, meaning food remains in the stomach for longer, which further contributes to satiety. It also has beneficial effects on blood glucose control by stimulating insulin secretion in a glucose-dependent manner and suppressing glucagon release. Clinical trials (STEP 1 and 3) have demonstrated that Wegovy can lead to significant and sustained weight loss—typically around 10–15% of initial body weight over 68 weeks—when combined with lifestyle modifications.

Wegovy is typically started at a lower dose and gradually increased over several weeks to the full 2.4 mg dose to improve tolerability and reduce gastrointestinal side effects.

On the NHS, Wegovy is available through specialist weight management services according to NICE guidance (TA875). NHS eligibility criteria include a BMI of at least 35 kg/m² with weight-related comorbidities (or ≥30 kg/m² for people from certain ethnic backgrounds), or a BMI ≥30 kg/m² with type 2 diabetes. Treatment is typically limited to a maximum of 2 years. Wegovy is also available via private prescription.

Understanding Gout: Causes and Risk Factors

Gout is a common and painful form of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints, most frequently affecting the big toe. It occurs when serum uric acid levels become elevated—a condition known as hyperuricaemia—leading to the formation of monosodium urate crystals that deposit in and around joints, triggering intense inflammation, swelling, redness, and severe pain.

Uric acid is a waste product formed from the breakdown of purines, substances found naturally in the body and in certain foods such as red meat, organ meats, shellfish, and alcohol (particularly beer). Normally, uric acid dissolves in the blood, is filtered by the kidneys, and excreted in urine. However, when the body produces too much uric acid or the kidneys excrete too little, levels can rise, increasing the risk of gout.

Key risk factors for gout include:

• Obesity and metabolic syndrome: Excess body weight is strongly associated with higher uric acid levels and increased gout risk.

• Diet: High intake of purine-rich foods, fructose-sweetened beverages, and alcohol can elevate uric acid.

• Medications: Diuretics (often used for hypertension or heart failure) and low-dose aspirin can impair uric acid excretion.

• Medical conditions: Chronic kidney disease, hypertension, diabetes, and cardiovascular disease are all linked to gout.

• Genetics: A family history of gout increases susceptibility.

• Gender and age: Gout is more common in men and postmenopausal women, with incidence rising with age.

According to NICE guidance (NG219), the diagnosis of gout is typically clinical, supported by elevated serum uric acid levels and, where necessary, joint aspiration showing urate crystals. Management involves both acute treatment of flares (with NSAIDs, colchicine, or corticosteroids) and urate-lowering therapy (such as allopurinol), which should be offered from the first presentation of gout. Treatment aims to maintain serum urate below 360 µmol/L (or below 300 µmol/L in severe or tophaceous gout).

It's important to note that an acutely hot, swollen joint with fever or systemic illness requires urgent same-day assessment to exclude septic arthritis, which is a medical emergency.

Does Wegovy Cause Gout?

There is no official established link between Wegovy (semaglutide) and the development of gout. Gout is not listed as a recognised adverse effect in the Summary of Product Characteristics (SmPC) for Wegovy, nor has it been identified as a significant safety signal in large-scale clinical trials or post-marketing surveillance data reviewed by the MHRA or European Medicines Agency (EMA).

However, it is important to understand the context in which this question arises. Patients starting Wegovy are often individuals with obesity and associated metabolic conditions—populations already at elevated baseline risk for gout. Obesity, insulin resistance, hypertension, and type 2 diabetes are all independent risk factors for hyperuricaemia and gout. Therefore, any apparent association between Wegovy use and gout may reflect the underlying patient profile rather than a direct drug effect.

Rapid weight loss, which can occur with Wegovy, has been associated with transient increases in uric acid levels and, in some cases, may precipitate acute gout attacks. This phenomenon is thought to result from increased purine turnover during fat metabolism and tissue breakdown. Additionally, ketone bodies produced during rapid weight loss can reduce uric acid excretion by the kidneys. For this reason, individuals with a history of gout or elevated uric acid should be monitored carefully when initiating significant weight loss, whether through medication, diet, or surgery.

Additionally, gastrointestinal side effects of Wegovy—such as nausea, vomiting, and diarrhoea—can lead to dehydration, which may concentrate uric acid in the blood and theoretically increase gout risk. Maintaining adequate hydration is therefore important for all patients taking Wegovy.

If you have a personal or family history of gout, or if you develop symptoms such as sudden, severe joint pain, swelling, or redness (particularly in the big toe) while taking Wegovy, you should contact your GP promptly. Your doctor can assess your uric acid levels, review your medications, and provide appropriate management, which may include urate-lowering therapy or adjustments to your weight loss plan.

Managing Gout Risk While Taking Wegovy

For patients taking Wegovy who are concerned about gout or who have a history of the condition, several practical strategies can help minimise risk and support safe, effective weight loss.

Maintain good hydration: Drinking plenty of water throughout the day helps the kidneys excrete uric acid more efficiently and reduces the risk of crystal formation. Aim for adequate fluid intake (often around 1.5–2 litres daily), but this should be individualised based on your circumstances, particularly if you have heart failure or kidney disease.

Adopt a gout-friendly diet: While losing weight, focus on a balanced diet that limits purine-rich foods such as red meat, organ meats, shellfish, and certain fish (e.g., sardines, anchovies). Reduce intake of fructose-sweetened drinks and alcohol, particularly beer. Instead, emphasise low-fat dairy, vegetables, whole grains, and plant-based proteins.

Lose weight gradually: Although Wegovy facilitates significant weight loss, aiming for steady, sustainable reduction (rather than extreme calorie restriction) may help avoid sharp spikes in uric acid. Follow the dietary and lifestyle advice provided by your healthcare team.

Monitor uric acid levels: If you have a history of gout or hyperuricaemia, your GP may recommend periodic blood tests to monitor serum uric acid. This allows for early intervention if levels rise.

Review medications: Discuss all your medications with your doctor, as some drugs (e.g., diuretics) can increase uric acid levels. Your GP may be able to adjust these if appropriate. Do not stop prescribed low-dose aspirin used for cardiovascular prevention without consulting your doctor.

Consider urate-lowering therapy: In line with NICE guidance (NG219), urate-lowering therapy such as allopurinol should be offered from the first presentation of gout to maintain uric acid below target levels (typically <360 µmol/L, or <300 µmol/L in severe or tophaceous gout). When starting urate-lowering therapy, prophylactic medication (such as low-dose colchicine) is usually recommended for at least 6 months to prevent flares. Urate-lowering therapy can be continued safely alongside Wegovy.

Recognise warning signs: Be alert to symptoms of an acute gout attack—sudden, severe pain, swelling, warmth, and redness in a joint. Early treatment with NSAIDs, colchicine, or corticosteroids can shorten the duration and severity of flares. Contact your GP or seek same-day advice if symptoms develop.

Seek urgent care if needed: If you develop an acutely hot, swollen joint with fever or feel systemically unwell, seek urgent same-day medical assessment to exclude septic arthritis, which requires emergency treatment.

If you experience any suspected adverse effects while taking Wegovy, report them to the MHRA through the Yellow Card scheme (yellowcard.mhra.gov.uk).

By working closely with your healthcare team and adopting these preventive measures, you can safely pursue weight loss with Wegovy while minimising the risk of gout-related complications.

Frequently Asked Questions