Wegovy (semaglutide 2.4 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for weight management in adults with obesity or overweight with weight-related comorbidities. Whilst leg cramps are not listed as a common adverse effect in the official Summary of Product Characteristics, some patients report muscle cramping during treatment. The physiological changes accompanying weight loss—including alterations in fluid balance, electrolyte levels, and dietary intake—may indirectly contribute to cramping. Understanding potential causes and management strategies can help ensure safe, effective treatment whilst minimising discomfort.

Can Wegovy Cause Leg Cramps?

Wegovy (semaglutide 2.4 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity, as an adjunct to a reduced-calorie diet and increased physical activity.

Leg cramps are not listed as a common adverse effect in the official Summary of Product Characteristics (SmPC) or Patient Information Leaflet (PIL). However, there have been limited post-marketing reports of muscle cramps, including in the legs, during treatment, though a direct causal relationship has not been established.

The physiological changes that accompany weight loss and alterations in fluid balance, electrolyte levels, and dietary intake during Wegovy therapy may indirectly contribute to muscle cramping in some individuals. It is important to distinguish between side effects directly attributable to the medication's pharmacological action and those arising from the broader context of weight management.

Leg cramps—characterised by sudden, involuntary, and often painful muscle contractions—can have multiple causes, including dehydration, electrolyte imbalances (particularly low potassium, magnesium, or calcium), reduced caloric intake, increased physical activity, or underlying medical conditions. When starting Wegovy, patients often make significant lifestyle changes, such as reducing food intake and increasing exercise, which may independently increase the risk of cramping.

If you experience leg cramps whilst taking Wegovy, it is advisable to consider potential contributing factors and discuss them with your GP or prescribing clinician. Monitoring your overall health and nutritional status during treatment is essential to ensure safe and effective weight management.

Why Leg Cramps May Occur During Wegovy Treatment

Understanding the potential mechanisms behind leg cramps during Wegovy treatment requires consideration of both the medication's effects and the physiological changes associated with weight loss. Wegovy works by mimicking the action of GLP-1, a naturally occurring hormone that regulates appetite and blood glucose levels. It slows gastric emptying, enhances satiety, and reduces caloric intake, leading to significant weight loss over time.

One plausible explanation for leg cramps is dehydration and electrolyte disturbance. According to the Wegovy SmPC, gastrointestinal side effects including nausea, vomiting, and diarrhoea are common, particularly during dose escalation. These symptoms can lead to fluid and electrolyte losses, which may precipitate muscle cramps. Sodium, potassium, magnesium, and calcium are critical for normal muscle contraction and relaxation; imbalances in these electrolytes are well-recognised triggers for cramping.

Additionally, patients on Wegovy often experience a substantial reduction in dietary intake. Rapid or significant calorie restriction, especially if nutritionally unbalanced, may result in inadequate intake of essential minerals and vitamins. Low magnesium and potassium levels, in particular, are frequently implicated in muscle cramps. Furthermore, some individuals may inadvertently reduce their intake of fluids alongside food, compounding dehydration risk.

Increased physical activity is another factor. Many people starting Wegovy also begin or intensify exercise regimens as part of their weight management plan. Unaccustomed or strenuous physical activity, especially without adequate warm-up, hydration, or conditioning, can lead to muscle fatigue and cramping.

Finally, there is a theoretical possibility that rapid weight loss itself may alter muscle metabolism and function. Changes in circulation or shifts in body composition during significant weight reduction could potentially contribute to cramping, although this remains an area requiring further research.

Managing and Preventing Leg Cramps on Wegovy

If you experience leg cramps whilst taking Wegovy, several practical strategies may help manage and prevent them. Maintaining adequate hydration is paramount. Aim to drink 6-8 glasses (around 1.2 litres) of fluid daily, and more during hot weather, when exercising, or if you experience vomiting or diarrhoea. Avoid excessive caffeine or alcohol, as these can contribute to dehydration.

Ensuring a balanced, nutrient-rich diet is equally important, even when reducing caloric intake. Focus on foods rich in key electrolytes:

• Potassium: bananas, oranges, spinach, sweet potatoes, and avocados

• Magnesium: nuts, seeds, whole grains, leafy green vegetables, and legumes

• Calcium: dairy products, fortified plant-based alternatives, and green vegetables

If dietary intake is limited due to reduced appetite, discuss with your GP or a registered dietitian before starting any supplements, as some electrolyte supplements (especially potassium) can be harmful without appropriate monitoring.

Adequate protein intake is also important during weight loss to help preserve muscle mass. Include lean protein sources with each meal, and consider gentle resistance exercises as part of your physical activity plan.

Gentle stretching exercises, particularly before bed and after physical activity, can help reduce the frequency and severity of cramps. Focus on calf stretches, hamstring stretches, and gentle yoga or Pilates movements that promote flexibility and circulation. Regular, moderate exercise is beneficial, but avoid sudden increases in intensity or duration that may overload muscles.

Gradual dose escalation of Wegovy, as recommended in the prescribing guidance, helps minimise gastrointestinal side effects and allows your body to adjust. If cramps coincide with dose increases, inform your prescriber—they may advise maintaining the current dose longer before escalating, as indicated in the SmPC.

Some individuals find relief from warm baths or heat application to cramping muscles, or gentle massage to promote relaxation and blood flow. If cramps occur at night, ensure your bedding is not too tight and consider keeping your legs warm.

If simple measures do not alleviate symptoms, or if cramps are frequent or severe, consult your healthcare provider for further assessment and tailored advice.

When to Seek Medical Advice About Leg Cramps

Whilst occasional, mild leg cramps during Wegovy treatment may be manageable with self-care measures, certain circumstances warrant prompt medical evaluation. Contact your GP or prescribing clinician if:

• Leg cramps are severe, persistent, or worsening despite hydration and dietary adjustments

• You experience difficulty walking or performing daily activities due to cramping or muscle pain

• Cramps are associated with other concerning symptoms such as dizziness or palpitations

Seek urgent same-day medical assessment if:

• Cramps are accompanied by significant muscle weakness, swelling, redness, or warmth in one leg, which could indicate deep vein thrombosis (DVT)

• You experience numbness, tingling, or loss of sensation in your legs, which may suggest nerve involvement

Call 999 or go to A&E immediately if:

• You develop chest pain or sudden shortness of breath (possible pulmonary embolism)

• You have severe, persistent abdominal pain radiating to the back, with nausea and vomiting (possible pancreatitis)

Your GP may wish to perform a clinical assessment and arrange investigations, such as blood tests to check electrolyte levels (sodium, potassium, magnesium, calcium), renal function, and thyroid function, as abnormalities in these areas can contribute to muscle cramps. Additional tests may include creatine kinase (CK) if severe muscle pain is present, particularly if you are taking statins, and vitamin D or B12 levels if clinically indicated.

If you have pre-existing medical conditions such as diabetes, kidney disease, or cardiovascular disease, or if you are taking other medications (such as diuretics, statins, or blood pressure medications) that may increase cramping risk, inform your healthcare provider. They can assess potential interactions or compounding factors and adjust your treatment plan accordingly.

Do not stop taking Wegovy without consulting your prescriber, even if you experience side effects. Abrupt discontinuation may affect your weight management progress, and your clinician can help identify solutions to manage symptoms whilst continuing treatment safely.

Other Side Effects of Wegovy to Be Aware Of

In addition to the possibility of leg cramps, Wegovy is associated with a range of other side effects, most commonly affecting the gastrointestinal system. According to the Wegovy SmPC, the following side effects may occur:

Very common side effects (affecting more than 1 in 10 people) include:

• Nausea, diarrhoea, constipation, vomiting: often most pronounced during dose escalation; usually improve over time

Common side effects (affecting up to 1 in 10 people) include:

• Abdominal pain or discomfort

• Headache and dizziness

• Fatigue and weakness

• Indigestion and flatulence

• Gastritis and gastroesophageal reflux disease

These side effects are generally mild to moderate and tend to diminish as your body adapts to the medication. Eating smaller, more frequent meals and avoiding high-fat or spicy foods may help reduce gastrointestinal symptoms.

Important but less common side effects include:

• Hypoglycaemia (low blood sugar): particularly in patients with type 2 diabetes taking other glucose-lowering medications; symptoms include sweating, tremor, confusion, and palpitations

• Gallbladder problems: including gallstones and cholecystitis; seek medical attention if you experience severe upper abdominal pain, especially after eating

• Pancreatitis: characterised by severe, persistent abdominal pain radiating to the back, nausea, and vomiting—requires urgent medical assessment

• Dehydration and acute kidney injury: due to vomiting, diarrhoea and reduced fluid intake

• Diabetic retinopathy complications: in people with type 2 diabetes, rapid improvement in blood glucose control may temporarily worsen existing retinopathy

• Injection site reactions: redness, itching, or swelling at the injection site

• Increased heart rate: monitor if you have cardiovascular conditions

Serious allergic reactions are rare but require immediate medical attention. Symptoms include difficulty breathing, swelling of the face, lips, or throat, and severe rash.

The MHRA continues to monitor the safety profile of Wegovy. If you experience any side effects, report them via the Yellow Card Scheme (yellowcard.mhra.gov.uk) to contribute to ongoing safety monitoring. Regular follow-up with your healthcare provider ensures that Wegovy remains a safe and effective component of your weight management plan, with side effects appropriately monitored and managed.

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