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Semaglutide-induced Wernicke encephalopathy: a comprehensive analysis

European Journal of Clinical Nutrition volume 79, pages 1160–1163 (2025)Cite this article

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Abstract

Although GLP-1 receptors analogues (RAs) benefits-risks profile has been largely documented in diabetes, higher dosages recently approved in obesity still require further assessment. We describe here the case of a 49-year-old female patient treated with semaglutide for obesity, who presented with Wernicke encephalopathy in a context of iterative vomiting and reduced food intake. Eighteen other cases of Wernicke encephalopathy were reported in literature and in the WHO global safety database (VigiBase). A context of nausea/vomiting or reduced food intake is described in 68% of cases, with weight loss ranging from −3.5 to −13.3 kg/month over 3 to 6 months. Disproportionality analysis in VigiBase showed that Wernicke encephalopathy was disproportionately reported with semaglutide, tirzepatide and the whole GLP-1RAs group. Altogether, this comprehensive analysis supports a safety signal regarding the risk of Wernicke encephalopathy with GLP-1RAs, which requires a prompt assessment, accounting for the growing use of these drugs.

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Data availability

All data relevant to the study are included in the article or uploaded as supplementary information. Aggregated data of VigiBase are publicly available on https://www.vigiaccess.org/.

References

  1. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989–1002.

    Article  CAS  PubMed  Google Scholar 

  2. Sheth K, Garza E, Saju A, Nazir N, Agarwal A. Wernicke encephalopathy associated with semaglutide use. Cureus. 2024. https://doi.org/10.7759/cureus.61783.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Foster S, Kyle A. From weight loss to neurological deficits: a case of wernicke’s encephalopathy stemming from prescription weight loss medication. 2023. https://www.emra.org/emresident/article/wernicke-july-2023 (accessed 15 Jan2025).

  4. Ali SA, Khadra M, Sitto M, Graifman M, Gietzen J. S4686 semaglutide’s hidden perils: a rare case of malnutrition and wernicke encephalopathy. Am J Gastroenterol. 2024;119:S2964–S2964.

    Article  Google Scholar 

  5. Sharma N, Vura NVRK, Shweikeh F, Ramirez-Osoria LC, Chakinala RC, Sharma AN. S4690 semaglutide-linked dry beriberi: a rare adverse reaction. Am J Gastroenterol. 2024;119:S2967–S2968.

    Article  Google Scholar 

  6. Verstraeten C, Barbier A, Jonneaux C, Faure G, Guillain P, Dervaux D, et al. Cas clinique: encéphalopathie de Gayet-Wernicke sous inhibiteur de la pompe à proton au long cours. Pharm Clin. 2022;57:e104.

    Google Scholar 

  7. Sechi G, Sechi E, Fois C, Kumar N. Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev. 2016;74:281–300.

    Article  PubMed  Google Scholar 

  8. Aneke-Nash C, Hung KS, Wall-Wieler E, Zheng F, Sharaiha RZ. Comparing the risk of gastroparesis following different modalities for treating obesity: semaglutide versus bupropion-naltrexone versus sleeve gastrectomy—a retrospective cohort study. BMJ Open Gastroenterol. 2025;12:e001704.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205–16.

    Article  CAS  PubMed  Google Scholar 

  10. Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A Randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373:11–22.

    Article  PubMed  Google Scholar 

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Author notes

  1. These authors contributed equally: Victoria De Wit, Nacima Oussedik.

Authors and Affiliations

  1. Centre Régional de Pharmacovigilance, Service de Pharmacologie périnatale, pédiatrique et adulte, Hopital Cochin, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France

    Cécile Gras, Venceslas Bourdin, Delphine Callot, Ghiles Chegrani & Laurent Chouchana

  2. Service d’Endocrinologie, Hôpital Cochin, APHP.Centre—Université Paris Cité, Paris, France

    Victoria De Wit & Sylvie Daclin

  3. Service de Pharmacie clinique, Hôpital Cochin, APHP.Centre—Université Paris Cité, Paris, France

    Nacima Oussedik

  4. Nutrition Department, Assistance Publique Hôpitaux de Paris, European Hospital Georges Pompidou, Paris, France

    Claire Rives-Lange

  5. HEKA Team, UMR1346 : INRIA, Univ Paris Cite, Inserm, France

    Claire Rives-Lange

  6. Université Paris Cité, INSERM UMR-S 1343, Pharmacologie et évaluations des thérapeutiques chez l’enfant et la femme enceinte, Paris, France

    Laurent Chouchana

Authors
  1. Cécile Gras
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  2. Victoria De Wit
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  3. Nacima Oussedik
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  4. Sylvie Daclin
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  5. Venceslas Bourdin
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  6. Delphine Callot
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  7. Ghiles Chegrani
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  8. Claire Rives-Lange
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  9. Laurent Chouchana
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Contributions

NO reported the case and provided medication history, SD and VDW were in charge of the patient and completed the computerized medical record. CG analyzed the data and drafted the manuscript. LC analyzed the data and provided supervision. VB, DC, GC and CRL provided critical revision of the manuscript. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Cécile Gras.

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Competing interests

No funding was received for this study. None of the authors have any financial or personal relationships with other people or organizations that could influence the design, conduct, or reporting of this work. CRL received remuneration for attending symposia by Nestlé Health Science®.

Ethics statement

This study was conducted in compliance with the principles of Good Clinical Practices and the Declaration of Helsinki. Due to its retrospective nature, in accordance with French law, the study was determined not to require ethics committee review. Individual informed consent has been obtained regarding this case report, which has been reported to the French Pharmacovigilance system under the number FR-AFSSAPS-PV2024001276. VigiBase is managed by the Uppsala Monitoring Center (Uppsala, Sweden), an independent center for drug safety and scientific research for WHO. Information from VigiBase comes from a variety of sources and the probability that the suspected adverse effect is drug-related is not the same in all cases. The findings of this study do not represent the opinion of the Uppsala Monitoring Center (Uppsala, Sweden) or the World Health Organization and only reflect the authors’ opinion. All safety reports from these databases are anonymized with no possibility to trace back patients’ or reporters’ personal information. Data were treated following EU and national legislation regarding the protection of personal data (e.g. the Data Protection Directive 95/46/EC and Regulation (EC) No 45/2001).

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Gras, C., De Wit, V., Oussedik, N. et al. Semaglutide-induced Wernicke encephalopathy: a comprehensive analysis. Eur J Clin Nutr 79, 1160–1163 (2025). https://doi.org/10.1038/s41430-025-01653-7

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