What To Know About GLP-1 Medications and Alcohol Use 
Insights From a Pharmacist

GLP-1 receptors are found throughout the body, but they’re particularly effective for treating obesity because they promote a feeling of fullness in the brain, slow down stomach emptying, and help the body manage blood sugar better. These medications also affect the gut-brain axis and can influence reward pathways and dopamine signaling, which are involved in cravings and addiction.

The doses differ between oral and injectable medications mainly because of bioavailability—the proportion of a medication that reaches the bloodstream and becomes available to the body. Injectable GLP-1s, such as semaglutide, have higher bioavailability because they are absorbed beneath the skin, avoiding the digestive system entirely, which allows for a greater amount of the medication to enter systemic circulation.

Based on current evidence, moderate alcohol intake doesn’t seem to interfere with the absorption or effectiveness of oral GLP-1 medications, and the FDA labeling for these drugs doesn’t include warnings about drinking alcohol while on them. It’s worth noting, though, that GLP-1 medications can cause pancreatitis (which is rare, less than 1%), and alcohol use is a known risk factor of pancreatitis. Heavy drinking or binge episodes can increase this risk, especially over the long term. Also, ingesting alcohol can make some gastrointestinal side effects of the medications, such as nausea, vomiting, reflux, and diarrhea, much worse.

Some research with injectable semaglutide has shown reductions in the number of drinks per day, fewer heavy drinking days, and decreased alcohol cravings. Right now, the VA in Atlanta is participating in a double-blind randomized clinical trial called CRAVE—the Cessation of Reduction of Alcohol Consumption in Veterans—which is studying the effects of oral semaglutide on heavy drinking days.

Additionally, a phase 2 trial of an oral semaglutide study found that while it didn’t significantly reduce craving or total drinks per day, it did reduce heavy drinking days. Barefield believes these findings are very encouraging and suggest that GLP-1 medications might become a novel approach to treating AUD.

Patients taking oral GLP-1 medications should avoid binge drinking, stay hydrated and be mindful that alcohol may worsen gastrointestinal side effects. They should also monitor blood sugar as directed, recognize symptoms of low blood sugar and discuss their alcohol use with their healthcare provider.