Using an experimental drug sold over the internet to lose weight is an inherently risky gamble. That’s a lesson a 32-year-old man had to painfully learn first-hand after he experienced horrific bouts of diarrhea likely caused by overdosing on the GLP-1 medication retatrutide.
Opeyemi Komolafe, an internist at the Medical University of South Carolina’s Marion Medical Center, detailed the gut-churning case in a recent paper. The man developed unceasing diarrhea soon after mistakenly taking an extra dose of retatrutide, an experimental treatment set to become the most potent obesity drug created to date. Though the man was hospitalized for several days as a result, he ultimately made a full recovery.
“This case report highlights the need for continued, perhaps increased, regulation of access to not-yet-approved pharmaceuticals because of potentially deleterious adverse effects that can result from their unregulated use,” Komolafe wrote in his paper, published last month in the Annals of Internal Medicine Clinical Cases.
Intractable diarrhea
According to the report, the man visited an emergency room following a week of uncontrolled, “intractable diarrhea.” Right before his visit, he was using the bathroom every 20 to 30 minutes, up to 30 times a day. He was also experiencing abdominal cramps and nausea without vomiting.
While frequent, the man’s stools were free of mucus and blood, making an infectious cause less likely. He quickly admitted to doctors that his symptoms began a few hours after he took an extra-large heaping of retatrutide purchased online. He started on a weekly 10 milligram dose of the injectable drug to help him lose weight (at the time of the visit, he had a body mass index of 34), but he had just moved up to 20 milligrams. However, the man forgot he had already taken his weekly dose before injecting another the next day, meaning he had 40 milligrams of retatrutide in his system.
The man was admitted to the hospital, where tests ruled out any other likely causes for his diarrhea. Though the constant bowel movements left him dehydrated and caused some acute kidney damage, his condition didn’t worsen once hospitalized. Doctors kept him hydrated, gave him extra potassium, and managed his symptoms with medication. His kidney function steadily improved, and he was discharged from the hospital after four days. He continued to look well at a follow-up visit a week later.
A lesson learned?
Retatrutide is being developed by the company Eli Lilly, makers of the existing obesity and diabetes drug tirzepatide. Though it mimics GLP-1 like semaglutide (Ozempic and Wegovy), it also mimics two other hunger- and metabolism-related hormones: GIP and glucagon. This triple-agonist combination seemingly allows retatrutide to help people lose more weight than any other drug seen yet.
In late-stage clinical trials, people on the highest doses of retatrutide have lost 28% of their baseline weight on average—numbers rivaling the typical success of gold-standard bariatric surgeries. The drug can be so effective that some people in these trials reportedly stopped taking them because they were losing too much weight. Though retatrutide is still being evaluated in Phase III trials, it’s almost certain that it will receive regulatory approval in the U.S. and other countries in the near future.
The impressive results seen with retatrutide have also fueled a black market around it. Less scrumptious companies are distributing and selling retatrutide and other unregulated peptides, often produced in China, to people all around the world.
Even if retatrutide is highly effective for obesity, it’s no guarantee that people who buy it through these companies are actually getting the genuine article. And as this case illustrates, using the drug without medical supervision can be dangerous on its own. Notably, the highest dose of retatrutide used in clinical trials so far is 12 milligrams. That means the man in this case was already taking a dose nearly twice as large as that, even before he doubled it further.
GLP-1 drugs have greatly improved obesity treatment. But like any medication, they have their side effects and risks—risks that are amplified when people take these drugs from shady online sources. As for the man himself, following his hospital discharge, Komolafe wrote that he was referred to a primary care doctor so he could be given “structured, holistic, and regulated care for his weight loss concerns.”
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