Weight loss medications

Acceptability at Recruitment

QUALIFIED

Acceptability at VT / Work-Up

QUALIFIED

Naltrexone–bupropion (Mysimba) – DISCUSS with MO

Individual at Risk

Donor

Explanation of Condition

GLP-1 agonists were originally developed for the treatment of diabetes. A notable side effect observed during their use was weight loss. In recent years, their application has expanded to include non-diabetic patients, specifically for weight management and obesity treatment.

Commonly used medications in this class are Ozempic, Wegovy, Mounjaro, and Saxenda. The names of the active medications are semaglutide, tirzepatide, and liraglutide. Liraglutide (Saxenda) and semaglutide (Wegovy) are available on the NHS.

Orlistat is a tablet medication that works by decreasing the amount of fat absorbed from food, and can be prescribed via the NHS.

Rybelsus is an oral GLP-1 agonist which is available off-license. It is not available via the NHS.

Naltrexone–bupropion (Mysimba) works by decreasing appetite and cravings. It is not available via the NHS.

Guidance

AT RECRUITMENT

Acceptable

Ask the patient whether they have a diagnosis of type 2 diabetes. If they do and they take a GLP1 agonist, the donor cannot donate per our guidelines.

AT VT

The use of weight loss medications is generally acceptable, but the following steps should be taken:

Medical history

• Ask the patient whether they have a diagnosis of type 2 diabetes. If they do and they take a GLP-1 agonist, the donor cannot donate per our guidelines for diabetes.
• Ask the donor about their current BMI and refer to the corresponding guidelines in the Weight section. A donor’s BMI is likely to fall when taking GLP-1 agonists, so it may be appropriate to make the donor TU for a period if their BMI is currently above our discretionary limits.
• Determine whether the donor is experiencing any significant side effects related to their current medication regimen. Common side effects include nausea and stomach upset. If the donor is experiencing unpleasant side effects, defer the donation until they have settled, or the donor ceases the medication.

Source of medication

• Weight loss medications may be accessed through the NHS, but they are often obtained privately.
• If the donor has acquired the medication from an online pharmacy, confirm that the pharmacy is properly registered. You can check registration status through NHS resources:

https://www.nhs.uk/service-search/other-health-services/pharmacies/internetpharmacies

• Check the medical or nursing registration number of the prescribing clinician for donors who have obtained the medication through a clinic.

• If an injectable weight loss drug has been obtained from an unverified or non-legitimate source, apply a deferral period of three months between the last injection date and the donation. This deferral period may be reduced at the discretion of the MO and TC.

• For non-injectable weight loss drugs (i.e. in tablet form) obtained from an unverified source, discuss the case with an MO.

• Naltrexone–bupropion (Mysimba) – discuss with MO even if the medication has been obtained from a reliable source.

Bone marrow harvests

Donors taking weight loss injections are suitable for a bone marrow harvest. However, they should hold one dose prior to the operation. For an emergency bone marrow harvest where holding a medication dose is not possible, the decision to proceed is undertaken on a risk-benefit basis after discussion with the donor. This decision would be undertaken by the anaesthetist.

Justification

Since GLP-1 agonist injections are administered subcutaneously, it is essential to verify that the medication has been sourced from a reputable supplier due to the risk of needle-transmitted blood borne viruses.

Naltrexone–bupropion (Mysimba) interacts with some painkillers and anaesthetic drugs. Therefore, any donor taking this medication should be discussed with an MO.

Weight loss medications increase anaesthetic risk due to the risk of aspiration secondary to reduced gut motility, hence the recommendation to omit a dose for planned BMHs.

Version

Version 1, Edition 1

Date of Last Update

11th April 2025