Glucagon-like peptide-1s (GLP-1s) are a class of medications approved by the U.S. Food and Drug Administration (FDA). People use them for a handful of purposes, from diabetes care to chronic weight management. 

Like any medication, it’s important to understand the side effects before beginning treatment. For example, research shows a link between GLP-1s and gallbladder disease, especially when weight loss happens quickly. 

Having gallbladder issues or a higher risk of them doesn’t necessarily rule out GLP-1 treatment, but you should speak with your doctor about your risk and what symptoms to look out for. Read on to better understand the connection between GLP-1s and gallbladder disease. 

‍

What does a gallbladder do?

The gallbladder is a small organ in the upper right abdomen. It’s responsible for storing and releasing bile, a fluid produced by your liver that helps you digest fat. The gallbladder is part of the biliary system, which also includes ducts that carry bile to the small intestine.

‍

What’s gallbladder disease?

Gallbladder disease is an umbrella term for conditions that affect the gallbladder and its bile ducts. These include: 

• Gallstones (cholelithiasis) and bile duct stones (choledocholithiasis) are collections of bile material that can cause pain, nausea, and inflammation.
• Gallbladder inflammation (cholecystitis) and bile duct inflammation (cholangitis) can occur due to an infection or obstruction, such as gallstones, and they might lead to abdominal pain and fever. 
• Gallbladder dysfunction (biliary dyskinesia) describes when your gallbladder can’t move bile into your bile ducts as it’s supposed to, so it remains in the gallbladder, leading to bloating, pain, and nausea. 

‍

Can GLP-1s raise gallbladder disease risk?

Yes, there’s a link between GLP-1s and gallbladder issues. One potential contributing factor is rapid weight loss. GLP-1s promote weight loss in a few ways, including suppressing appetite and keeping food in the stomach longer. Quick weight loss may increase the risk of gallbladder disease because of: 

• Cholesterol-saturated bile: Bile contains bile salts, which keep cholesterol dissolved. Rapid weight loss may prompt the liver to release excess cholesterol into bile. If the salts can’t dissolve this cholesterol, it can crystallize into gallstones. 
• Bile stasis: When you eat, the gallbladder contracts. This helps release bile. Eating less means the gallbladder doesn’t contract as often. GLP-1s amplify this effect by slowing gallbladder movement. Either way, bile can remain in the gallbladder for extended periods, which can make bile more concentrated. This increases gallstone risk. 

‍

Which GLP-1 patients are at risk of gallbladder disease?

Increased gallbladder disease risk may affect any GLP-1 patient. However, certain factors can raise this risk. 

A 2022 review, published in JAMA Internal Medicine, sheds light on these risk factors. It pools outcomes from 76 randomized clinical trials involving 103,371 patients. Researchers identified the following contributing factors: 

• Formulation: Liraglutide (Victoza® and Saxenda®), dulaglutide (Trulicity®), and high doses of semaglutide injections (Ozempic® and Wegovy®) were associated with higher gallbladder disease risk. Oral semaglutide (Rybelsus®, Ozempic®, and Wegovy®), lixisenatide (Adlyxin®), and albiglutide (Tanzeum®) showed no increased risk. 
• Dose: Higher doses are associated with an increase in gallbladder disease risk. Specific dosages vary by medication. 
• Duration: Longer treatment durations were associated with a moderate increase in gallbladder disease risk.
• Patient characteristics: Certain populations may be at increased risk. These include those with a history (family or personal) of gallbladder disease.

Though these factors contribute to increased risk, the overall risk is still relatively low. Researchers linked GLP-1s to 27 additional cases of gallbladder or biliary disease per 10,000 people, per year. 

Here’s a closer look at the review’s key details:

Gallbladder disease symptoms

Here are some common gallbladder disease symptoms to look out for:

• Upper abdomen pain (right side)
• Nausea
• Vomiting
• Fever
• Jaundice (yellowing of the skin)

‍

Symptoms can vary across conditions, so it’s important to talk to your care team about any new or worsening effects. In addition, up to eight in 10 people with gallstones never experience any symptoms. This is why routine check-ins matter, even if you’re feeling well. 

‍

Managing gallbladder disease risk on GLP-1s

There are ways to mitigate the gallbladder disease risk associated with GLP-1s. These include: 

• Pretreatment screening: Before prescribing GLP-1s, your doctor will screen for gallbladder disease risk factors. Depending on risk and personal history, they may also order imaging procedures such as ultrasounds to help spot abnormalities. 
• Paced weight loss: Gradual weight loss may keep this risk in check. Your doctor can give you strategies that support paced, sustainable weight loss, like a nutrient-dense diet and regular exercise regiment. 
• Ongoing monitoring: Your doctor will review how your body is responding to treatment on a routine basis. These check-ins provide an opportunity to catch signs of gallbladder disease early. 
• Early symptom identification: Your doctor will explain which symptoms warrant immediate medical attention, like chalky stool, dark urine, persistent abdominal pain, and fever. Early intervention may limit the risk of serious, long-term complications. 

In some cases, doctors may prescribe additional medication to limit gallbladder disease risk. For example, they may recommend ursodeoxycholic acid (UDCA) to reduce gallstone risk. Your doctor will assess which medications, if any, make sense for you. 

Multidisciplinary care is another key part of the puzzle. Several factors influence gallbladder disease risk, from your lifestyle to underlying metabolic health. In coordinated care settings, specialists work together to address each area, supporting your full health picture. 

‍

Whole-person GLP-1 care at Maven Clinic

GLP-1 treatment can cause a small increase in gallbladder disease risk, especially for those with a preexisting condition or family history. Talk to your doctor about your personal risk, which symptoms to watch out for, and how to mitigate gallbladder disease risk during treatment. 

Millions of women trust Maven Clinic with their GLP-1 care, due to our personalized, multidisciplinary approach. As our Medical Director, Dr. Janelle Duah (MD), explains: “Our clinicians take the time to really understand your experience, so every evidence-based recommendation actually makes sense for you.”
Discover our approach to GLP-1 care.