GLP-1 Overdoses on the Rise: Cause for Concern?

 GLP-1 overdoses have been skyrocketing, with poison centers seeing a nearly 1500% increase in calls related to overdose or side effects of injectable weight-loss drugs since 2019, according to US National Poison Data Center. Between January and April 30, 2025, alone, poison centers managed 3633 GLP-1 related exposure cases.

Statewide poison control data, such as California’s, also show upsurges, including overdose cases requiring emergency department treatment — and overdose cases in Washington have doubled since 2024.

Experts suggest that the use of compounded drugs has exacerbated the overdose problem. However, increased utilization of GLP-1s and lack of patient education are also among the contributing factors.

Real-World Examples

Poison centers are most often contacted about accidental therapeutic errors to FDA- approved GLP-1 drugs — ie, taking doses too closely together or taking a higher than recommended dose at once. For compounded products, patients have reported accidentally taking 10 times the recommended dose while using a syringe due to confusing measurement units.

“I’ve seen patients who’ve taken doses too early, doubled up after thinking the pen malfunctioned, or drawn incorrect amounts from multi-dose vials — all of which constitute therapeutic overdose,” American Gastroenterological Association spokesperson Sara Ghoneim, MD, an inflammatory bowel disease specialist at Massachusetts General Hospital, Boston, told Medscape Medical News.

“These cases mirror what’s in the literature,” she said. “A recent case series described a 53-year-old man who unintentionally injected semaglutide 2 mg instead of the recommended 0.1 mg, and a 45-year-old woman who injected 2.4 mg instead of 0.25 mg — both at initiation of therapy.”

Ajay Rao, MD, chief of endocrinology, diabetes and metabolism at the Lewis Katz School of Medicine at Temple University, Philadelphia, told Medscape Medical News, he’s only seen this a “handful of times,” most predominantly when patients obtain GLP-1s from compounded pharmacies.

“When patients get clear directions from their prescribing providers and obtaining noncompounded versions of these medicines, I feel less concerned about it being a problem.” But when patients receive “poor directions” from clinicians, or compounded or unregulated versions of the drugs, “I get very worried about it,” Rao added.

“Mistakes have happened,” said Marc-André Cornier, MD, professor of medicine and director of the Division of Endocrinology, Diabetes and Metabolic Diseases at the Medical University of South Carolina, Charleston, South Carolina. “For example, I had a patient whose mother was on one of these medications and wasn’t taking it, and so my patient decided on her own to take it, and she took it daily. She injected herself every day instead of once a week and got extremely sick and ended up in the emergency room.”

That said, Cornier believes the cost of the drugs limit the overdosing risk. “In general, people aren’t going to take extra injections because the cost is so high and they would run out too quickly,” he told Medscape Medical News. Side effects are also a limiting factor for people who want to double or triple a dose to lose weight faster. “They’re going to get sicker and again, cost is an issue unless they’re going outside the usual channels and getting it compounded.

“I’m more concerned about abuse by people who don’t meet the indications who take these agents not necessarily at higher doses, but they shouldn’t be on them at all,” he added. “In a way, in this situation, any dose would be an overdose.”

Anne Peters, MD, a professor of clinical medicine and a clinical scholar at the Keck School of Medicine of the University of Southern California, Los Angeles, has seen patients overdosing by mistake and others increasing the dose intentionally. Some patients have supplemented their prescriptions from the US with additional doses of drugs from Canada.

“In some cases, I’ve seen GI [gastrointestinal] side effects that end up in hospitalization, generally for abdominal pain, and severe vomiting and diarrhea,” she told Medscape Medical News. “More commonly, I see side effects that don’t require hospitalization, but obviously are something to avoid. It’s all about safely taking the right individual dose and realizing that not all patients respond the same way.”

Like Peters, Priya Jaisinghani, MD, clinical assistant professor at NYU Grossman School of Medicine, New York City, told Medscape Medical News, “In some cases, overdoses can be intentional in an attempt to dose higher amounts or skip titration in attempt to lose more weight quickly.

“Patients may have confusion regarding weekly vs daily dosing, dialing errors on multidose pens, injecting a full pen instead of a single dose on a multidose pen, or confusion transitioning between different incretin therapies and formulations,” Jaisinghani added.

An ‘Underappreciated’ Risk

Overdose signs and symptoms are similar to side effects; however, the duration of symptoms may be longer, according to the National Poison Data Center.

Some of the more common side effects include nausea, vomiting, diarrhea, constipation, and abdominal pain.

But Ghoneim said that while the clinical picture of overdose is dominated by GI symptoms, “hypoglycemia is a real, underappreciated risk. It has been reported in up to 9% of overdose cases, even without insulin or sulfonylurea co-administration, particularly in nondiabetic or lean individuals. So blood glucose monitoring matters even when the clinical picture looks straightforward.”

Indeed, authors of a recent review of California poison control system data concluded, “Hypoglycemia, while infrequent, was reported; nondiabetic patients using GLP-1 RA [receptor agonist] should be educated on recognizing hypoglycemia.”

Polysubstance exposure — for example, with alcohol or cannabis — “is where outcomes get serious,” said Ghoneim. Practices such as “stacking” and “cycling” the drugs, used by bodybuilders among others, can increase risks further.

What to Do

Should clinicians prepare patients in the first visit about overdose risks with GLP-1s? “I do, and I think it needs to become standard practice for everyone prescribing these agents,” Ghoneim said. “Research shows that 91% of GLP-1 exposures are due to self-administration errors, and 21% of those involve mistakes on the very first use of the pen. That tells me the window of highest risk is right at initiation — exactly when I’m sitting across from the patient.”

Ghoneim walks patients through the injection technique, confirms they understand the dosing schedule, and makes sure patients know that if they think they’ve taken too much, they should call poison control immediately. “I also now specifically counsel patients who have children at home to store these medications securely — a lockbox in the refrigerator is a simple, inexpensive safeguard.”

Rao “always” brings up the overdose risk and spends a lot of time talking about the slow titration needed for these medications. “We need to spend the time discussing why slow titration of dose is needed and reconcile that with the fact that many patients may be very anxious to get to the maximum doses as soon as possible,” he said. “Partnership is key.”

For Jaisinghani, the overdose problem “reinforces the need for adequate counseling, clear instructions regarding dosing, and demonstration of injection dialing, dose confirmation, and injection technique. With better education, device demonstration, and expectation-setting around safe weight reduction, we can prevent some of these events from occurring.”

Currently, there’s neither an antidote nor consensus on observation time after acute overdose, Ghoneim noted. “Supportive care is the mainstay, and consultation with poison control or a medical toxicologist should be the default when there’s clinical uncertainty. Given that these drugs are now being prescribed by clinicians across virtually every specialty, that knowledge gap needs to close.”

Local Poison Center centers can be reached by calling the Poison Help line: 1-800-222-1222. To save the number in a mobile phone, text POISON to 301-597-7137.

Ghoneim declared receiving a research grant from Eli Lilly for an IBD drug (not a GLP-1). Rao declared having no relevant conflicts. Jaisinghani serve(d) as a speaker or a member of a speaker’s bureau for Eli Lilly; Novo Nordisk, Madrigal, Corcept. Peters declared having no competing interests. Cornier has been on advisory boards for Eli Lilly and Novo Nordisk.

https://www.medscape.com/viewarticle/glp-1-overdoses-rise-cause-concern-2026a1000dob