Wegovy (semaglutide 2.4 mg) is a GLP-1 receptor agonist licensed in the UK for chronic weight management in adults with obesity or overweight with weight-related comorbidities. As with any medication, patients and clinicians may have concerns about potential adverse effects. One question that occasionally arises is whether Wegovy can cause neuropathy—damage to peripheral nerves resulting in symptoms such as tingling, numbness, or pain. This article examines the current evidence on any association between Wegovy and neuropathy, explores relevant risk factors, and provides guidance on monitoring and managing nerve-related symptoms during treatment.
Quick Answer: Current evidence does not establish a causal link between Wegovy (semaglutide) and peripheral neuropathy, with no such association listed in UK regulatory documentation or clinical trial safety data.
Wegovy (semaglutide 2.4 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for chronic weight management in adults with obesity or overweight with weight-related comorbidities. Administered as a once-weekly subcutaneous injection, Wegovy mimics the action of the naturally occurring hormone GLP-1, which plays a crucial role in appetite regulation and glucose metabolism.
The mechanism of action centres on activating GLP-1 receptors in multiple tissues throughout the body. In the brain, particularly in areas controlling appetite and satiety, semaglutide reduces hunger signals and increases feelings of fullness after eating. This leads to reduced caloric intake and subsequent weight loss. Additionally, Wegovy slows gastric emptying, prolonging the sensation of satiety, and modulates insulin secretion in a glucose-dependent manner, which helps maintain stable blood glucose levels.
In the UK, NICE Technology Appraisal 875 recommends Wegovy for adults with a BMI of at least 35 kg/m² (or ≥30 kg/m² with weight-related comorbidities) who have at least one weight-related condition and are referred to a specialist weight management service. Clinical trials such as the STEP 1 study demonstrated significant weight reduction—typically 14.9% of body weight over 68 weeks compared with 2.4% with placebo—alongside improvements in cardiovascular risk factors.
Understanding how Wegovy functions throughout the body is essential when considering potential adverse effects, including concerns about neurological complications such as neuropathy. Whilst the primary therapeutic effects are well-established, patients and healthcare professionals must remain vigilant about the full spectrum of possible reactions during treatment.
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Start HereThere is currently no established causal link between Wegovy (semaglutide) and peripheral neuropathy in the published medical literature or regulatory documentation. The Summary of Product Characteristics (SmPC) approved by the MHRA does not list neuropathy as a recognised adverse effect of semaglutide at the doses used for weight management. Clinical trials involving thousands of participants have not identified neuropathy as a significant safety signal associated with Wegovy treatment.
The most commonly reported adverse effects of Wegovy are gastrointestinal in nature, including nausea (occurring in approximately 44% of patients in the STEP 1 trial), diarrhoea, vomiting, constipation, and abdominal pain. These typically emerge during dose escalation and often diminish over time. Other documented side effects include injection site reactions, fatigue, and dizziness, but neurological complications such as neuropathy have not featured prominently in safety data.
However, it is important to recognise that rapid weight loss itself—regardless of the method—can occasionally be associated with nutritional deficiencies that may contribute to nerve problems. Significant caloric restriction can lead to deficiencies in B vitamins (particularly B1, B6, and B12), which are essential for nerve health. Additionally, rapid weight loss has been associated with compressive neuropathies such as peroneal neuropathy (sometimes called 'slimmer's palsy'). These represent indirect mechanisms rather than direct drug effects.
Patients taking metformin, which is common in this population, should be aware that long-term use can reduce vitamin B12 levels, potentially contributing to neuropathy risk. The MHRA has issued a Drug Safety Update highlighting this association and recommending periodic B12 monitoring in at-risk patients.
Post-marketing surveillance continues to monitor for rare or unexpected adverse events. Healthcare professionals are encouraged to report any suspected adverse drug reactions through the Yellow Card Scheme. Whilst current evidence does not support a direct association between Wegovy and neuropathy, ongoing pharmacovigilance remains essential to detect any emerging safety concerns as real-world use expands beyond clinical trial populations.
Peripheral neuropathy refers to damage or dysfunction of the peripheral nerves, which can manifest through various sensory, motor, or autonomic symptoms. Patients taking Wegovy should be aware of potential nerve-related symptoms, even though there is no official link, as early recognition enables prompt evaluation and management.
Sensory symptoms are often the earliest manifestations and may include:
Tingling or 'pins and needles' sensations (paraesthesia), typically beginning in the feet or hands
Numbness or reduced ability to feel temperature, pain, or touch
Burning sensations or shooting pains, particularly in the extremities
Increased sensitivity to touch (hyperaesthesia) or pain from normally non-painful stimuli (allodynia)
Loss of balance or coordination due to reduced proprioception (awareness of limb position)
Motor symptoms may develop if neuropathy affects motor nerves, including muscle weakness, difficulty with fine motor tasks (such as buttoning clothes), foot drop, or muscle cramps and twitching. Autonomic symptoms can occur if autonomic nerves are involved, potentially causing dizziness upon standing (postural hypotension), digestive problems, or abnormal sweating patterns.
It is crucial to understand that these symptoms can arise from numerous causes unrelated to Wegovy, including diabetes (the most common cause of peripheral neuropathy in the UK), vitamin deficiencies, alcohol use, other medications, autoimmune conditions, or infections. Many patients prescribed Wegovy have type 2 diabetes or prediabetes, conditions that independently carry significant neuropathy risk.
If you experience any of these symptoms whilst taking Wegovy, do not immediately assume the medication is responsible. However, these symptoms warrant medical evaluation to determine the underlying cause and ensure appropriate management. For more information on peripheral neuropathy symptoms, the NHS website provides patient-friendly guidance.
Several pre-existing conditions and risk factors increase the likelihood of developing neuropathy, independent of Wegovy use. Understanding these factors helps contextualise any nerve-related symptoms that emerge during treatment.
Diabetes mellitus represents the most significant risk factor for peripheral neuropathy in the UK, with approximately 50% of people with long-standing diabetes eventually developing some degree of nerve damage, according to Diabetes UK. Diabetic neuropathy results from prolonged exposure to elevated blood glucose levels, which damage nerve fibres and blood vessels supplying nerves. Patients prescribed Wegovy often have type 2 diabetes or metabolic syndrome, placing them at inherently elevated risk for neuropathy regardless of medication use.
Nutritional deficiencies constitute another important consideration, particularly during significant weight loss. Deficiencies in vitamin B12, vitamin B1 (thiamine), vitamin B6, vitamin E, and folate can all contribute to nerve damage. Patients following very low-calorie diets or those with malabsorption issues face increased risk. Additionally, alcohol consumption can cause both direct toxic effects on nerves and nutritional deficiencies, particularly thiamine deficiency.
Medication-induced deficiencies are also relevant. Long-term metformin use can reduce vitamin B12 absorption, potentially contributing to neuropathy. The MHRA has advised that healthcare professionals should consider periodic B12 monitoring in patients at risk of deficiency.
Other relevant risk factors include:
Chronic kidney disease, which can lead to uraemic neuropathy
Autoimmune conditions such as rheumatoid arthritis, lupus, or Sjögren's syndrome
Infections including HIV, shingles, or Lyme disease (though the latter is less common in the UK)
Exposure to toxins or certain medications (chemotherapy agents, some antibiotics)
Thyroid disorders, particularly hypothyroidism
Family history of hereditary neuropathies
Patients with multiple risk factors require particularly careful monitoring. Healthcare professionals should conduct a thorough baseline assessment before initiating Wegovy, documenting any pre-existing neurological symptoms to distinguish new developments from pre-existing conditions. This baseline evaluation proves invaluable if symptoms emerge during treatment.
If you develop symptoms suggestive of neuropathy whilst taking Wegovy, prompt medical evaluation is essential to identify the underlying cause and initiate appropriate management. Do not discontinue Wegovy without consulting your prescribing healthcare professional, as the symptoms may be unrelated to the medication.
Contact your GP or prescribing clinician if you experience:
Persistent tingling, numbness, or burning sensations in your hands or feet
Progressive weakness or difficulty walking
Loss of balance or coordination
Severe or worsening pain in your extremities
Any symptoms that interfere with daily activities or quality of life
Seek urgent medical attention (contact NHS 111 or attend A&E) if you develop sudden, severe weakness, complete loss of sensation, inability to walk, or symptoms suggesting acute neurological compromise. Call 999 immediately for rapidly progressive paralysis, facial weakness, breathing difficulty, or new urinary retention/incontinence.
During your consultation, your healthcare professional will conduct a comprehensive assessment including:
Detailed medical history, including all medications and supplements
Physical examination with neurological assessment (testing reflexes, sensation, strength, and coordination)
Blood tests to evaluate glucose control (HbA1c), vitamin B12, folate, thyroid function, kidney function, and other relevant parameters
Review of your weight loss pattern and dietary intake
Depending on findings, your doctor may refer you to a neurologist for specialist evaluation, which might include nerve conduction studies or electromyography (EMG) to assess nerve function objectively. They will also review whether Wegovy should be continued, adjusted, or discontinued based on the clinical picture.
If neuropathy is confirmed, treatment focuses on addressing the underlying cause—whether optimising diabetes control, correcting nutritional deficiencies, or managing other contributing factors. Symptomatic treatments for neuropathic pain may include medications such as amitriptyline, duloxetine, gabapentin, or pregabalin, as recommended by NICE Clinical Guideline 173 on neuropathic pain management. Treatment should be individualised based on comorbidities, contraindications, and patient preferences.
Regular monitoring throughout Wegovy treatment helps ensure both efficacy and safety, enabling early detection of potential complications. NICE Technology Appraisal 875 emphasises the importance of ongoing clinical review for patients receiving semaglutide for weight management.
Before initiating Wegovy, healthcare professionals should establish a comprehensive baseline assessment including:
Complete medical history and medication review
Physical examination with baseline weight, BMI, and blood pressure
Blood tests: HbA1c (if diabetic or at risk), lipid profile, liver function, kidney function, and thyroid function
Assessment for contraindications (the UK SmPC lists hypersensitivity to semaglutide or any excipients as the only contraindication)
Documentation of any existing neurological symptoms
According to NICE TA875, Wegovy should be prescribed within specialist weight management services. Treatment should be discontinued if patients have not lost at least 5% of their initial body weight after 12 weeks on the maintenance dose.
During treatment, patients should attend regular follow-up appointments as determined by their specialist weight management service. These reviews should assess:
Weight loss progress and tolerability
Blood glucose control (particularly in diabetic patients)
Cardiovascular risk factors
Nutritional status and dietary adequacy
Any new symptoms or adverse effects
Mental health and eating behaviours
Patients can optimise safety by:
Following the prescribed dose escalation schedule to minimise side effects
Maintaining adequate nutrition despite reduced appetite
Discussing nutritional needs with a dietitian, particularly if dietary intake is significantly reduced
Monitoring blood glucose levels if diabetic, as Wegovy may necessitate adjustment of other diabetes medications
Staying well-hydrated, especially if experiencing gastrointestinal side effects
Reporting any new or concerning symptoms promptly
Healthcare professionals and patients should report suspected adverse reactions through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk), contributing to ongoing safety surveillance. Whilst current evidence does not establish a link between Wegovy and neuropathy, vigilant monitoring ensures that any emerging safety signals are detected and investigated appropriately, protecting patient welfare whilst enabling access to effective obesity treatment.
No, neuropathy is not listed as a recognised adverse effect in the MHRA-approved Summary of Product Characteristics for Wegovy, and clinical trials have not identified it as a significant safety signal.
Contact your GP or prescribing clinician promptly for a comprehensive assessment, including neurological examination and blood tests to identify the underlying cause. Do not stop Wegovy without medical advice, as symptoms may be unrelated to the medication.
Diabetes itself is the most common cause of peripheral neuropathy in the UK, with approximately 50% of people with long-standing diabetes developing some degree of nerve damage independent of weight management medications.
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