Living with hemophilia means balancing various aspects of daily health, from managing bleeding risks to being mindful of potential medication interactions. With the growing use of glucagon-like peptide 1 (GLP-1) receptor agonists — medications commonly prescribed for managing type 2 diabetes and obesity — many people with hemophilia may wonder: Are these medications safe for me?

While there isn’t a lot of direct research on how GLP-1 drugs interact with hemophilia, understanding how these medications work and what the potential risks might be can help guide important conversations with your health care provider.

What Are GLP-1 Drugs?

GLP-1 receptor agonists are a class of medications that help control blood glucose (blood sugar) levels and support weight management. They mimic glucagon-like peptide 1, a hormone produced in the gut that helps regulate insulin levels and slows digestion. This contributes to a longer feeling of fullness.

These medications are often prescribed for managing type 2 diabetes and are increasingly used to treat obesity. Some well-known examples approved by the U.S. Food and Drug Administration (FDA) include:

• Dulaglutide (Trulicity)
• Liraglutide (Victoza)
• Semaglutide (Ozempic, Rybelsus, Wegovy)

GLP-1 medications can be effective for weight management due to their appetite-suppressing effects, which may lead to meaningful weight loss over time. For individuals managing type 2 diabetes or obesity — conditions that can also affect some people with hemophilia — these drugs might be an appealing option.

Hemophilia, Diabetes, and Obesity: What’s the Connection?

Before considering the safety of GLP-1 drugs for people with hemophilia, it's important to understand the link between hemophilia, diabetes, and obesity. Although these conditions may seem unrelated, individuals with hemophilia can face an increased risk of developing both obesity and type 2 diabetes.

Obesity

Obesity is defined as having a body mass index (BMI) of 30 or higher, calculated using a person's weight and height. Maintaining a healthy weight can be challenging for those with hemophilia, especially when physical activity is limited to prevent injury and bleeding. This is particularly true for people with hemophilic arthropathy (joint damage), which can make movement and exercise more difficult.

Type 2 Diabetes

Obesity is a significant risk factor for developing type 2 diabetes, and this risk extends to people with hemophilia. As rates of obesity rise, more individuals are managing both diabetes and hemophilia.

Given these overlaps, some people with hemophilia may be considered for GLP-1 medications to help manage their weight or blood sugar levels. But a key question remains: Are these drugs safe for those with hemophilia?

Potential Concerns for People With Hemophilia

The main concern for people with hemophilia when starting a new medication is its potential impact on bleeding and blood clotting. Hemophilia is a genetic condition that affects the blood’s ability to clot properly, making even minor injuries a significant concern.

Although GLP-1 drugs don’t directly affect blood clotting, they can cause side effects that may be problematic for people with hemophilia. For example, some people taking GLP-1 medications have reported digestive tract side effects such as nausea, vomiting, and diarrhea. These symptoms can lead to dehydration, which can alter blood pressure and reduce blood volume, potentially complicating the management of hemophilia.

Additionally, while weight loss can be beneficial for some people, it needs careful monitoring for those with hemophilia. Rapid weight loss, which may occur with GLP-1 drugs, can lead to muscle loss or increased frailty, raising the risk of joint bleeds or injuries. However, current research does not show that GLP-1 drugs directly increase the risk of bleeding.

Limited Research on GLP-1 and Hemophilia

There is currently very limited research on the effects of GLP-1 drugs specifically in people with hemophilia. Most clinical trials for these medications focus on people with type 2 diabetes and obesity. Because hemophilia is a rare condition, it is often excluded from studies that assess the safety of these drugs.

Due to the lack of targeted research, it’s not possible to definitively determine whether GLP-1 drugs are completely safe or unsafe for those with hemophilia. Available data suggest that GLP-1 drugs do not directly affect blood clotting factors or cause excessive bleeding in the general population. However, this does not rule out the possibility that people with hemophilia might experience unique side effects.

What Do Health Experts Say?

Due to the limited research on GLP-1 drugs in people with hemophilia, health care professionals often recommend using these medications with caution. Although GLP-1 drugs do not appear to directly increase bleeding risk or interfere with blood clotting, their long-term effects on people with hemophilia remain uncertain.

Health care providers advise weighing the potential benefits of GLP-1 drugs — such as better blood sugar control and weight loss — against possible unknown risks. For instance, if a person with hemophilia is already maintaining a healthy weight or does not have type 2 diabetes, these medications may not be necessary.

Because hemophilia presents unique challenges related to bleeding and joint health, it is essential to have a thorough discussion with a health care provider before starting any new medication. This helps ensure that all potential risks are carefully considered and that treatment plans are personalized to meet an individual’s overall health needs, including their hemophilia management.

Are There Alternatives?

If you have hemophilia and are concerned about using GLP-1 drugs, it’s worthwhile to discuss alternatives with your doctor. Several other medications and lifestyle approaches can help manage both weight and blood sugar levels.

Weight Management

Dietary changes and exercise (as appropriate for your condition) are typically the first line of treatment for weight management. Working with a registered dietitian who understands hemophilia can help you develop a plan that supports weight loss without putting too much strain on your joints.

Blood Sugar Control

For those with type 2 diabetes, medications such as metformin may be a safer option. Metformin helps reduce blood sugar levels and generally has different side effects compared to GLP-1 medications. Newer medications, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, can also help by encouraging the kidneys to remove excess blood sugar through urine. SGLT-2 inhibitors also have their own set of side effects that differ from those of GLP-1 drugs.

As always, the best choice of medication depends on your unique health history. What works well for one person may not be suitable for another.

Discuss GLP-1 Drugs With Your Doctor

Managing hemophilia requires a cautious approach, especially when considering new medications. GLP-1 drugs can provide benefits for people with diabetes and obesity, but their effects on individuals with hemophilia remain uncertain due to limited research. This makes it crucial to consider these medications with care.

If you are thinking about using a GLP-1 drug for weight management or blood sugar control, have a thorough discussion with your health care provider. They can help you evaluate the potential benefits and risks, taking into account your specific health needs and how your hemophilia might influence the decision.

Always consult your doctor before starting or stopping any medication. Staying informed and maintaining open communication with your health care team empowers you to make the best choices for your health and to manage your hemophilia safely.

Talk With Others Who Understand

On MyHemophiliaTeam, the social network for people with hemophilia and their loved ones, more than 6,600 members come together to ask questions, give advice, and share their stories with others who understand life with hemophilia.

Are you living with hemophilia and considering a GLP-1 medication? Share your experience in the comments below, or start a conversation by posting on your Activities page.