Is there any data about using GLP-1 medications in patients with quadriplegia or neurogenic bowels?

Comment by InpharmD Researcher

There is no high-quality evidence establishing GLP-1 RA safety or efficacy specifically in patients with neurogenic bowel. Spinal cord injury (SCI) specific evidence consists primarily of a very small semaglutide-controlled case series, a tirzepatide case report in a patient with C6 tetraplegia, and recent narrative/clinical reviews. Available reports describe weight loss with semaglutide or tirzepatide; however, the semaglutide case series did not report bowel-function results by treatment group or injury level, and the tirzepatide case report documented no diarrhea or constipation after 6 months. Overall, no study specifically evaluated GLP-1 RA safety, efficacy, or bowel-related outcomes in patients with neurogenic bowel.

PubMed, Google Scholar, and Embase were searched using combinations of “GLP-1 receptor agonist,” semaglutide, tirzepatide, quadriplegia, tetraplegia, spinal cord injury, and neurogenic bowel. Direct clinical evidence was limited to a small controlled case series and a case report, with additional mechanistic and prescribing-pattern studies identified in the broader SCI population.

Background

A 2026 review article synthesized existing evidence regarding glucagon-like peptide-1 receptor agonists and dual agonists (GLP-1s) as pharmacologic treatments for obesity and cardiometabolic disease in individuals with spinal cord injury (SCI). Given the disproportionate burden of neurogenic obesity and associated cardiometabolic risk in SCI, alongside limited effectiveness of lifestyle interventions alone, the review emphasized the potential clinical relevance of GLP-1 therapies, which have demonstrated substantial weight loss and cardiometabolic improvements in the general population. The review integrated data from phase 3 trials and case series, including a controlled case series of semaglutide in five sedentary adults with chronic SCI that reported average body weight reductions of 6 kg, notable decreases in fat mass and visceral adiposity, and modest improvements in glycemic control. Additionally, a single case report described a chronic C6 motor-complete SCI patient achieving a 14 kg weight loss over three months with tirzepatide, alongside lipid profile improvements and minimal gastrointestinal side effects. Unique SCI-specific challenges and potential adverse effects related to GLP-1 use were discussed, such as exacerbation of preexisting gastrointestinal dysfunction, risk of nutrient deficiencies due to suppressed hunger and altered satiety, and accelerated lean mass and bone mineral density loss that could compound injury-related musculoskeletal vulnerability and increase pressure injury risk. Given these complexities, it underscored the need for cautious dosing with slow titration, individualized risk-benefit assessments, and integration of GLP-1 pharmacotherapy with SCI-tailored nutritional strategies and resistance or electrically stimulated exercise to preserve muscle and bone health. Practical clinical guidance included monitoring for gastrointestinal intolerance, micronutrient adequacy, mood disorders, and early signs of complications such as superior mesenteric artery syndrome. The article called for rigorous, adequately powered SCI-specific trials to clarify optimal dosing, long-term safety, efficacy, and functional outcomes to support evidence-based incorporation of GLP-1 therapy into comprehensive obesity and cardiometabolic management in this vulnerable population. [1]

A 2026 systematic review aggregated clinical evidence from 11 individual case reports and 1 case series encompassing 13 adult patients who developed suspected or confirmed gastroparesis associated with GLP-1RA therapy for diabetes or weight loss; none were identified as having quadriplegia or neurogenic bowel. Data extraction encompassed patient demographics, GLP-1RA type, dosing patterns, symptom onset timing, diagnostic methods including gastric emptying scintigraphy, management strategies, and clinical outcomes. Findings revealed a predominant involvement of female patients aged 18 to 74 years, with 11 of 13 having type 2 diabetes, although non-diabetic patients were also affected. Semaglutide emerged as the most frequently implicated GLP-1RA, followed by liraglutide, dulaglutide, and exenatide, with symptom onset ranging from within 24 hours to approximately 3 months after treatment initiation, re-exposure, dose escalation, or overdose. Clinical presentations were consistent with gastroparesis features such as nausea, vomiting, early satiety, abdominal pain, bloating, and oral intolerance. Diagnostic evaluation commonly included imaging and endoscopy that excluded mechanical obstruction but demonstrated gastric distension or retained contents. Six patients underwent gastric emptying scintigraphy confirming delayed emptying; among patients who underwent repeat scintigraphy after GLP-1RA discontinuation, gastric emptying normalized. Management centered on withdrawal of the offending agent, supplemented with supportive care such as antiemetics, prokinetics (notably metoclopramide), intravenous fluids, and, in some cases, gastric decompression. Outcomes were favorable in nearly all cases, with symptom resolution reported following GLP-1RA discontinuation, although one patient experienced a more prolonged or complicated course. Overall, this review describes GLP-1RA–associated gastroparesis in the general adult population but provides no direct evidence regarding GLP-1RA use in patients with quadriplegia or neurogenic bowel. [2]

A 2026 retrospective cohort study used de-identified electronic health record data from more than 60 U.S. healthcare organizations to evaluate GLP-1 receptor agonist prescribing among individuals with obesity with and without SCI (see Table 4). After balancing the cohorts for age, gender, race, and type 2 diabetes, individuals with SCI were significantly less likely to receive a GLP-1RA than those without SCI (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.61–0.73). When complete and incomplete SCI were compared separately with individuals without SCI, no significant differences in GLP-1RA prescribing were observed; however, individuals with complete SCI had lower odds of receiving a GLP-1RA than those with incomplete SCI (OR 0.71; 95% CI 0.52–0.96). The study demonstrates lower GLP-1RA prescribing among individuals with obesity and SCI but does not identify the factors responsible for this difference or evaluate the safety or efficacy of GLP-1RAs in this population. Further studies are needed to elucidate the factors influencing these prescribing patterns. [3]

Background References: [1] Farkas GJ, Solinsky R, Park AJ. GLP-1 Receptor Agonists as Pharmacologic Treatment for Obesity After Spinal Cord Injury: Clinical Considerations. Arch Phys Med Rehabil. 2026 Aug;107(8):2227-2236. doi:10.1016/j.apmr.2026.02.498
[2] Olubodun T, Osundina MA, Soyoye DO, de Oliveira NMB, Olubodun AB, Ogundele OO. Gastroparesis induced by glucagon-like peptide-1 receptor agonists: A systematic review of clinical features, diagnosis, management, and outcomes. PLoS One. 2026 Aug 13;21(8):e0354497. doi:10.1371/journal.pone.0354497
[3] Thatte S, Oleson CV, Haberman J, Burke S, Al Arabia DH, Wilson JR. Differences in Prescribing Rates of Glucagon-Like Peptide-1 Receptor Agonists Between Spinal Cord Injured and Non-Spinal Cord Injured Individuals: A Retrospective Study. Top Spinal Cord Inj Rehabil. 2026;32(3):185-195. doi:10.46292/sci25-00066
Literature Review

A search of the published medical literature revealed 4 studies investigating the researchable question:

Is there any data about using GLP-1 medications in patients with quadriplegia or neurogenic bowels?

Level of evidence

D - Case reports or unreliable data  Read more→


Please see Tables 1-4 for your response.

Treatment of Obesity in Spinal Cord Injury with Tirzepatide: A Case Report

Design

  Case Report

Case presentation

A male patient in his 40s with a C6 American Spinal Injury Association Impairment Scale B spinal cord injury sustained 15 years previously presented for management of obesity. Despite working with multiple dietitians, previously receiving phentermine, following dietary modifications—including a 1600-kcal/day diet composed of 40% carbohydrates, 30% fat, and 30% protein—and performing upper-extremity weightlifting five times weekly and modified hand cycling at least twice weekly, he was unable to lose weight.

Tirzepatide was initiated at 2.5 mg subcutaneously once weekly as an adjunct to diet and exercise through an automatic 20-week dose-escalation program; the dose was increased to 7.5 mg weekly during the second month and 15 mg weekly during the third month. According to the reported weight measurements, his weight decreased from 255 pounds at baseline to 248 pounds after 1 month, 244 pounds after 2 months, and 229 pounds after 3 months, representing a 26-pound reduction at 3 months. During the third month, tirzepatide was temporarily discontinued during a 1-month hospitalization for a thermal injury; his weight decreased further to 224 pounds by discharge while following a standardized diet.

Tirzepatide 15 mg weekly was resumed after discharge, and his weight was 222 pounds after 1 year, representing a total reduction of 33 pounds from baseline. Total cholesterol, LDL cholesterol, triglycerides, and the total cholesterol-to-HDL ratio were lower 2 months after treatment initiation than on a lipid panel obtained 2 years before treatment, while HDL cholesterol decreased from 41 to 38 mg/dL. Mild heartburn was the only adverse effect reported throughout treatment, and the patient reported no diarrhea or constipation after 6 months. His medical history included neurogenic bladder and a colostomy; the report did not explicitly identify neurogenic bowel or describe genitourinary outcomes during tirzepatide treatment.

Study Author Conclusions

The metabolic dysfunction associated with SCI and barriers to adequate exercise for weight loss place individuals with SCI at increased risk for obesity and CMD. Tirzepatide may be a practical, safe, and effective adjunct therapy to exercise and dietary intervention to help facilitate weight loss and prevent CMD in those with SCI. Further research is indicated to examine the long-term efficacy, benefits, and adverse effects that may be associated with tirzepatide. To the author’s knowledge, this is the first case report of tirzepatide being used to treat obesity associated with SCI.
Table 1 References:
[4] Juszczak M, Shem K. Treatment of obesity in spinal cord injury with tirzepatide: a case report. Spinal Cord Ser Cases. 2025 Mar 1;11(1):4. doi:10.1038/s41394-025-00699-w

Preliminary Observations on the Administration of a Glucagon-like Peptide-1 Receptor Agonist on Body Weight and Select Carbohydrate Endpoints in Persons with Spinal Cord Injury: A Controlled Case Series
Design

Open-label, randomized drug intervention case series

N= 5
Objective

To describe the effect of semaglutide, a glucagon-like peptide-1 (GLP-1) agonist, to reduce body weight and improve glycemic control in overweight or obese individuals with spinal cord injury (SCI)
Study Groups

Semaglutide (n= 3)

Control (n= 2)
Inclusion Criteria

Five individuals with chronic SCI meeting criteria for obesity and abnormal carbohydrate metabolism
Exclusion Criteria

Personal and/or family history of medullary thyroid carcinoma; personal and/or family history of multiple endocrine neoplasia syndrome type 2; personal and/or family history of pancreatitis; existing diagnosis of diabetes mellitus; reduced kidney function (GFR <60 ml/min) or abnormal liver function tests (AST and ALT ≥2.5 times above the upper limit of normal); elevated calcitonin level > 50 pg/mL; pregnancy or women who may become pregnant; medically unstable due to an acute illness or infection; diminished mental capacity to provide informed consent
Methods

Participants were randomized 1:1 by the research pharmacist to once-weekly subcutaneous semaglutide or no treatment; only investigators were blinded to group assignment. Semaglutide was initiated at 0.25 mg once weekly for 4 weeks and increased to 0.50 mg and then 1 mg at weeks 4 and 8, respectively, if fasting plasma glucose remained ≥100 mg/dL or HbA1c remained ≥5.6%; all treated participants required 1 mg. Body composition was measured by DXA at baseline and week 26. Fasting plasma glucose, HbA1c, renal and hepatic laboratory values, the 10-Question Bowel Function Survey, and the Bowel Management item-bank short form were assessed at baseline and weeks 4, 8, and 26. Participants were contacted weekly to identify changes from baseline health status. Because of the small sample, only descriptive statistics and absolute changes were reported; inferential testing was not performed.
Duration

26 weeks
Outcome Measures

Primary: Change in total body weight (TBW), fat tissue mass (FTM), total body fat percent (TBF%), and visceral adipose tissue volume (VATvol)

Secondary: Fasting plasma glucose (FPG) concentration and serum glycated hemoglobin (HbA1C) values
Baseline Characteristics

 

 Semaglutide (n= 3) Control (n= 2)

Age, years

 47 (11) 53 (4)

Height, cm

 186.3 (12.8) 181.6 (1.8)

Weight, kg

 103.2 (17.7) 106.7 (14.7)

BMI, kg/m2

 29.5 (1.2) 32.6 (4.1)

Duration of Injury, years

 28 (11) 29 (6)
Results

 

 Semaglutide (n= 3) Control (n= 2)

Change in TBW, kg

 -6.0 (2.1) +3.3 (4.6)

Change in FTM, kg

 -4.4 (2.5) +4.5 (2.5)

Change in TBF%

 -1.7 (0.6) +2.5 (5.1)

Change in VATvol, cm3

 -674 (200) +991 (1365)

Change in FPG, mg/dl

 -17 (4) +11 (3)

Change in HbA1C, %

 -0.2 (0.1) +0.3 (0.1)
Adverse Events

No major safety concerns were observed. AST, ALT, and GFR values remained within normal limits for all participants. 
Study Author Conclusions

Administration of semaglutide for 26 weeks resulted in favorable changes in body composition and glycemic control, suggesting a reduced risk for the development of cardiometabolic disease in obese individuals with SCI. 
Critique

This randomized controlled case series provides direct, although preliminary, data on semaglutide use in five wheelchair-dependent men with chronic SCI, including two participants with cervical SCI, and incorporates validated bowel-function assessments. Interpretation is substantially limited by the sample size, premature study termination, absence of inferential testing, lack of bowel-function results by treatment group or injury level, and no disclosed gastrointestinal adverse-event data; therefore, the study does not specifically establish safety or efficacy in patients with quadriplegia or neurogenic bowel.
Table 2 References:
[5] Cirnigliaro CM, La Fountaine MF, Sauer SJ, Cross GT, Kirshblum SC, Bauman WA. Preliminary observations on the administration of a glucagon-like peptide-1 receptor agonist on body weight and select carbohydrate endpoints in persons with spinal cord injury: A controlled case series. J Spinal Cord Med. 2024 Jul;47(4):597-604. doi:10.1080/10790268.2023.2207064

Gastrointestinal Dysmotility and Impaired Gut Peptide-satiety Coupling in Men with Spinal Cord Injury
Design

Pilot study with two laboratory visits

N= 32
Objective

To examine gut transit, hormone responses, and satiety ratings after standardized meals in men with and without SCI to identify factors contributing to energy overconsumption in neurogenic obesity
Study Groups

Men with SCI (n= 16)

Controls without SCI (n= 16)
Inclusion Criteria

Adults aged 18 years or older; SCI participants ≥12 months post-injury with tetraplegia (C5-C8) or paraplegia (T1-L2), AIS A, B, or C classification, non-ambulatory and wheelchair-dependent, adhering to a bowel care program
Exclusion Criteria

On a weight loss program, history of prediabetes, diabetes, thyroid disease, GI or neurological conditions, recent abdominal surgery, swallowing disorder, GI obstruction, food allergies, or use of certain medications. Under 18 or pregnant
Methods

Participants consumed standardized meals during two visits. GI motility was measured using the SmartPill Wireless Motility Capsule. Blood samples were collected to assess postprandial levels of GI peptides, glucose, insulin, and triglycerides. Hunger and satiety ratings were collected pre- and post-prandially. 
Duration

24 months
Outcome Measures

Primary: Differences in GI transit, gut hormone release, postprandial metabolic responses, and hunger and satiety ratings

Secondary: Associations between GI transit times, circulating appetite-related hormones, and hunger and satiety ratings
Baseline Characteristics

 

 Controls (n=16) SCI (n=16) p-value

Age, years

 41.6 ± 14.4 42.1 ± 14.9 0.88

Weight, kg

 85.3 ± 17.5 79.3 ± 16.8 0.57

Height, cm

 179.8 ± 7.4 175.6 ± 9.1 0.27

Body mass index, kg/m2

 26.3 ± 4.8 25.8 ± 5.2 0.83

Race

Caucasian/White

African American/Black

Other

 

10 (63.0%)

4 (25.0%)

2 (13%)

 

14 (87.5%)

2 (12.5%)

0

0.26

-

-

-

Ethnicity

Hispanic/Latino

Non-Hispanic/Latino

 

6 (38.0%)

10 (63.0%)

 

6 (37.5%)

10 (62.5%)

0.97

-

-
Results

Compared to controls, men with SCI exhibited prolonged upper GI transit time (p = 0.043, d =-0.75), colonic (p = 0.007, d =-1.22), small-large bowel (p = 0.007, d =-1.22), and whole gut (p = 0.007, d =-1.34) transit times. Persons with SCI also demonstrated a trend toward delayed gastric emptying compared to controls (p = 0.078, d =-0.61). Small bowel transit time was not different between the groups (p = 0.427, d =-0.33). For PeptideYY, circulating levels were consistently lower in the SCI group, with moderate to large between-group effects observed at both the -60 min (d = 1.1) and -15 min (d = 0.9) baseline time points, as well as in the early postprandial period at 0 min (d = 0.9) and 30 min (d =0.5). No group differences or time × group interactions were observed (all, p > 0.50), suggesting similar overall hunger and satiety response patterns between men with and without SCI.

Across all participants, GLP-1 iAUC was positively associated with fullness iAUC (β = 0.06, p = 0.021); however, the association was weaker in SCI (interaction β =-0.09, p = 0.020), suggesting a blunted satiety response to GLP-1. The association between insulin iAUC and GLP-1 iAUC was stronger in in dividuals with SCI compared to the controls (interaction β = 2.10, p = 0.027), suggesting a compensatory incretin response in SCI due to impaired glucose dynamics. 
Adverse Events

No specific adverse events reported
Study Author Conclusions

Differences in gut-brain and metabolic signaling in SCI may impair appetite regulation and contribute to neurogenic obesity. There is a need for further investigation into gut-brain communication in relation to food intake.
Critique

This pilot study provides indirect mechanistic information; it included men with chronic SCI, including 8 with tetraplegia, and demonstrated gastrointestinal dysmotility and altered endogenous GLP-1–satiety coupling. However, no GLP-1 medication was administered, and the study did not evaluate treatment efficacy, safety, or effects on neurogenic bowel. The small, all-male sample and cross-sectional laboratory assessments further limit generalizability.
Table 3 References:
[6] Farkas GJ, Cunningham PM, Berg AS, Jimsheleishvili G, Mendez AJ, Gater DR Jr, Nash MS, Rolls BJ. Gastrointestinal dysmotility and impaired gut peptide-satiety coupling in men with spinal cord injury. Physiol Behav. 2026 Mar 1;305:115207. doi:10.1016/j.physbeh.2025.115207

Differences in Prescribing Rates of Glucagon-Like Peptide-1 Receptor Agonists Between Spinal Cord Injured and Non-Spinal Cord Injured Individuals: A Retrospective Study
Design

Retrospective cohort study

N= not specified
Objective

To determine if prescribing rates of GLP-1RAs in individuals with obesity differ between those with and without SCI
Study Groups

Obesity without spinal cord injury (n= not disclosed)
Inclusion Criteria

Individuals with obesity, with or without SCI, within 5 years of meeting inclusion criteria
Exclusion Criteria

Individuals with a prior history of bariatric surgery or GLP-1RA use
Methods

Two cohorts were identified using deidentified electronic health record data from the TriNetX platform and evaluated for GLP-1 receptor agonist prescribing within 5 years after meeting the inclusion criteria. One cohort had obesity without spinal cord injury, while the other had obesity and spinal cord injury. The cohorts were balanced for age, gender, race, and type 2 diabetes mellitus. Prescribing rates were compared between individuals with and without spinal cord injury and among complete and incomplete spinal cord injury subgroups.
Duration

Within 5 years of meeting inclusion criteria
Outcome Measures

GLP-1 receptor agonist prescribing rates within 5 years among individuals with obesity, comparing: (1) any spinal cord injury versus no spinal cord injury; (2) complete spinal cord injury versus no spinal cord injury; (3) incomplete spinal cord injury versus no spinal cord injury; and (4) complete versus incomplete spinal cord injury
Baseline Characteristics

The cohorts included individuals with obesity with or without spinal cord injury and were balanced for age, gender, race, and type 2 diabetes mellitus. Cohort sizes and specific baseline values were not disclosed in the abstract.
Results

Individuals with obesity and spinal cord injury had lower odds of receiving a GLP-1 receptor agonist prescription than those without spinal cord injury (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.61–0.73).

Prescribing rates did not differ significantly when the complete and incomplete spinal cord injury subgroups were separately compared with individuals without spinal cord injury; however, individuals with complete spinal cord injury had lower odds of receiving a prescription than those with incomplete spinal cord injury (OR 0.71; 95% CI 0.52–0.96).
Adverse Events

Not assessed
Study Author Conclusions

GLP-1RA prescribing rates are significantly lower in individuals with obesity and any degree of SCI compared with non-SCI individuals. Future studies will help elucidate factors that influence prescribing patterns.
Critique

The study used multicenter electronic health record data and balanced the cohorts for several relevant characteristics. However, the abstract does not disclose the sample size, specific prescribing rates, or clinical outcomes and does not report whether participants had quadriplegia or neurogenic bowel; therefore, it provides evidence about GLP-1 receptor agonist prescribing in the broader spinal cord injury population but does not directly evaluate safety, efficacy, or bowel-related effects.
Table 4 References:
[7] Thatte S, Oleson CV, Haberman J, Burke S, Al Arabia DH, Wilson JR. Differences in Prescribing Rates of Glucagon-Like Peptide-1 Receptor Agonists Between Spinal Cord Injured and Non-Spinal Cord Injured Individuals: A Retrospective Study. Top Spinal Cord Inj Rehabil. 2026;32(3):185-195. doi:10.46292/sci25-00066