Muscle cramps on semaglutide — electrolyte imbalance management

Yes, eyelid twitching (myokymia) is a classic sign of magnesium deficiency. Very common complaint in my GLP-1 patients.

I want to emphasize that electrolyte monitoring should be part of routine follow-up for anyone on GLP-1 RAs, especially in the first few months. I check a BMP and magnesium at baseline, 1 month, 3 months, and then every 3-6 months. Too many prescribers write the script and don't do adequate monitoring.

The combination of reduced oral intake + potential GI losses (diarrhea, vomiting) + increased water intake diluting electrolytes = a perfect setup for deficiency.

Got my labs back — magnesium was 1.4 (low), potassium was on the low end at 3.6. Started magnesium glycinate 400 mg and eating a banana daily for potassium. Three days in and already sleeping better, cramps are less severe. Going to follow up in a month. Thanks everyone! 🙏

Adding a tip that helped me with nighttime calf cramps specifically: stretching my calves before bed. Just a wall stretch, 30 seconds each side. Between that and the magnesium, I went from getting jolted awake in agony to sleeping through the night. Simple stuff but it makes a huge difference when you're dealing with these.