From the Guidelines
Ozempic (semaglutide) can cause significant short-term and long-term side effects, including gastrointestinal issues, pancreatitis, and potential kidney problems, emphasizing the need for careful patient selection, gradual dose titration, and ongoing monitoring 1.
Short-term Side Effects
The most common short-term side effects of Ozempic include:
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Constipation These side effects typically occur during the first few weeks of treatment and often improve as the body adjusts to the medication 1. Patients may also experience decreased appetite, headaches, dizziness, fatigue, and injection site reactions.
Long-term Side Effects
Long-term side effects may include:
- Thyroid C-cell tumors (based on animal studies, though human risk is unknown)
- Potential kidney problems in patients with existing kidney disease
- Diabetic retinopathy complications
- Gallbladder problems including gallstones Weight loss, while often a desired effect, can be significant and should be monitored 1.
Recommendations
To minimize the risk of gastrointestinal adverse effects, gradual dose titration is recommended for semaglutide, starting at 0.25 mg weekly and increasing every 4 weeks until the maintenance dose of 2.4 mg is reached 1. Patients should stay well-hydrated and report severe or persistent symptoms to their healthcare provider immediately. The medication works by mimicking GLP-1, a hormone that regulates blood sugar and appetite, which explains many of these effects.
Safety Considerations
Pancreatitis has been reported in clinical trials, but causality has not been established, and use caution is advised in people with kidney disease due to the potential risk of acute kidney injury 1. Monitoring for potential consequences of delayed absorption of oral medications and gastrointestinal disorders is also recommended. A black box warning exists for the risk of thyroid C-cell tumors in rodents, although human relevance has not been determined 1.
From the FDA Drug Label
When initiating WEGOVY, consider reducing the dose of concomitantly administered insulin or insulin secretagogue (such as sulfonylureas) to reduce the risk of hypoglycemia [see Drug Interactions (7)]. There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which have in some cases required hemodialysis, in patients treated with semaglutide. Use of WEGOVY has been associated with gastrointestinal adverse reactions, sometimes severe [see Adverse Reactions (6. 1)]. Serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) have been reported with WEGOVY. Diabetic retinopathy was reported by 4% of WEGOVY-treated patients and 2.7% placebo-treated patients. Treatment with WEGOVY was associated with increases in resting heart rate. Suicidal behavior and ideation have been reported in clinical trials with other weight management products. WEGOVY delays gastric emptying [see Clinical Pharmacology (12. 2)]. The following serious adverse reactions are described below or elsewhere in the prescribing information: • Risk of Thyroid C-Cell Tumors [see Warnings and Precautions (5.1)] • Acute Pancreatitis [see Warnings and Precautions (5. 2)] • Acute Gallbladder Disease [see Warnings and Precautions (5.3)] • Hypoglycemia [see Warnings and Precautions (5.4)] • Acute Kidney Injury [see Warnings and Precautions (5.5)] • Severe Gastrointestinal Adverse Reactions [see Warnings and Precautions (5.6)] • Hypersensitivity Reactions [see Warnings and Precautions (5.7)]
The short-term and long-term side effects of Ozempic (semaglutide) include:
- Hypoglycemia: risk of hypoglycemia, especially when used with insulin or insulin secretagogues 2
- Acute kidney injury: reports of acute kidney injury and worsening of chronic renal failure 2
- Severe gastrointestinal adverse reactions: sometimes severe, including nausea, vomiting, and diarrhea 2
- Hypersensitivity reactions: serious hypersensitivity reactions, including anaphylaxis and angioedema 2
- Diabetic retinopathy: increased risk of diabetic retinopathy complications, especially in patients with a history of diabetic retinopathy 2
- Increased heart rate: treatment with WEGOVY was associated with increases in resting heart rate 2
- Suicidal behavior and ideation: reported in clinical trials with other weight management products 2
- Pulmonary aspiration: rare postmarketing reports of pulmonary aspiration during general anesthesia or deep sedation 2
- Thyroid C-cell tumors: risk of thyroid C-cell tumors 2
- Acute pancreatitis: risk of acute pancreatitis 2
- Acute gallbladder disease: risk of acute gallbladder disease 2
From the Research
Short-term Side Effects of Ozempic (Semaglutide)
- Gastrointestinal side effects such as nausea, vomiting, and abdominal pain are common short-term side effects of semaglutide, as reported in studies 3, 4, 5
- Injection-site reactions and allergic reactions are also possible short-term side effects 3
- Hypoglycemia is a potential short-term side effect, particularly when semaglutide is used in combination with other diabetes medications 3
Long-term Side Effects of Ozempic (Semaglutide)
- Increased risk of biliary disease (cholelithiasis) is a potential long-term side effect of semaglutide 3
- Potential increased risk of pancreatic cancer and thyroid cancer, although the evidence is still limited and inconclusive 3
- Semaglutide may also increase the risk of acute kidney injury and worsen existing diabetic retinopathy, particularly in patients with type 2 diabetes 3, 6, 7
- However, semaglutide has also been shown to have kidney-protective effects in patients with type 2 diabetes and chronic kidney disease, reducing the risk of major kidney disease events and slowing the decline in estimated glomerular filtration rate (eGFR) 6, 7
Special Considerations
- Patients with chronic kidney disease (CKD) may be at increased risk for certain side effects, such as gastrointestinal adverse events, and should be closely monitored while taking semaglutide 4, 7, 5
- Semaglutide may be effective in reducing albuminuria and slowing kidney disease progression in patients with CKD, both with and without diabetes 6, 7, 5