What are the risks and management of fat necrosis associated with Ozempic (semaglutide) injections?

Fat Necrosis from Ozempic (Semaglutide) Injections: Risks and Management

While fat necrosis is a rare complication of subcutaneous injections, proper injection technique and site rotation are essential to minimize this risk with Ozempic (semaglutide) injections. 1

Risk of Fat Necrosis with GLP-1 Receptor Agonists

GLP-1 receptor agonists like semaglutide (Ozempic) have been associated with injection site reactions, though at a lower rate than insulin injections. According to the latest guidelines:

• Palpable subcutaneous nodules have been reported following delivery of once-weekly semaglutide 1
• The risk of lipohypertrophy (a form of lipodystrophy) is considerably less with GLP-1 receptor agonists compared to insulin 1
• Fat necrosis can manifest as severe, persistent, and well-localized pain at injection sites 2

Prevention Strategies

To minimize the risk of fat necrosis and other injection site complications:

1. Proper site rotation:

   • Follow systematic rotation schemes between and within injection sites 1
   • Use injection site maps or rotation apps to track injection locations 1
   • Avoid repeated injections in the same area 1

2. Correct injection technique:

   • Use appropriate needle length for subcutaneous delivery 1
   • Follow the same recommendations for injection technique as those used for insulin injections 1
   • Ensure proper depth of injection to avoid inadvertent intramuscular administration 3

3. Regular monitoring:

   • Regularly examine injection sites for nodules, induration, or pain 1
   • Perform visual and palpation examinations of injection sites during follow-up visits 1

Clinical Presentation and Diagnosis

Fat necrosis from injectable medications typically presents as:

• Sudden-onset, well-localized, and severe pain at the injection site 2
• Exquisitely tender subcutaneous nodule at the injection site 2
• May progress to skin changes or ulceration in severe cases 4

Diagnosis is best confirmed by:

• MRI, which shows characteristic findings of fat necrosis (central fat signal surrounded by a peripheral ring) 2
• Histological confirmation in cases requiring surgical intervention 2

Management of Fat Necrosis

If fat necrosis is suspected or confirmed:

1. Immediate actions:

   • Cease injections into the affected area 1
   • Document the site and size of the lesion for tracking purposes 1

2. Treatment options:

   • Conservative management for mild cases
   • Surgical excision for severe or persistent cases 2
   • Pain management as needed

3. Follow-up care:

   • Educate the patient on proper injection technique
   • Implement systematic site rotation
   • Regular monitoring of injection sites

Special Considerations

• Patients with obesity may have altered drug absorption from subcutaneous injections due to changes in tissue composition and depth 3
• Improper needle length selection in patients with obesity may lead to inadvertent administration into incorrect tissue layers 3
• Other potential adverse effects of subcutaneous injections include granulomas and calcification 3

By following proper injection techniques and site rotation protocols, the risk of fat necrosis with Ozempic injections can be significantly reduced, allowing patients to safely benefit from the medication's effects on glycemic control and weight management.