Side Effects of Ozempic (Semaglutide)
Ozempic (semaglutide) commonly causes gastrointestinal side effects including nausea, vomiting, diarrhea, abdominal pain, and constipation, with a 38% higher risk of serious adverse events compared to placebo. 1
Common Side Effects
Gastrointestinal Effects
- Nausea and vomiting: Most frequent adverse effects, typically dose-dependent 1
- Diarrhea: Common side effect reported in FDA labeling 2
- Constipation: Reported in ≥5% of patients 2
- Abdominal pain: Listed among most common adverse reactions 2
- Dyspepsia: Can occur during treatment 1
- Gastroesophageal reflux: May develop during therapy 1
These gastrointestinal side effects are typically mild-to-moderate and transient, with severity decreasing over time. Gradual dose titration helps mitigate these adverse effects 1.
Other Common Side Effects
- Injection site reactions: Can occur with subcutaneous formulation 3
- Elevated heart rate: Observed in clinical trials 1
Serious Adverse Events
Pancreatic Issues
- Pancreatitis: Stop using Ozempic immediately and seek medical attention if severe abdominal pain occurs that may radiate to the back, with or without vomiting 2
- GLP-1 receptor agonists have been associated with increased risk of pancreatitis 1
Gallbladder Disease
- Cholelithiasis (gallstones): Increased risk with semaglutide use 1
- Cholecystitis: Reported in clinical trials 1
- Semaglutide increases the risk of biliary disease 3
Cardiovascular Effects
- Cardiac arrhythmia/tachycardia: May require monitoring and consideration of beta blockers if symptomatic 1
Kidney Problems
- Acute kidney injury: In people with existing kidney problems, dehydration from gastrointestinal side effects may worsen kidney function 2
- Adequate fluid intake is important to reduce dehydration risk 2
Other Serious Concerns
- Diabetic retinopathy complications: Patients at risk should be carefully monitored, particularly if also treated with insulin 3
- Allergic reactions: Stop using and seek medical help immediately if symptoms of serious allergic reaction occur, including itching, rash, or difficulty breathing 2
- Hypoglycemia: Risk increases when combined with sulfonylureas or insulin 2
Contraindications
- Personal or family history of medullary thyroid carcinoma 1
- Multiple endocrine neoplasia syndrome type 2 1
- Pregnancy 4
Management of Side Effects
For Gastrointestinal Effects
- Start at low dose and titrate slowly to improve tolerability 1
- Reduce meal size to help with digestive symptoms 1
- Limit alcohol and carbonated drinks to reduce reflux 1
- Avoid high-fat diet to minimize constipation 1
- Maintain adequate hydration to prevent dehydration, especially important for kidney function 2
For Hypoglycemia
- Monitor blood glucose levels regularly
- Have fast-acting glucose sources available
- Be aware of hypoglycemia symptoms: dizziness, blurred vision, anxiety, sweating, slurred speech, hunger, confusion, weakness, headache, fast heartbeat 2
Special Considerations
- Gastroparesis: Avoid use in patients with existing gastroparesis as semaglutide may delay gastric emptying and worsen symptoms 5
- Medication absorption: Semaglutide may delay gastric emptying, potentially affecting absorption of other medications 1
- Chronic kidney disease: Recent evidence suggests potential benefits in reducing albuminuria in patients with CKD, but gastrointestinal adverse events remain more common than with placebo 6
While semaglutide is effective for weight loss and glycemic control with cardiovascular benefits, patients should be informed about the range of potential side effects and monitored appropriately, especially during the initial titration period.