Ozempic (Semaglutide) Side Effects
Gastrointestinal side effects are the most common adverse reactions to Ozempic (semaglutide), including nausea (40%), vomiting (16%), diarrhea, and dyspepsia, which are typically dose-dependent and often transient. 1
Common Side Effects
Gastrointestinal Effects
- Nausea (40% vs 14.8% with placebo)
- Vomiting (16% vs 4.3% with placebo)
- Diarrhea
- Abdominal pain
- Constipation
- Dyspepsia (indigestion)
- Gastroesophageal reflux 2, 1
Other Common Side Effects
- Injection site reactions
- Elevated heart rate
- Hypoglycemia (especially when combined with insulin or sulfonylureas) 2
Serious Side Effects
Pancreatic Issues
- Pancreatitis - Stop using Ozempic immediately and contact healthcare provider if severe abdominal pain occurs (with or without vomiting) 3
- FDA label instructs to discontinue if pancreatitis is suspected and not restart if confirmed 3
Gallbladder Disorders
- Cholelithiasis (gallstones)
- Gallstone-related complications 2
Gastrointestinal Complications
- Severe constipation
- Small bowel obstruction/ileus progression 2
Kidney Problems
- Acute kidney injury - particularly when initiating or increasing dose in patients with existing kidney disease
- Dehydration from gastrointestinal side effects may worsen kidney function 3
Vision Changes
- Changes in vision during treatment should be reported to healthcare provider
- Diabetic retinopathy complications have been reported, particularly with rapid improvement in blood glucose control 2, 3
Serious Allergic Reactions
- Stop using and seek immediate medical help for symptoms like itching, rash, or difficulty breathing 3
Thyroid Concerns
- Black box warning: Risk of thyroid C-cell tumors in rodents (human relevance not determined)
- Contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 2, 1, 3
Management of Side Effects
| Adverse effect | Management |
|---|---|
| Nausea and vomiting | Avoid in gastroparesis; start at low dose and titrate slowly |
| Dyspepsia | Start at low dose and titrate slowly |
| Diarrhea | Reduce meal size |
| Gastrointestinal reflux | Limit alcohol and carbonated drinks |
| Constipation | Avoid high-fat diet |
| Gallbladder disorders | Monitor for symptoms |
| Cardiac arrhythmia/tachycardia | If symptomatic, monitor and consider beta blockers |
| [2,1] |
Dosing Considerations to Minimize Side Effects
The standard titration protocol for semaglutide is designed to minimize gastrointestinal side effects:
| Week | Semaglutide Dose |
|---|---|
| 1-4 | 0.25 mg weekly |
| 5-8 | 0.5 mg weekly |
| 9-12 | 1.0 mg weekly |
| 13-16 | 1.7 mg weekly |
| 17+ | 2.4 mg weekly (maintenance) |
| [1] |
Special Precautions
Pretreatment Assessment: Current pretreatment assessment approaches are often underdeveloped, particularly regarding disease history that might affect semaglutide use 4
Medication Absorption: Monitor for potential consequences of delayed absorption of oral medications, particularly those with narrow therapeutic index like warfarin 2
Contraception: Women using oral hormonal contraception should use or add a non-oral contraception method for 4 weeks after initiation and dose escalations 2
Pregnancy: Contraindicated in women who are or may become pregnant 2
Overdose Management: In case of overdose, supportive care is recommended, including antiemetics, correction of fluid and electrolyte imbalances, and monitoring for hypoglycemia 5
By understanding these potential side effects and following appropriate management strategies, patients can better navigate treatment with Ozempic while minimizing adverse reactions.