Side Effects of Ozempic (Semaglutide)
The most common side effects of Ozempic (semaglutide) are gastrointestinal, including nausea, vomiting, diarrhea, abdominal pain, and constipation. 1, 2
Common Gastrointestinal Side Effects
- Nausea, vomiting, diarrhea, constipation, and abdominal pain are the most frequently reported adverse effects of semaglutide 1, 2, 3
- These gastrointestinal effects are typically dose-dependent and more pronounced during initial treatment or dose escalation 2, 3
- Gradual dose titration is recommended to minimize gastrointestinal side effects 3
- Dyspepsia and gastrointestinal reflux may also occur 4
Management of Gastrointestinal Side Effects
- Start semaglutide at a low dose and titrate upward slowly 4
- Reduce meal size to help manage nausea and vomiting 4
- Limit alcohol and carbonated drinks to reduce reflux symptoms 4
- Avoid high-fat diets to help with constipation 4
Serious Adverse Events
- Clinical trials show a 38% higher risk of serious adverse events with semaglutide compared to placebo 2, 3
- Potential serious adverse events include:
Pancreatic Issues
- Inflammation of the pancreas (pancreatitis) - stop using Ozempic and seek medical attention if experiencing severe abdominal pain that may radiate to the back, with or without vomiting 1, 2
Gallbladder Disorders
- Increased risk of gallbladder disease, including cholelithiasis (gallstones) and cholecystitis 2, 3
- These are typically uncommon but require monitoring 4
Kidney Problems
- Risk of kidney problems (kidney failure), particularly in patients with pre-existing kidney disease 1, 3
- Dehydration from diarrhea, nausea, and vomiting may worsen kidney problems 1
- Adequate fluid intake is important to reduce dehydration risk 1
Cardiovascular Considerations
- Cardiac arrhythmia/tachycardia may occur - if symptomatic, monitoring and consideration of beta blockers may be necessary 4
- Despite these concerns, semaglutide has shown cardiovascular benefits in clinical trials 2
Vision Changes
- Risk of diabetic retinopathy complications, particularly in patients with pre-existing retinopathy 1, 2
- Report any vision changes to healthcare providers 1
Hypoglycemia
- Risk of low blood sugar (hypoglycemia), especially when used with insulin or insulin secretagogues 1, 2
- Signs include dizziness, blurred vision, anxiety, sweating, slurred speech, hunger, confusion, weakness, headache, and fast heartbeat 1
Other Potential Side Effects
- Delayed gastric emptying, which may affect absorption of other medications 3, 5
- Risk of gastroparesis, especially in predisposed patients 6, 2
- Insomnia has been reported as a potential side effect 3
- Injection site reactions may occur 2
- Risk of suicidal ideation has been reported in some cases 2
Contraindications
- Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 2, 3
- FDA Black Box Warning regarding the risk of thyroid C-cell tumors based on rodent studies 2
- Pregnancy or breastfeeding 2
- Severe gastroparesis 2
Special Considerations
- Patients with severe renal impairment require careful monitoring but can generally use semaglutide 7, 2
- Caution in patients with prior gastric surgery, including bariatric surgery 2
- Potential for severe allergic reactions - seek immediate medical help if experiencing itching, rash, or difficulty breathing 1
Monitoring Recommendations
- Regular monitoring of renal function, especially in those with pre-existing kidney disease 2, 7
- Monitor for signs of pancreatitis and gallbladder disease 2, 3
- Monitor blood glucose levels, especially if taking other glucose-lowering medications 1
- Monitor for vision changes, particularly in patients with pre-existing diabetic retinopathy 1, 2