What bloodwork is recommended for patients on Ozempic (semaglutide)?

Bloodwork Monitoring for Ozempic (Semaglutide)

No specific routine bloodwork is mandated for patients on Ozempic, but baseline and periodic monitoring of renal function, glycemic parameters, and lipid panels is recommended to assess treatment efficacy and detect potential complications.

Pre-Initiation Baseline Testing

Before starting Ozempic, obtain the following baseline laboratory values:

• HbA1c to establish glycemic control baseline and set treatment targets 1
• Complete metabolic panel including serum creatinine and eGFR to assess renal function, as GLP-1 receptor agonists can affect kidney function through hemodynamic changes 1
• Lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) to evaluate cardiovascular risk factors 1
• Liver function tests (ALT, AST) as baseline, though no dose adjustment is required for hepatic impairment 2
• Thyroid function testing should be considered in patients with symptoms or risk factors, given the black box warning for thyroid C-cell tumors (though human relevance is undetermined) 1, 2

Ongoing Monitoring Schedule

During treatment, monitor the following parameters:

Glycemic Control Assessment

• HbA1c every 3 months initially to assess treatment efficacy, then quarterly once stable 1
• Fasting glucose or self-monitoring blood glucose as clinically indicated, particularly if combined with insulin or sulfonylureas due to hypoglycemia risk 1, 2

Renal Function Monitoring

• Serum creatinine and eGFR should be monitored when initiating or escalating doses, especially in patients with pre-existing chronic kidney disease 1
• Monitor eGFR in patients reporting severe gastrointestinal adverse reactions (nausea, vomiting, diarrhea), as volume depletion can precipitate acute kidney injury 1
• Urine albumin-to-creatinine ratio should be assessed periodically in diabetic patients to monitor for nephropathy progression or improvement 3

Lipid Profile

• Repeat lipid panel at 3-6 months after initiation to assess cardiovascular risk factor improvement, as semaglutide can reduce triglycerides and improve lipid profiles 1

Additional Safety Monitoring

• Liver enzymes if clinically indicated by symptoms, though routine monitoring is not required 2
• Amylase and lipase are NOT routinely recommended but should be checked if pancreatitis is suspected (severe persistent abdominal pain) 1, 4

Special Population Considerations

Patients with chronic kidney disease:

• No dose adjustment is required even in end-stage renal disease 1, 2
• However, monitor eGFR more frequently (every 1-3 months initially) when starting or escalating doses in patients with eGFR <60 mL/min/1.73 m² 1

Patients on concomitant diabetes medications:

• Check glucose levels more frequently if combined with insulin or sulfonylureas, as dose reductions of these agents may be necessary to prevent hypoglycemia 1, 2

Patients with cardiovascular disease:

• Standard cardiovascular risk monitoring including lipids and blood pressure, as semaglutide has proven cardiovascular benefits 1

Common Pitfalls to Avoid

• Do not discontinue monitoring renal function in patients with normal baseline eGFR, as gastrointestinal side effects can lead to dehydration and acute kidney injury 1
• Do not routinely check amylase/lipase unless pancreatitis is clinically suspected, as asymptomatic elevations are not clinically meaningful 4
• Do not delay treatment waiting for "perfect" baseline labs; the medication can be started with basic metabolic and glycemic assessment 2
• Do not forget to assess for diabetic retinopathy before initiating semaglutide in patients with pre-existing retinopathy, as rapid glycemic improvement may transiently worsen retinopathy 1, 4