Holding Ozempic (Semaglutide) During Acute Illness
You are asking about Ozempic (semaglutide, a GLP-1 receptor agonist), but your evidence pertains to empagliflozin and dapagliflozin (SGLT2 inhibitors)—these are entirely different drug classes with different sick day management rules. For SGLT2 inhibitors like empagliflozin, the answer is clear: yes, they must be held during acute illness. For Ozempic specifically, the guidance differs.
Critical Distinction: SGLT2 Inhibitors vs GLP-1 Receptor Agonists
SGLT2 Inhibitors (Empagliflozin/Dapagliflozin) - MUST BE HELD
Temporarily discontinue SGLT2 inhibitors during any acute illness, particularly when patients experience reduced food and fluid intake, fever, vomiting, or diarrhea. 1
Specific Sick Day Rules for SGLT2 Inhibitors:
Hold immediately during fever, vomiting, diarrhea, or any intercurrent illness requiring hospitalization 1
Withhold at least 3 days before major surgery or procedures requiring prolonged fasting to prevent postoperative ketoacidosis 1
Monitor for euglycemic diabetic ketoacidosis (DKA) even with normal blood glucose levels—this is a serious risk during illness with SGLT2 inhibitors 1
Check blood or urine ketones if patients develop malaise, nausea, or vomiting 1
The diuretic effect of SGLT2 inhibitors combined with illness-related fluid losses significantly increases risk of hypovolemia 1
When to Restart SGLT2 Inhibitors:
Resume only after patient has recovered from acute illness 1
Resume only after normal oral intake is re-established 1
Critical Safety Point for Insulin Users:
Maintain at least low-dose insulin in insulin-requiring individuals even when SGLT2 inhibitors are held, as complete insulin cessation increases DKA risk 1
Do not reduce insulin doses excessively when holding SGLT2 inhibitors during illness 1
GLP-1 Receptor Agonists (Ozempic/Semaglutide) - Different Guidance
GLP-1 receptor agonists like Ozempic do NOT carry the same mandatory sick day hold requirements as SGLT2 inhibitors. The primary concerns with GLP-1 RAs during illness are:
Nausea and vomiting may be exacerbated during acute illness, potentially worsening dehydration
Reduced oral intake during illness may increase hypoglycemia risk if combined with insulin or sulfonylureas
Volume depletion is less of a concern than with SGLT2 inhibitors, as GLP-1 RAs do not have osmotic diuretic effects
Practical Approach for Ozempic During Illness:
Consider temporary discontinuation if severe nausea/vomiting prevents adequate hydration
Continue Ozempic if patient can maintain oral intake and is not experiencing severe GI symptoms
Reduce or hold concurrent insulin/sulfonylureas to prevent hypoglycemia if oral intake is reduced
No specific requirement to hold before surgery unless NPO status is prolonged (>24 hours)
Patient Education Requirements
For SGLT2 Inhibitor Users (Empagliflozin):
Counsel patients to stop immediately when they become sick and contact their healthcare provider 1
Educate on specific triggers: reduced ability to eat or drink normally, fever, vomiting, diarrhea 1
Instruct to seek immediate medical attention if symptoms of DKA develop (nausea, vomiting, abdominal pain, malaise) 1
For Ozempic Users:
Educate on monitoring for severe nausea/vomiting that prevents hydration
Maintain contact with healthcare provider during illness for guidance on continuation
Monitor blood glucose more frequently during illness
Common Pitfall to Avoid
Do not confuse sick day management between SGLT2 inhibitors and GLP-1 receptor agonists. SGLT2 inhibitors have a mandatory hold requirement due to DKA and volume depletion risks that do not apply to GLP-1 RAs. The evidence provided focuses on SGLT2 inhibitors, which require strict sick day protocols, whereas Ozempic management is more individualized based on GI tolerance and hydration status.