Can dizziness be a side effect of Ozempic (semaglutide) in patients, particularly those with a history of hypoglycemia, kidney disease, or cardiovascular disease?

Is Dizziness a Side Effect of Ozempic?

Yes, dizziness is a recognized side effect of Ozempic (semaglutide), occurring in more than 0.4% of patients in placebo-controlled trials, though it is generally less common than gastrointestinal side effects. 1

Direct Evidence from FDA Labeling

The FDA-approved prescribing information for Ozempic explicitly lists dizziness as an adverse reaction with a frequency greater than 0.4%, alongside fatigue and dysgeusia. 1 This establishes dizziness as a documented side effect based on clinical trial data.

Mechanisms and Risk Factors for Dizziness

Hypoglycemia-Related Dizziness

• Patients taking insulin or sulfonylureas face substantially increased risk of hypoglycemia when Ozempic is added, which can manifest as dizziness. 1
• In combination with sulfonylureas, documented symptomatic hypoglycemia occurred in 17.3-24.4% of patients, and severe hypoglycemia in 0.8-1.2% of patients. 1
• When combined with basal insulin, documented symptomatic hypoglycemia occurred in 16.7-29.8% of patients. 1
• Reduce sulfonylurea dose by 50% or discontinue if already on minimal dose, and reduce total daily insulin by 20% when initiating Ozempic to minimize hypoglycemia risk. 2

Volume Depletion and Orthostatic Hypotension

• Ozempic has a diuretic effect that may cause volume depletion, particularly in elderly patients or those on concurrent diuretic therapy. 2
• Patients should monitor for orthostatic lightheadedness and contact their clinician if symptoms occur. 2
• This mechanism is especially relevant in patients with cardiovascular disease or those taking multiple antihypertensive medications. 2

Kidney Disease Considerations

• Patients with chronic kidney disease may experience more pronounced effects due to altered drug clearance and increased baseline cardiovascular risk. 3, 4
• In patients with moderate renal impairment (eGFR 30-59 mL/min/1.73 m²), Ozempic showed an initial decline in eGFR during the first 12-16 weeks that plateaued thereafter, though this was not associated with increased adverse events. 3
• Severe renal impairment can result from vomiting and dehydration caused by gastrointestinal side effects, potentially contributing to dizziness. 2

Clinical Monitoring Recommendations

Before Initiating Ozempic

• Assess for hypoglycemia risk factors: current use of insulin or sulfonylureas, history of hypoglycemia, erratic eating patterns. 1
• Evaluate volume status: check for concurrent diuretic use, baseline blood pressure including orthostatic measurements, and signs of dehydration. 2
• Review kidney function: obtain baseline eGFR and UACR, particularly in patients with known kidney disease. 3

During Treatment

• First 3-4 weeks: Patients on insulin or sulfonylureas should self-monitor blood glucose levels closely. 2
• Monitor for volume depletion signs: orthostatic lightheadedness, dizziness upon standing, decreased urine output. 2
• Check renal function within first several weeks, particularly in patients with baseline renal impairment, as some patients may be "hyperresponders" with more pronounced eGFR decline. 2

Common Pitfalls to Avoid

• Do not assume all dizziness is benign: Differentiate between hypoglycemia-related dizziness (which requires immediate glucose monitoring and medication adjustment) versus volume depletion (which may require fluid management). 1, 2
• Do not overlook medication interactions: The combination of Ozempic with other medications that lower blood pressure or cause volume depletion (diuretics, ACE inhibitors, ARBs) increases dizziness risk. 2
• Do not ignore gastrointestinal symptoms: Severe nausea and vomiting can lead to dehydration and secondary dizziness, particularly during dose escalation. 1
• Elderly patients require extra vigilance: Age-related physiological changes increase susceptibility to orthostatic hypotension and volume depletion. 2

Cardiovascular Disease Context

In patients with established cardiovascular disease, dizziness warrants careful evaluation as it may indicate hemodynamic instability. 2 However, semaglutide has demonstrated cardiovascular safety and benefit across a broad spectrum of kidney function and cardiovascular risk, with consistent MACE reduction regardless of baseline eGFR or albuminuria. 5