Ozempic is the buzziest diabetes drug in memory. It’s been a huge hit both inside and outside the diabetes community, particularly for its almost unprecedented effect on weight loss. It’s been so popular, in fact, that the manufacturer has reported shortages, partly driven by demand from people without diabetes. There are even new reports that Ozempic can help you drink less alcohol.
But Ozempic has some side effects, and certain patients even find the medicine intolerable. It is most strongly associated with gastrointestinal distress, including diarrhea and vomiting.
This article will discuss the side effects of Ozempic and related drugs, and what people in the diabetes community are doing about them.
Ozempic, in Brief
Ozempic is a brand name for semaglutide, a member of a family of drugs known as GLP-1 receptor agonists. These medications are among the most powerful glucose-lowering agents ever developed, and diabetes authorities are very excited about their potential for type 2 diabetes. Some clinicians are also eager to prescribe these drugs off-label for patients with type 1 diabetes.
Glucagon-like peptide 1 (GLP-1) is a hormone that stimulates insulin secretion after you eat; it helps you feel full and regulates your blood sugar. GLP-1 receptor agonists are drugs that mimic the effect of GLP-1. They help your body use GLP-1 and insulin properly, and can also help you feel full after eating. People often find themselves effortlessly cutting calories, leading to easy weight loss.
Ozempic is not the only drug on the market that works this way:
Wegovy is semaglutide marketed for weight loss rather than diabetes.
Rybelsus is an oral version of Ozempic.
Mounjaro is a newer drug that mimics two hormones, GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). The combination appears to be even more effective for weight loss.
While this article concentrates on Ozempic, the most famous of these related drugs, some of this advice may work for others in the same family, if they cause the same side effects.
Ozempic’s Gastrointestinal Side Effects
While many people feel perfectly healthy on Ozempic, the side effects can be pretty nasty for others. As a blogger for New York magazine’s “The Cut” put it, “You might go through Hell for your post-Ozempic body.” The author spoke to a 42-year-old woman with diabetes who endured “constant nausea” and “power-puking” for weeks, before finally weaning herself off the drug.
According to the U.S. Food and Drug Administration (PDF), placebo-controlled trials of Ozempic found the following rates of side effects from the 1 milligram (mg) dose:
Nausea: 20.3 percent
Vomiting: 9.2 percent
Diarrhea: 8.8 percent
Abdominal pain: 5.7 percent
Constipation: 3.1 percent
Smaller numbers reported symptoms such as acid reflux and excessive belching or flatulence.
All told, 30.8 percent of adults reported a gastrointestinal symptom. But that was only the 1 mg dose. The numbers were much higher in a trial of semaglutide (Wegovy) at 2.4 mg:
Nausea: 44.2 percent
Vomiting: 24.8 percent
Diarrhea: 31.5 percent
Abdominal pain: 10.0 percent
Constipation: 23.4 percent
Reports from the Diabetes Daily forum suggest that these unfortunate effects are strongest in the days immediately after injecting the once-weekly medication.
Semaglutide is generally titrated: You begin on a very small dosage and gradually work your way up to higher doses. Ozempic begins with a 0.25 mg dose, ideally for four weeks, and proceeds up to 0.5 mg, 1 mg, and finally 2 mg. Wegovy, the semaglutide formulation marketed specifically for weight loss, has five steps and a full dosage of 2.4 mg. Tirzepatide (Mounjaro) has an additional sixth step; it takes five months of patiently increasing the dosage before you get to the full-strength injection.
If you’re having gastrointestinal issues, it might be wise to slow down or even take a step back. You can stay at one of the low or intermediate doses for longer than four weeks.
Of course, you won’t decide your own titration schedule. That’s up to the doctor who prescribed your medication. If you’re bothered by the side effects, let your healthcare provider know. They may recommend putting off that next dosage increase or going back to a lower dosage.
Just Stick With It
Most of the time, Ozempic’s nasty side effects go away. If your side effects are uncomfortable but tolerable, it might be best to just stick with the drug and continue to benefit from its positive metabolic effects. Many members of the Diabetes Daily community have endured these tummy troubles for weeks but have come out on the other side feeling perfect.
Treat Your Symptoms
Don’t just allow yourself to be miserable: Treat your symptoms.
Dehydration is no joke. Hydration is surprisingly important for people with diabetes, and the dehydration that reliably results from diarrhea or vomiting can make glucose management not only more difficult but also more dangerous. Drink plenty of water and also consider beverages that can help replace electrolytes, like zero-sugar Gatorade or bone broth.
Reach out to your doctor without delay and ask them what other medications you should be taking for your side effects. They may recommend an over-the-counter diarrhea medication or may prescribe something more powerful, such as prescription-strength antinausea medication.
Watch Your Diet
The miracle of Ozempic is that it will allow you to feel full while eating less food, resulting in a nearly effortless caloric deficit.
People using Ozempic are often surprised by how quickly they feel full. If you fill your plate with as much food as you used to, you can easily eat yourself to an upset stomach. Be prepared to change your eating and snacking habits, perhaps rapidly.
Some users also report that the kind and quality of food that you eat matters, too. There’s no official guidance on this topic, though the label says that you should stick with the healthy diabetes diet that your doctor recommends. Pay attention to what you’re eating; you might find that some foods cause more stomach distress than others.
Ask Your Doctor About Switching Medicines
Ozempic is a powerful medication, but it’s certainly not the only option for diabetes management and weight loss. If the side effects are making your life miserable, it might be time to switch.
If you’re struggling with Ozempic, an injected medication, ask your doctor about oral semaglutide (Rybelsus). Perhaps you’ll tolerate it better.
Other GLP-1 receptor agonists are good options, too. Dulaglutide (Trulicity) and liraglutide (Victoza) are also associated with weight loss and improved glycemic control. Tirzepatide (Mounjaro), the only GIP/GLP-1 receptor agonist on the market, appears to be even stronger than Ozempic.
SGLT2 inhibitors, including canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance), help flush excess glucose out of the body through the urine. Though they are not associated with the same dramatic weight loss as semaglutide, they are known to drive modest weight loss and have several other major long-term health benefits.
This is a decision that cannot be made without the consultation of an expert. If Ozempic just isn’t working for you, talk to your doctor about these other options.
Other Side Effects
Increased Heart Rate
In trials, Ozempic increased heart rates across the board by 1 to 6 beats per minute. We have read anecdotes from Ozempic users who are nervous about their hearts racing for no good reason.
Evidently, experts are not much concerned by this change, but it might be a good idea to keep an eye on your heart rate, especially if your resting heart rate spends much time outside of the normal range of 60 to 100 beats per minute.
While Ozempic is not itself associated with a significant risk of low blood sugar, its glucose-lowering effect can sharply increase the odds that insulin or sulfonylureas cause hypoglycemia.
It’s very likely that you’ll need to change the amount of other diabetes drugs that you use. Your doctor may ask you to be extra vigilant about checking your blood sugar. If you’re not comfortable changing your insulin-dosing practices by yourself, you should be ready to contact your doctor between visits to get clearance for making adjustments.
Rare, Serious Side Effects
Ozempic also leads to a small number of rare but serious side effects:
Pancreatitis, in which the digestive enzymes attack the pancreas, may feel like intense stomach pain that radiates to your back.
Changes in vision: There is a chance that Ozempic will exacerbate diabetic retinopathy.
Kidney failure. There have been some cases of semaglutide contributing to kidney disease. Dehydrating side effects, particularly diarrhea and vomiting, may enhance this risk.
Gallbladder disease may present with severe stomach pain, yellowing of the eyes or skin, fever, and “clay-colored stools.”
Finally, the one Ozempic side effect that everyone is talking about: so-called “Ozempic face.”
To put it simply, people using Ozempic can lose so much weight that they also lose healthy-looking fat from their faces, which can result in a saggy, aged appearance.
There is no evidence that Ozempic or any other similar drug directly affects your facial appearance. Ozempic face is purely caused by weight loss.