Semaglutide, known commercially as Ozempic and Wegovy, mimics the action of glucagon-like peptide-1 (GLP-1). It is widely used to improve blood sugar control in type 2 diabetes and is approved for chronic weight management in individuals with obesity or who are overweight with related health conditions. Like all prescription treatments, semaglutide carries common effects and a few serious, though rare, risks. This article details the safety considerations, from routine side effects to contraindications and monitoring requirements.
Understanding Common Adverse Reactions
The most frequent side effects experienced by people taking semaglutide are related to the gastrointestinal system. These reactions result from the medication slowing down the movement of food through the stomach and intestines. Nausea is the most commonly reported symptom, often followed by diarrhea, vomiting, constipation, and abdominal pain.
These gastrointestinal effects are generally mild to moderate and tend to resolve as the body adjusts to the medication. They are also dose-dependent, meaning they are most pronounced when treatment is started or the dose is increased. To manage these reactions, patients are advised to eat slowly and consume smaller, more frequent meals. Focusing on bland, low-fat foods and avoiding greasy or overly sweet items can help reduce symptom severity. Staying well-hydrated is also important, especially if vomiting or diarrhea occurs, to prevent dehydration.
Serious Safety Warnings and Rare Risks
Semaglutide carries several serious safety warnings, the most notable of which is included as a Boxed Warning by the Food and Drug Administration (FDA). This warning concerns the risk of thyroid C-cell tumors, specifically medullary thyroid carcinoma (MTC). This caution is based on findings from rodent studies where semaglutide caused dose-dependent thyroid tumors.
It is currently unknown whether this risk translates to humans, but the warning necessitates that patients with a personal or family history of MTC, or those with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), must not use the medication. Patients should be aware of symptoms of a thyroid tumor, such as a lump in the neck, persistent hoarseness, or difficulty swallowing. Another serious risk is acute pancreatitis, an inflammation of the pancreas. Patients must immediately stop taking semaglutide and seek medical attention if they experience severe, persistent upper abdominal pain that may radiate to the back and be accompanied by vomiting.
Gallbladder issues, including gallstones, have also been reported with semaglutide use. This risk is believed to be associated with the rapid and substantial weight loss that the medication can induce. Symptoms of gallbladder problems include pain in the upper stomach, fever, and yellowing of the skin or eyes. Semaglutide can also increase the risk of hypoglycemia (low blood sugar), particularly when combined with other blood sugar-lowering medications like insulin or sulfonylureas. This combination may require a dose reduction of the other diabetes medications to prevent symptoms like dizziness or confusion. Severe gastrointestinal reactions leading to dehydration can also cause acute kidney injury, particularly in patients with pre-existing kidney issues.
Patient Contraindications and Screening Requirements
Specific pre-existing conditions or medical histories make the use of semaglutide unsafe, requiring thorough screening before a prescription can be issued. The medication is absolutely contraindicated for anyone with a personal or family history of medullary thyroid carcinoma (MTC). Similarly, individuals with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) must also avoid semaglutide.
The medication should not be used by patients who have had a severe allergic reaction to semaglutide or any of its components. Pregnancy and breastfeeding are also contraindications, and women of childbearing age are advised to stop the medication for a specified period before attempting conception. While semaglutide can be used cautiously in some patients with chronic kidney disease, those with severe renal impairment or end-stage renal disease (ESRD) require close monitoring. Another important consideration for screening is the potential for worsening diabetic retinopathy, which is linked to a rapid and significant improvement in blood sugar control.
Safe Administration and Ongoing Monitoring
To minimize the common gastrointestinal side effects, the administration of semaglutide begins with a slow and careful dose titration schedule. This gradual escalation, starting at a low dose and increasing every four weeks, allows the body time to adjust to the medication. If a patient experiences significant gastrointestinal issues, the dose may be maintained for a longer period, or a slower upward titration may be used to improve tolerability.
Ongoing monitoring is necessary to track the patient’s response and watch for any signs of the rare, serious risks. Regular assessment of kidney function, typically through measuring creatinine and estimated Glomerular Filtration Rate (eGFR), is performed, especially when starting the drug or increasing the dose. Patients need to be educated on recognizing the symptoms of serious complications, such as the severe abdominal pain indicative of pancreatitis or the signs of gallbladder issues. Proper injection technique and storage of the medication are also important for ensuring safe and effective use.