Ozempic

Ozempic (semaglutide) pill and injection are prescription medications used for type 2 diabetes to improve blood glucose levels and reduce the risk of heart attack, stroke, and the injection can also be used to slow kidney disease progression in certain type 2 diabetes patients.

Semaglutide, the active ingredient of Ozempic, is also used for weight loss and weight management under the brand name Wegovy.

Ozempic pills are taken once daily in the morning with water at least 30 minutes before eating food, drinking beverages or taking other oral medications.

Ozempic injection is self-administered once weekly as a subcutaneous injection (under the skin) using an Ozempic pen.

Ozempic tablets and injections are FDA-approved for type 2 diabetes in adults to:

• improve blood sugar control
• reduce the risk of a major cardiovascular event (MACE), such as a heart attack, stroke, or death, in type 2 diabetic patients who are at high risk for these events

Ozempic injection is also FDA approved in adults for:

• reducing the risk of kidney function decline, kidney failure, and cardiovascular death in patients with type 2 diabetes and chronic kidney disease (CKD)

Ozempic pills and injections should be used with a reduced-calorie diet and increased physical activity.

Ozempic is a GLP-1 receptor agonist that mimics GLP-1, a hormone your body releases after you eat.

Ozempic works by:

• Increasing insulin levels when blood sugar is high.
• Reducing glucagon to reduce sugar release from the liver.
• Slow stomach emptying so food leaves the stomach more gradually
• Reduce appetite and enhance fullness, helping people eat less.

These effects help improve blood sugar levels, reduce risk of major cardiovascular events, kidney function decline, and help with weight loss.

Ozempic Injection Instructions

You should read the Instructions for Use carefully and ask your pharmacist or doctor to explain any part you do not understand. It is important to use this medicine exactly as directed. Do not take more or less of it or more often than your doctor prescribes.

Ozempic injection is a pre-filled pen injected under the skin (subcutaneously).

• Ozempic is usually given 1 time a week
• It can be given with or without meals at any time of the day
• It may be injected under the skin of the thigh, abdomen, or upper arm.
• You should rotate the injection site for each dose.
• If using Ozempic with insulin, you may give insulin in the same area, but they should not be given right next to each other. Do not mix insulin and Ozempic in the same injection.

The day of weekly administration can be changed if necessary, as long as the time between two doses is at least 2 days (>48 hours).

Ozempic Pill Instructions

• Take Ozempic tablets once a day.
• Take the tablet when you first wake up and at least 30 minutes before you eat or drink anything.
• Take the tablet with a small amount of water (no more than 4 ounces, or 120ml). Do not take the tablets with any other liquids besides water.
• Swallow the tablet whole and do not crush, chew, or break it.
• After 30 minutes of taking the tablet, you may eat, drink, or take other oral medicines.

Take tablets exactly as prescribed by your doctor by following all directions on your prescription label and reading all medication guides or instruction sheets.

This medicine is usually started at a low dose that is gradually increased every 4 weeks to 30 days. Follow your doctor's dosing instructions very carefully.

Ozempic has a boxed warning for the risk of thyroid C-cell tumors. Ozempic and medicines that work in a similar way caused thyroid tumors, including thyroid cancer, in trials with rodents. It is not known if Ozempic will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.

• If you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath, tell your healthcare provider, as these may be symptoms of thyroid cancer.
• If you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC), or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), you should not use this medicine.

Severe gastrointestinal adverse reactions, including stomach paralysis. Postmarketing data have shown an association between semaglutide and ileus (stomach paralysis). Because these reports are voluntary, it is not possible to estimate the frequency of these effects. Talk to a healthcare provider if you develop symptoms such as bloating, stomach cramps or pain, nausea or vomiting, constipation or diarrhea, or loss of appetite. Ozempic is not recommended for patients with severe gastroparesis.

Acute pancreatitis has been observed in patients being treated with medicines like semaglutide. If you have signs and symptoms of pancreatitis, including persistent severe abdominal pain, sometimes radiating to the back, and which may or may not be accompanied by vomiting, seek medical advice immediately.

Serious hypersensitivity reactions may occur, including anaphylaxis and angioedema. Discontinue Ozempic if hypersensitivity reactions are suspected and promptly seek medical advice.

Acute kidney injury due to volume depletion has been reported in postmarketing reports occurring in patients who experienced nausea, vomiting, or diarrhea, leading to dehydration. If you have persistent or extended nausea, vomiting, and diarrhea, you need to drink fluids to help reduce your chance of dehydration and see your healthcare provider immediately.

Diabetic retinopathy complications have been reported in a clinical trial; therefore, patients with a history of diabetic retinopathy should be monitored.

Low blood glucose levels (hypoglycemia), including severe hypoglycemia, may occur if this medicine is used with an insulin secretagogue or insulin. It may be necessary to reduce the dose of the insulin secretagogue or insulin.

Acute gallbladder disease may occur, including gallstones within the gallbladder (cholelithiasis) or inflammation of the gallbladder(cholecystitis). Gallbladder studies are indicated if these are suspected.

Pulmonary aspiration during general anesthesia or deep sedation has been reported in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures. Instruct patients to inform healthcare providers of any planned surgeries or procedures.

You should not use this medicine if you are allergic to semaglutide or any other ingredients in this medicine, or if you have:

• multiple endocrine neoplasia type 2 (tumors in your glands); or
• a personal or family history of medullary thyroid carcinoma (a type of thyroid cancer).

To make sure this medicine is safe for you, tell your doctor if you:

• have a stomach or intestinal disorder
• have severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems with digesting food
• have or have had pancreas problems (pancreatitis)
• are planning surgery or other procedure that requires anesthesia or deep sedation
• have kidney disease
• have eye problems caused by diabetes (retinopathy)
• are pregnant or intending to become pregnant
• are breastfeeding or intending to breastfeed.

This medicine caused thyroid tumors or thyroid cancer in animal studies. It is not known whether these effects would occur in people. Ask your doctor about your risk.

Also, talk to your healthcare provider about what side effects Ozempic may cause before you start taking it.

Pregnancy

It is not known if Ozempic will harm an unborn baby. Talk to your healthcare provider before you become pregnant because it is recommended you stop using this medicine at least 2 months before you get pregnant. If you do become pregnant while taking semaglutide, tell your healthcare provider right away.

Semaglutide may indirectly improve fertility by promoting weight loss and better blood sugar control (see Ozempic babies: Does Ozempic increase fertility?).

Talk to your healthcare provider about the best way to control your blood sugar if you plan to become pregnant or while you are pregnant.

Breastfeeding

It is not known if Ozempic passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using the injection. Breastfeeding is not recommended during treatment with Ozempic tablets.

Common Ozempic side effects

Common Ozempic side effects include nausea, vomiting, decreased appetite, diarrhea, abdominal pain, and constipation, which occurred in 5% or more of patients.

Serious Ozempic side effects

Ozempic has a boxed warning for the risk of thyroid C-cell tumors. A boxed warning is the strongest safety-related warning issued by the FDA.

Ozempic can cause serious side effects, such as inflammation of the pancreas, vision changes, low blood sugar levels, kidney problems, and serious allergic reactions, and it can also increase the risk of food or liquid getting into your lungs during surgery or a medical procedure. See the warning section for more details on these serious side effects and the risk of thyroid C-cell tumors.

Get emergency medical help if you have signs of an allergic reaction, such as hives, itching, dizziness, fast heartbeats, difficulty breathing, or swelling of your face, lips, tongue, or throat.

This medicine can cause other serious side effects. Call your healthcare provider at once if you have:

• vision changes;
• pounding heartbeats or fluttering in your chest;
• a light-headed feeling, like you might pass out;
• signs of a thyroid tumor - swelling or a lump in your neck, trouble swallowing, a hoarse voice, feeling short of breath;
• symptoms of pancreatitis - severe pain in your upper stomach spreading to your back, nausea with or without vomiting, fast heart rate;
• gallbladder problems - upper stomach pain, fever, clay-colored stools, jaundice (yellowing of the skin or eyes);
• low blood sugar - headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery;
• kidney problems - swelling, urinating less, blood in urine, feeling tired or short of breath
• stomach flu symptoms - stomach cramps, vomiting, loss of appetite, diarrhea (may be watery or bloody)
• symptoms of stomach paralysis (ileus) - bloating, stomach cramps or pain, nausea or vomiting, constipation or diarrhea, loss of appetite.
• Food or liquid getting into the lungs during surgery or other procedures that require anesthesia or deep sedation. Ozempic may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking this medicine before you are scheduled to have surgery or other procedures.

Also see “What are the long-term side effects of Ozempic?”

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Following these tips may help you manage stomach side effects:

• eat more slowly
• consume smaller meals
• select more bland, low-fat foods (like crackers, toast, and rice)
• avoid greasy, fried foods or sugar treats
• eat foods that contain water (like soup or gelatin)
• don’t lie down right after eating
• drink clear or ice-cold liquids
• if possible, go outside for fresh air if you feel sick to your stomach.

Ozempic and type 2 diabetes

In the SUSTAIN 1 trial (NCT02054897), 73% of people with type 2 diabetes taking Ozempic 0.5 mg injection reached an A1C of 7% or less within 30 weeks.

Ozempic for CKD and heart disease

The FLOW phase 3b clinical trial (NCT03819153) demonstrated that when Ozempic 1 mg injection was used in adults with type 2 diabetes and CKD, Ozempic demonstrated:

• 24% reduced the risk of kidney disease progression, kidney failure, and cardiovascular death at 3 years when compared to placebo.

Ozempic for weight loss

Ozempic’s active ingredient, semaglutide, is used for weight loss and weight management, under the brand name Wegovy.

Semaglutide, the active ingredient in Ozempic injection, was shown to be effective for weight loss in a 30-week semaglutide SUSTAIN 1 clinical trial (NCT02054897). Semaglutide patients had:

• 7.7 lbs (3.5 kg) more weight loss than placebo (with a 1 mg injection dose)
• 5.7 lbs (2.6 kg) more weight loss than placebo (with a 0.5 mg injection dose)

Ozempic injection helped with weight loss and weight loss maintenance when used with diet and exercise in clinical trials, however, it is not FDA-approved for weight loss. Wegovy is the brand of semaglutide approved for weight loss. See Wegovy vs Ozempic: Which is right for you? Or Ozempic for weight loss, for more information.

Ozempic Injection Dosing Information

Ozempic injection is given as a once-weekly injection under the skin (subcutaneous injection), using an autoinjector (pen).

Ozempic should be started at a low dose to reduce the risk of gastrointestinal side effects.

Ozempic Injection Dose for Blood Sugar Control

• Weeks 1 through 4: 0.25 mg dose 1 time a week.
• Weeks 5 through 8: 0.5 mg dose 1 time a week.
• If additional glycemic control is needed, increase the dosage to 1 mg once weekly after at least 4 weeks on the 0.5 mg dose.
• If additional glycemic control is needed, increase the dosage to 2 mg once weekly after at least 4 weeks on the 1 mg dosage.

Usual maintenance dose: 0.5 mg, 1mg or 2 mg injected one time a week.

Maximum dosage: Do not exceed 2 mg injected one time a week.

Ozempic injection dose for Type 2 Diabetes Mellitus and Chronic Kidney Disease

• Weeks 1 through 4: 0.25 mg dose 1 time a week.
• Weeks 5 through 8: 0.5 mg dose 1 time a week.
• Week 9 onward: Increase the dosage to 1 mg once weekly after at least 4 weeks on the 0.5 mg dosage.

Ozempic pen strengths

Ozempic injection is available in 3 strength options:

• 0.25 mg or 0.5 mg dose pen (4 doses of 0.25 mg and 2 doses of 0.5 mg, or 4 doses of 0.5 mg)
• 1 mg dose pen (4 doses per pen)
• 2 mg dose pen (4 doses per pen)

Each Ozempic pen carton contains 4 NovoFine Plus needles with 1mg and 2mg pens and 6 NovoFine Plus needles with the 0.25/0.5mg dose pen.

Each injection is pre-filled and intended to be used by one patient only, even if the needle is changed.

Ozempic Pill Dosing Information

Starting Ozempic Dosage (Initiation phase):

• Days 1 through 30: 1.5 mg orally once daily (this dose is not effective for glycemic control).

Escalation and Maintenance Ozempic Dosage:

• Days 31 to 60: 4 mg orally once daily.
• Day 61 or thereafter if: If no additional glycemic control is needed, then maintain the dosage at 4 mg orally once daily. If additional glycemic control is needed, then increase the dosage to 9 mg orally once daily.

Switching from Ozempic Injection to Ozempic Tablets

From the Ozempic injection 0.5 mg dose, may switch to Ozempic tablets.

• One week after discontinuing Ozempic 0.5mg injection, start taking 4 mg or 9 mg of Ozempic tablets orally once daily.

Switching Between Rybelsus and Ozempic Pills

You can only switch between Rybelsus and Ozempic tablets after the initiation phase (days 1 to 30). When switching between Rybelsus and Ozempic tablets, start the new semaglutide tablet product the day after stopping the previous semaglutide tablet product.

Dose conversion from Rybelsus to Ozempic Pills (escalation or maintenance phase)

Switching from Ozempic Injection to Rybelsus Tablets

From the Ozempic injection 0.5 mg dose, may switch to Rybelsus tablets.

• One week after discontinuing Ozempic 0.5mg injection, start taking 7 mg or 14 mg of Rybelsus tablets orally once daily.

Ozempic Pill Formulations

Ozempic pill is available as 1.5 mg, 4 mg, and 9 mg.

Never share an injection, even if you changed the needle. Sharing this device can pass infection or disease from person to person.

For the injection: If a dose is missed, administer Ozempic as soon as possible within 5 days after the missed dose. If more than 5 days have passed, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once-weekly dosing schedule. For the pill: If you miss a dose, skip the missed dose and go back to your regular schedule.

If you take too much Ozempic, call your healthcare provider or Poison Help line at 1-800-222-1222 or go to the nearest hospital emergency room right away.

Ozempic cost may be as little as $25 for a 1-month, 2-month, or 3-month supply for up to 48 months with the Savings or Ozempic Coupon card, if you have commercial or private insurance.

Ozempic cost for injection depends on whether you have insurance, your insurance plan, the pharmacy you use, and if you are eligible for Savings or an Ozempic Coupon card.

For more information on Ozempic cost, see our Ozempic price guide or How much is Ozempic with or without insurance?

This medicine can slow your digestion, and it may take longer for your body to absorb any medicines you take by mouth.

Tell your doctor about all your other prescription and over-the-counter medicines, especially insulin or other diabetes medicines, such as dulaglutide, exenatide, liraglutide, Byetta, Trulicity, Victoza, and others. There is an increased risk of hypoglycemia (low blood sugar) when Ozempic is used in combination with insulin or other diabetes medications such as glyburide, glipizide, glimepiride, or gliclazide. The dosage of these other agents may need to be reduced to lower the risk of low blood sugar levels.

Drinking alcohol while taking this medicine may be risky, see Can I drink alcohol on Ozempic?.

Other drugs, including prescription and over-the-counter medicines, vitamins, and herbal products, may affect this medicine. Tell your healthcare provider about all the other medicines you take.

Ozempic Pen Storage

Unopened Ozempic Pens

• Store unopened injection pens in the original carton in a refrigerator between 36ºF to 46ºF (2ºC to 8ºC).
• Do not freeze. Discard any medicine that has been frozen.
• Do not use past the expiration date.

After first use

• The Ozempic injection pen contains multiple doses.
• After your first use, store the pen with the needle removed in a refrigerator or at room temperature.
• Protect from heat and light.
• Keep the cap on when you are not using it.
• Discard pen 56 days after first opening it.
• Do not reuse a needle. Place it in a puncture-proof "sharps" container and dispose of it following state or local laws. Keep out of the reach of children and pets.

Ozempic Tablet Storage

• Store at room temperature between 68°F and 77°F (20°C to 25°C).
• Store in a dry place away from moisture.
• Store tablets in the original closed bottle until you are ready to take one. Do not store in any other container.
• Keep all medicines out of the reach of children.

HCPs and patients often use the Ozempic Prescribing Information (Injection) or Ozempic Tablet Prescribing Information for more detailed information about this medicine. The Prescribing Information contains more comprehensive information on Indications and Usage, Dosage and Administration, Clinical Pharmacology, Clinical Studies, Drug Interactions, and more. Discuss any medical questions you have with your HCP (health care professional). This is not all the information you need to know about this medicine for safe and effective use, and it does not take the place of talking to your doctor about your treatment.

The Prescribing Information is sometimes called the Ozempic Package Insert or the FDA label.

Active Ingredient: semaglutide

Ozempic Injection Inactive Ingredients: disodium phosphate dihydrate, propylene glycol, phenol, and water for injection.

Ozempic Tablet Inactive Ingredients: magnesium stearate and salcaprozate sodium

Ozempic pills and injections are manufactured by Novo Nordisk, a Danish multinational pharmaceutical company based in Bagsværd, Denmark, with a history dating back to 1923. The company specializes in diabetes care, hormone replacement therapy, and treatments for rare endocrine and blood disorders.

Novo Nordisk also makes Wegovy, Rybelsus, Victoza, and Saxenda.