What to Know About Ozempic (Semaglutide Injection)

A GLP-1 Agonist for Type 2 Diabetes

Patient using insulin pen on thigh

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Ozempic (semaglutide injection) is a medication prescribed to help manage type 2 diabetes in adults. It belongs to a class of drugs known as glucagon-like peptide 1 (GLP-1) receptor agonists. These drugs also are referred to as incretin mimetics, because they mimic the functions of the incretin hormones naturally released by the pancreas when food is eaten. These include insulin, which plays a key role in how the body utilizes food, and glucagon—a hormone that triggers the liver to release stored sugar into the bloodstream. Ozempic was approved for type 2 diabetes by the U.S. Food and Drug Administration (FDA) in December of 2017. It's worth noting that research has shown that GLP-1 receptor agonists, including Ozempic, can have other health benefits for people with type 2 diabetes, including positive effects on blood pressure, cholesterol levels, and beta-cell function.

Uses

Ozempic is used as an adjunct to a diet and exercise plan devised to help control blood glucose levels in adults who have type 2 diabetes. It's important to note that Ozempic is not appropriate for treating type 1 diabetes (diabetes mellitus).

Off-Label Uses

There's some evidence GLP-1 agonists may help people who are obese lose weight by signaling the brain to eat and drink less, and also by slowing the rate at which food is emptied from the stomach, which results in a prolonged feeling of fullness. In one study of Ozempic, researchers noted that "semaglutide was associated with less hunger and food cravings, better control of eating and a lower preference for high‐fat foods." For this reason, the drug may sometimes be prescribed as a weight loss treatment.

Before Taking

It's important to note that Ozempic (like other GLP-1 agonists) is not a first-line treatment for diabetes. Before your doctor prescribes it, you will have been on an oral diabetes medication such as Metformin that has failed to adequately control your blood glucose levels. He or she may add Ozempic to your medication or have you try it separately.

Precautions and Contraindications

Overall, Ozempic has been found to be a safe medication. However, there are three groups of people who should not take it—namely, those who have a history of:

  • Thyroid cancer (see discussion of boxed warning below)
  • Diabetic retinopathy, an adverse effect of diabetes that involves the eyes. It's been found that Ozempic increases the risk of complications associated with diabetic retinopathy.
  • Pancreatitis. Studies have found people taking Ozempic have experienced both acute and chronic pancreatitis (inflammation of the pancreas). Even people who don't have pancreatitis should be attuned to any signs and symptoms of pancreatitis, such persistent severe abdominal pain, sometimes radiating to the back with or without vomiting.

In addition, be aware that there are certain circumstances in which it may not advisable to Ozempic:

  • You have a known allergy to semaglutide or another GLP-1 agonist, or to any other medication or any of the ingredients in Ozempic.
  • You take insulin or a sulfonylurea (an oral medication for controlling blood glucose), as Ozempic may interfere with how they're absorbed.
  • You're pregnant or breastfeeding. If you plan to become pregnant, tell your doctor. He probably will advise you to stop taking Ozempic and wait two months before you try to conceive.
  • You've recently had diarrhea, nausea, or vomiting.
  • You aren't able to drink liquids by mouth, which may cause dehydration.

Dosage

According to the manufacturer, Novo Nordisk, when you start Ozempic you should begin by taking 0.25 mg once a week for four weeks. The purpose of this four-week period is for initiation; you will not experience changes in your blood glucose levels.

The dose should then be increased to 0.5 mg per week. If after at least four weeks of taking Ozempic at this dose blood glucose levels are not where they should be, the dose should be increased once again, to 1 mg per week.

[All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.]

How to Take

Ozempic comes in a disposable device called a FlexTouch pen. There are two sizes—one that delivers either 0.25 milligrams (mg) or 0.5 mg of medication per injection, and another that delivers 1 mg of Ozempic per injection. The first pen contains enough medication for six doses (and six disposable needles), the second contains four doses (and four needles).

For most people, the pen is much easier to master than a traditional needle and syringe. Ozempic is administered subcutaneously, that is, into fatty tissue of the abdomen, thigh, or upper arm. Your doctor or a certified diabetes educator will show you how to inject yourself.

You can schedule your doses of Ozempic for any day of the week, at any time. Be consistent, but if you find you need to switch to a different day for convenience, it's OK to do so as long as it has been 2 or more days (48 or more hours) since your last dose.

If you happen to forget an injection, nothing bad will happen, but it's important to administer the missed dose within five days. However, if more than five days have passed since your last dose, skip the missed one and then continue taking Ozempic as usual.

One advantage of premeasured doses is that it's difficult to take too much of the drug at once, However, if you inadvertently do so, let your doctor know right away. Ozempic has a long half-life, meaning it will stay in your system for some time, and so you'll need to be monitored for any adverse effects of having too much in your system at once.

Storage and Disposal

Ozempic pens should be kept in the refrigerator (not the freezer), away from the cooling unit, with the caps on, until needed. Once a pen has been used it can be stored at room temperature or in the fridge. The pens also can be stored at room temperature during travel but should not be kept in the glove compartment of a car or other hot place.

Make a note of the date you first use an Ozempic pen: It should be disposed of after 56 days, even if there is some solution left in the pen.

Safe Disposal

Leftover Ozempic should be disposed of where pets, children, or other people can't get to it. The best way to do this is through a medicine take-back program. Your pharmacist or local garbage/recycling department can tell you about take-back programs in your community. If there isn't one, check the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach.

Side Effects

As with all medications, Ozempic carries a risk for potential side effects. The most common ones are mildly-to-moderately uncomfortable and tend to diminish over time. However, there have been reports of severe adverse effects from taking Ozempic in some people.

Common

If you experience any of these symptoms while taking Ozempic, be assured that they're likely to go away. If they don't, talk to your doctor.

  • Nausea and/or vomiting
  • Vomiting
  • Diarrhea
  • Stomach pain
  • Constipation
  • Heartburn
  • Burping or flatulence

Severe

Call your doctor right away or go to the emergency department if you experience any of these adverse reactions to taking Ozempic:

  • Persistent pain in the upper left or middle of your stomach that spreads to your back, sometimes, but not always, accompanied by vomiting
  • Skin rash, itching, or swelling of the eyes, face, mouth, tongue, or throat and/or difficulty breathing or swallowing (which are signs of an allergic reaction)
  • Decreased urination; swelling of legs, ankles, or feet (which could indicate kidney damage)
  • Changes in your vision (possibly an exacerbation of diabetic retinopathy)

If you experience any side effect you think may be related to Ozempic, call your doctor even if what you're experiencing isn't listed here.

Warnings and Interactions

Ozempic has a boxed warning regarding a potential risk of thyroid cancer. In studies of the drug, lab animals developed thyroid tumors. Although it's not known if this will happen in humans, people who have a history of medullary thyroid carcinoma (MTC) or a disorder called multiple endocrine neoplasia syndrome type 2 (MEN 2), which causes tumors in more than one gland in the body, should not take Ozempic.

Ozempic also can interact with other medications—in particular, insulin and oral diabetes medications—causing blood glucose levels to dip too low, a condition called hypoglycemia. Be aware of these symptoms of low blood sugar and let your doctor know if you develop them:

  • Drowsiness
  • Headache
  • Confusion
  • Muscle weakness
  • Hunger
  • Irritability
  • Sweating
  • Jitteriness
  • Rapid pulse
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