Is Ozempic safe?

What does it mean to be obese or overweight?

Obesity is a chronic health condition that affects an increasing number of people worldwide. In the United States, more than 70% of adults are overweight and 40% are obese. Overweight is often defined as having a BMI of 25-29 kg/m2 and obesity as a BMI greater than or equal to 30 kg/m2. Complications of obesity include diabetes, heart disease, sleep apnea, anxiety, depression, and a reduced life expectancy. Because modest weight reduction can reduce many of these complications, scientists have developed prescription medications to help obese and overweight individuals achieve better weight control and live healthier, longer lives.

What are weight loss medications?

Multiple prescription medications have been evaluated and approved by the FDA for weight management in overweight or obese individuals. Weight loss drugs work in a variety of ways, which can include increasing metabolism, decreasing appetite, or by decreasing the absorption of food. It is important to note these medications are intended to be used in combination with lifestyle changes, such as diet and exercise. Also, weight loss medications are meant to be used in people who are overweight and at risk of developing medical problems or obese. They are not recommended for otherwise healthy people who only have a few pounds to lose. There are also several so-called "weight loss supplements". Unlike prescription and over-the-counter medicines, the FDA does not regulate dietary supplements. Here is a list of medications that have been approved by the FDA for weight loss.

Are weight loss medications safe?

Some weight loss drugs were better known for their undesirable side effects than for their weight loss benefits. One example was “phen-fen”, which was a combination of the medications phentermine and fenfluramine. While effective for weight loss, fenfluramine and a similar drug, dexfenfluramine were removed from the market because they caused damage to the valves of the heart. Lorcaserin (Belviq^®), approved in 2012, was withdrawn from the market in 2020 due to concerns that it caused cancer. Other medications such as sibutramine and phenylpropanolamine were removed from the market because they were associated with heart problems and strokes. Orlistat (Xenical^®), which the FDA approved in 1999, was associated with abdominal cramping and oily stools that would sometimes cause fecal incontinence.

What are some new weight loss medications?

Because there were a lot of problems with older weight loss medications, the search continued for safe and effective alternatives. When studying a class of medications called GLP-1 agonists for diabetes, researchers found that the medications also resulted in significant weight loss. In 2014, the FDA approved liraglutide (Saxenda^®) for chronic weight management in obese or overweight adults with weight-related medical conditions. The FDA expanded the approval age range to those aged 12 and older in 2020. In 2021, the FDA approved semaglutide (Wegovy^®) for chronic weight management in obese or overweight adults with high blood pressure, type 2 diabetes mellitus, or high cholesterol. Since then, additional medications have been approved, such as tirzepatide (Zepbound^®). Not all GLP-1 medications are approved by the FDA for weight loss. Some are only approved for the treatment of diabetes; however, sometimes these medications are used “off-label” for weight loss. 

How does Ozempic^® work?

Liraglutide (Saxenda^®, Victoza^®) and semaglutide (Wegovy^®, Ozempic^®, Rybelsus^®) belong to the "GLP-1 receptor agonist" class of drugs. Glucagon-like peptide (GLP)-1 is a hormone produced by the body in response to food intake. GLP-1 agonist drugs provide the body with higher levels of GLP-1, which can affect hunger, food intake, and weight. GLP-1 acts on the pancreas to increase insulin release after carbohydrate consumption, and it also causes a sensation of decreased appetite and increased fullness. This is in part due to the fact that the medications slow stomach emptying. GLP-1 agonist drugs are available in both oral and injectable forms. Rybelsus^® is an oral formulation of semaglutide, while Wegovy^® and Ozempic^® are injectable. Saxenda^® and Victoza^® are injectable versions of liraglutide. Tirzepatide is a GLP-1 receptor agonist that also works as an agonist of another hormone, glucose-dependent insulinotropic polypeptide (GIP). 

Ozempic^® vs. Wegovy^®

Ozempic^®, Wegovy^®, and Rybelsus^® all contain the same active ingredient, semaglutide. However, the drugs are dosed differently and are approved for treatment of different conditions. Ozempic^® and Rybelsus^® are only approved for blood sugar control in adults with diabetes, while Wegovy^® is FDA-approved for weight management. It is also important to note that Ozempic^® and Wegovy^® are dispensed in injector pens. While both pens contain the same medication, the pens themselves are different, which can lead to confusion and dosing errors.

Table: common GLP-1 agonist prescription medications

Is Ozempic^® insulin?

Ozempic^® is not insulin; it acts on the body differently than insulin does. Because of their effects on food intake, members of the GLP-1 class of drugs, including semaglutide and liraglutide, have many potential effects on the human body that affect hunger and weight. These drugs slow the rate at which food is transferred from the stomach to the intestines (called "gastric emptying"), which enhances the feeling of a full stomach. The drugs also pass through the bloodstream into the brain, where they act on the nervous system to decrease both food intake and appetite. Medications like Ozempic^® can increase insulin release from the pancreas in response to food, but they are not insulin. 

Does Ozempic^® work for weight loss?

The FDA approved Ozempic^® for improving blood sugar control and reducing risk of heart disease in diabetic patients. While Ozempic^® is not currently FDA-approved for weight loss, many studies have investigated the effects of GLP-1 agonist drugs on weight loss. In a 2009 study that evaluated the weight-loss effects of liraglutide versus orlistat or placebo, individuals who used liraglutide lost, on average, 11-16 pounds (4.8-7.2 kilograms) over 20 weeks. In a 68-week trial published in the New England Journal of Medicine in March 2021, obese or overweight adults who took semaglutide had a 15% decrease in body weight and also experienced improvements in physical function and risk factors for heart disease. The results of one study suggest that injectable semaglutide is more effective in promoting weight loss than oral liraglutide.

What happens when you stop taking Ozempic^®?

Weight loss caused by GLP-1 agonist drugs is not always permanent. In clinical trials, people who stopped taking semaglutide regained the majority of their prior weight loss within a year. In addition, those who stopped taking semaglutide also experienced increases in blood pressure, cholesterol, and blood sugar levels, suggesting that continued use of the medication is needed to maintain both weight loss and the reduction in risk factors for heart disease.

Is semaglutide (Ozempic^®) safe?

GLP-1 agonist drugs, are generally well-tolerated, but occasionally can cause severe adverse effects. Common adverse effects of these medications include nausea, vomiting, abdominal pain, and diarrhea. In some patients, stomach emptying can become so slow (gastroparesis) that it can lead to a blockage. Other severe adverse effects include dehydration, electrolyte problems, kidney damage, and pancreatitis (inflammation of the pancreas). Low blood sugar is rare, but can also happen, particularly when people are taking more than one medication for diabetes. These symptoms can be seen in both therapeutic use and in people who overdose. There have also been reports of people having suicidal thoughts while taking GLP-1 agonist medications. GLP-1 agonists have been shown to cause thyroid tumors in rats. For this reason people with a personal or family history of thyroid cancer or multiple endocrine neoplasia should not take GLP-1 agonists. In addition, medications like Ozempic^® can affect the absorption of other medications. In fact, it is thought that these medications can decrease the absorption of birth control pills, leading to unwanted pregnancy. 

Does insurance cover Ozempic^®?

While semaglutide (Wegovy^®, Ozempicv, Rybelsus^®), and liraglutide (Saxenda^®) are FDA-approved, individual insurance coverage policies for these medications vary and out of pocket costs can be high. A good way to find out if your insurance covers a prescription medication is to call the number on the back of your insurance card. 

Can foods act as natural Ozempic^®?

Some studies have shown that certain foods containing fiber, protein, omega-3 fatty acids, and non-digestible carbohydrates increase GLP-1 levels in the human body. Although regular consumption of these foods may lead to increased fullness that can translate into weight loss over time, there is no evidence that eating these foods is equivalent to taking Ozempic^® or other similar pharmaceuticals. One reason for this is the relatively short lifespan of GLP-1 in the body. Once it is released into the human body, GLP-1 is broken down very quickly, within minutes, into inactive metabolites. Pharmaceutical formulations of GLP-1 receptor analogs, including Ozempic^®, are specially designed so they are not broken down as fast. This means that the active forms of the drugs can persist for much longer periods of time within the human body, and result in more sustained clinical effects, including weight loss and appetite suppression. This also explains why Ozempic^® can be given once a week.

Does "Ozempic^® cookie dough" work?

Although regular consumption of healthy foods, including those rich in fiber and certain carbohydrates, may have beneficial health effects, there is no evidence that they provide the same sustained clinical effects as Ozempic^®, Wegovy^®, or other prescription GLP-1 receptor agonists. The "Ozempic^® cookie dough" recipe, as promoted on TikTok, may be delicious and fun to make. Some TikTok recipes for "Ozempic^® cookie dough" include protein powder, oatmeal flour as a carbohydrate, and coconut flour as a fiber source. When these ingredients are blended and eaten, they may stimulate a limited amount of natural GLP-1 release from the body. However, consumption of this concoction is unlikely to result in a sustained release of GLP-1 from the gut and brain that will result in significant weight loss. Furthermore, adding extra ingredients such as chocolate chips and sprinkles may promote weight gain, make the recipe much less healthy overall, and contribute to unwanted increases in blood glucose levels that can be harmful to those with diabetes.

Is compounded Ozempic^® safe?

Because of medication shortages due to increased demand, and the fact that many insurance plans do not cover GLP-1 medications for weight loss, some people have turned to pharmacies that make their own compounded semaglutide. While this may be a less expensive alternative, there can be errors in compounding or contamination of the product because compounding pharmacies are not held to the same standards of larger drug manufacturers. In addition, compounded products do not come in pens, but usually vials, where patients have to draw up the correct dose themselves. This can lead to dosing errors. In fact, the FDA has warned against the use of compounded semaglutide. 

How do I avoid overdosing on semaglutide?

There have been reports in the news of an increase in overdoses involving semaglutide. The most common reason people overdose on medications like Ozempic^® is dosing errors. The pens for Ozempic^® and Wegovy^® are different from one another. Ozempic^® is a multi-dose pen where the patient dials up the dose of medication. Wegovy^® comes in single-use once weekly pens. Compounded semaglutide can be made in different concentrations and has to be drawn up with a needle and syringe. It is important for patients to learn how to properly measure and inject the product. Also, while many medications are given once daily, semaglutide is only given once a week, which can lead to confusion.  

What do I do if I have a bad reaction to or take too much semaglutide (Wegovy^®, Ozempic^®, Rybelsus^®) or liraglutide (Saxenda^®)?

If you took too much or have unwanted or unexpected side effects after using GLP-1 agonist drugs such as liraglutide (Saxenda^®) and semaglutide (Wegovy^®, Ozempic^®, Rybelsus^®), use the webPOISONCONTROL^® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.