New side effects from Ozempic are emerging as more take the drug. Experts explain how to manage them

Although Ozempic is currently fashionable as a cosmetic weight loss drug, especially among the rich and famous, its intended use is to help individuals with diabetes or who struggle with severe obesity. Yet coverage of this drug is often filled with stories about dangerous long-term side effects like constant nausea and abdominal pain. The overwhelming majority of patients who use the drug do not report those symptoms, but their menacing nature is such that the risk is never far from a patient's mind.

These fears were recently reinforced by a study published in the scientific journal JAMA. It found that non-diabetic patients who use drugs like Ozempic and Wegovy for weight loss are at a higher risk of three rare, but severe, stomach conditions. One of those disorders, stomach paralysis, is not listed on the warning label for the drug. The drugs also put patients at an increased risk of inflammatory diseases like pancreatitis and certain types of bowel obstruction.

For people with diabetes, Ozempic (generically known as semaglutide) increases the levels of a hormone called incretin so that a diabetic person's pancreas produces more insulin. The drug also reduces the amount of glucose produced by the liver. For people with serious weight problems, Ozempic activates GLP-1 receptors in the brain because another important hormone, known as glucagon-like peptide-1, is released when your body is full.

By mimicking GLP-1, Ozempic makes the brain feel full faster, and as a bonus slows digestion by forcing food to take longer to leave the body. This is what makes Ozempic such a popular cosmetic weight loss drug, along with other related drugs, such as Trulicity and Victoza.The key is that the dosages must be titrated carefully and with careful medical supervision, as each patient's individual bodily makeup will heavily influence how they react to the drug.

"We know that nausea, vomiting, diarrhea, constipation are very common issues with these medications," Dr. Fatima Cody Stanford, an associate professor of medicine at Massachusetts General Hospital, told Salon. "But I do think it's important to work with people that know how to prescribe these and know how to titrate these medications accordingly. One of the things that if you look at the package insert for these medications, it tells you to titrate these medications after one month of use, but I find that titrating these according to the individual is really important."

This means that if a patient reacts badly to a dose of 0.50, Stanford might keep them on 0.25 for six months before titrating them to the higher dose. "Now that's not what the package insert tells you to do, but if that's what my patient needs to get their body acclimated to the dose so that they no longer have symptoms, that's what their body needs and not what the next person's body needs," Stanford explained. In short, Stanford argued, what matters most is how a person uses their semaglutide, not just the drug itself.

Dr. Bubu A. Banini is a digestive diseases physician and assistant professor of medicine at Yale School of Medicine. She acknowledged that although Ozempic does not cause adverse side effects for a majority of patients, there is going to be a smaller group whom the odds dictate are going to react badly to it.

"While the majority of patients who use Ozempic do not have any adverse side effects, a minority may experience adverse side effects most of which are gastrointestinal such as nausea, vomiting, diarrhea, or constipation," Banini told Salon by email. "Ozempic may increase the risk of pancreatitis. The FDA updated the side effect profile of Ozempic in late September 2023 to include ileus, a temporarily paralysis of the intestinal muscles. However, it is impossible to provide a frequency for this side effect as of now, or reliably establish this symptom as a consequence of the drug."

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The underlying problem is that, because Ozempic is a relatively new drug, there needs to be more ongoing research on it so doctors can accurately assess its safety.

"These drugs are still relatively new in clinical use, hence additional data needs to be accrued," Banini explained. "I would urge patients to report adverse side effects experienced while using the drug to Novo Nordisk Inc (the manufacturers) or to the FDA. This will help us better determine the side effect profiles."

"At Novo Nordisk, patient safety is a top priority. We work closely with the U.S. Food and Drug Administration to continuously monitor the safety profile of our medicines," a media representative at Novo Nordisk explained. "We are taking multiple steps to ensure responsible use of our semaglutide medicines which are detailed in this website. Full prescribing information for Ozempic is available here."

Dr. Dan Azagury, the section chief for bariatric and minimally invasive surgery and the medical director for the lifestyle and weight management clinic at Stanford University, elaborated on Banini's point about Ozempic being a relatively new drug.

"I think the challenge that we face right now is that there's a lot of buzz and it's going to be like that for a little while," Azagury told Salon. "The reason is, as you put millions and millions of people on a drug, there will be very rare side effects that are going out here."

At the same time, given that these drugs have been around for roughly a decade, "if there was going to be this explosion of side effects that nobody had studied, that nobody had found in the studies run by the companies, we'd probably know by now," Azagury said. The bigger problem, he noted, is that there have been some cases of severe reactions reported by patients. "Even if you have a risk of 1 in 100,000 we're going to hear about 30, 60 cases of that happening, and 1 in a 100,000 risk of having a problem with the drug is still pretty uncommon."

At the end of the day, the key to successfully using Ozempic is to only take it when prescribed by a reputable doctor, and to do so while making other necessary lifestyle changes in order to improve one's health.

"Generally, I recommend combining Ozempic with lifestyle changes including avoiding high sugar foods, limiting calories and unhealthy fats and engaging in moderate intensity exercise," Banini explained. "Avoid Ozempic if you have a personal of family history of Multiple Endocrine Neoplasia syndrome type 2. Please note that Ozempic is not approved for use in weight loss, so check with your physician if you do not have diabetes mellitus 2 but are interested in taking anti-obesity medications."