Overview:
Semaglutide can cause side effects that some people are unable to tolerate. Following dosing guidelines can help manage these side effects.
Nausea, vomiting, and diarrhea are the most common semaglutide side effects. These common side effects usually subside after a few weeks of using the medication.
Although rare, serious side effects are possible. Some may require immediate medical attention, such as pancreatitis and allergic reactions.
Keep reading to learn more about 19 semaglutide side effects to know about and how to manage them.
Nausea and Vomiting
Nausea is the most common semaglutide side effect.
You’re more likely to experience nausea and vomiting with higher doses of semaglutide. Your healthcare provider will raise your dose slowly over a few months to minimize these effects. For most people, side effects such as nausea should improve over time as your body gets used to the medication.
Eating smaller meals, avoiding high-fat foods, and remaining upright after you eat can also help manage potential nausea and vomiting from semaglutide. If these side effects are accompanied by severe pain in your upper and middle abdomen, get medical attention right away. This could be a sign of pancreatitis, a rare but serious side effect.
Diarrhea
Diarrhea is another common semaglutide side effect. Approximately 30% of people taking it for weight loss reported diarrhea during clinical trials.
Similar to nausea and vomiting, you’re more likely to experience diarrhea with higher doses of semaglutide. As mentioned above, your healthcare provider will slowly raise your dose over time to minimize this side effect.
Avoiding or minimizing foods that can worsen diarrhea, such as fatty or fried foods, milk, and caffeinated drinks, may help in the meantime.
Constipation
Constipation can also happen with semaglutide, but it tends to be less common than diarrhea. Similar to other semaglutide side effects discussed above, constipation tends to improve over time.
If you’re feeling constipated, a few small adjustments to your daily routine may help provide relief. Drinking enough water, getting regular exercise, and slowly incorporating more fiber-rich foods into your diet are a few examples. If needed, your healthcare provider may recommend an OTC laxative if these lifestyle changes aren’t enough.
Gas and Bloating
You may also experience gas and bloating from semaglutide. Similar to other digestion-related side effects, dietary and lifestyle changes may help. Examples include eating smaller meals and foods that are lower in fat. Adding fiber can also help, but doing this too quickly may worsen gas and bloating. Two additional servings a day is a good place to start.
If needed, your healthcare provider may recommend an OTC anti-gas remedy, such as simethicone (Gas-X), for bloating relief.
Stomach Pain
Mild stomach pain is another common stomach-related side effect of semaglutide. Similar to nausea, vomiting, and diarrhea, this should subside over time. Using the tips listed above can also help minimize this side effect.
Severe stomach pain can be a sign of other side effects, like pancreatitis or gallbladder problems (like gallstones). Contact your healthcare provider right away if this develops.
Fatigue
Semaglutide works for weight loss by making you feel less hungry. Eating fewer calories may cause you to feel more tired. Feelings of fatigue should subside as your body adjusts to potential changes in your diet.
Burping
Some people experience acid reflux symptoms while taking semaglutide, which can include burping or belching. This has been referred to as the “Ozempic burp” since it can have a distinct smell and taste.
If you’re experiencing burps or other acid reflux symptoms from semaglutide, it may help to avoid or minimize foods that can make them worse. Examples include greasy, spicy, and fried foods. Caffeine and alcohol can also be problematic. For fast relief, your healthcare provider may suggest an OTC antacid. Let them know if your symptoms aren’t going away or get worse.
Changes to your face (Ozempic face)
Some people taking semaglutide may notice less fullness in their face. In fact, this phenomenon has been referred to as “Ozempic face.”
Facial fat loss is one potential effect of fast and significant weight loss. This can also result in looser skin and wrinkles that are more noticeable.
Keep in mind the benefits of semaglutide on your health outweigh these effects. But if you’re concerned about possible changes to your appearance, talk to your healthcare provider.
Headache
Semaglutide isn’t known to directly cause headaches. But certain semaglutide side effects, such as dehydration, can result in headaches. So it’s important to keep hydrated, especially if you’re experiencing diarrhea or vomiting during treatment.
Rebound Weight Gain
Semaglutide is a medication that’s intended to be taken long term. As long as you’re taking the medication, the weight you’ve lost is typically sustained. But if you stop taking it, it’s possible to gain some (or all) of the weight back.
Semaglutide should be paired with a nutritious diet and regular exercise. Establishing habits that you can maintain long term is important if you decide to stop semaglutide.
If you’re concerned about regaining weight after stopping semaglutide, talk to your healthcare provider. They can help you weigh the pros and cons of stopping or continuing treatment.
Low Blood Glucose
Low blood glucose (hypoglycemia) isn’t very common if you’re taking semaglutide on its own. That’s because it works by telling your body to release insulin in response to a meal specifically.
But taking semaglutide with other blood glucose-lowering medications, such as insulin and sulfonylureas, raises the risk of hypoglycemia. Your healthcare provider may need to change the dose of these medications when starting semaglutide. If hypoglycemia develops, common symptoms include headache, shakiness, and sweating.
Vivid Dreams
Some people taking semaglutide have reported experiencing vivid or abnormal dreams. Experts don’t know for sure why this may happen. And it’s not entirely clear yet if this side effect is linked to semaglutide itself.
Keep in mind that several other medications can cause vivid dreams. If they start happening while you’re taking semaglutide, let your healthcare provider know, especially if they’re interfering with your sleep or quality of life. They can help determine the potential cause and next steps.
Hair Loss
Losing weight quickly can result in hair shedding or loss.
This type of hair loss, called telogen effluvium, is usually temporary. Hair loss you may be experiencing from semaglutide should subside as your body adjusts. Keep in mind this may take several months.
Since these medications can also affect your appetite, it’s important to make sure you’re getting enough vitamins, minerals, and protein. If you’re not, this can also contribute to hair loss. Your healthcare provider can help you ensure you’re getting adequate nutrition during treatment.
Pancreatitis
Although rare, pancreatitis has been reported with semaglutide. But it’s not clear yet if this is from semaglutide or another cause. If it happens, it can be life-threatening. Seek immediate medical attention if you develop severe abdominal pain, nausea and vomiting, and/or jaundice (yellowing of skin and eyes).
Let your healthcare provider know before starting semaglutide if you have a history of acute pancreatitis. They may recommend a different medication for you.
Gallbladder Disease
Gallbladder disease, including gallstones, is possible with semaglutide, but it isn’t common. It was reported in less than 2% of people taking it in clinical trials.
Symptoms of gallbladder problems include upper stomach pain, fever, and jaundice. You may also notice clay-colored stools. Let your healthcare provider know right away if these develop.
Talk to your healthcare provider about ways you can avoid gallbladder problems while taking semaglutide. This may include dietary changes and routine physical activity.
Kidney Damage
Studies have suggested that semaglutide may have some kidney benefits if you have Type 2 diabetes. But in rare cases, kidney damage has also been reported. This is more likely if you have severe nausea, vomiting, and/or diarrhea leading to dehydration.
Kidney damage is also more common if you already have kidney problems. Taking medications that cause you to get rid of excess water, like diuretics (water pills), also puts you at risk.
Your healthcare provider may monitor your kidneys if you’re experiencing a lot of stomach-related side effects. Let them know right away if you’re not urinating very much or at all, or notice swelling in your arms or legs.
Allergic Reactions
Severe allergic reactions (anaphylaxis) to semaglutide are rare, but possible. Call 911 or get immediate medical attention if you have swelling of the face, tongue, or throat, or shortness of breath after your dose.
Mild allergic reactions can include itching, rash, or redness at the injection site. Stopping semaglutide isn’t always necessary with mild reactions. But make sure to still tell your healthcare provider about your reaction.
Don’t use oral or injectable semaglutide if you’re allergic to any of their ingredients. And there’s a chance you could have an allergic reaction to semaglutide if you’ve had a reaction to a medication in the same class.
Thyroid Tumors
Semaglutide has a boxed warning (the strictest warning) from the FDA about a risk of thyroid C-cell tumors. This is because animal studies found that rodents developed thyroid tumors when exposed to GLP-1 agonists. However, human studies have yet to confirm this risk.
You shouldn’t take semaglutide if you or your family have a history of medullary thyroid cancer or multiple endocrine neoplasia (MEN) type 2. Contact your healthcare provider immediately if you notice signs or symptoms of thyroid cancer. These include a lump in your neck, and neck or jaw pain.
Stomach Paralysis (Gastroparesis)
One of the ways semaglutide works is by slowing down how quickly food leaves your stomach (called delayed gastric emptying), which appears to be a temporary effect. But some people have reported severe stomach paralysis (gastroparesis) while taking the medication. It’s possible this was from semaglutide, or an underlying condition.
However, one recent study found that semaglutide (and a similar medication called liraglutide) had higher rates of stomach paralysis in people taking them for weight loss. This was compared to people taking Contrave (bupropion / naltrexone), a weight-loss pill.
Gastroparesis symptoms, such as nausea, vomiting, and fullness after eating, are very similar to common semaglutide side effects. If these symptoms occur, it doesn’t necessarily mean there’s a problem, since they’re generally expected with treatment. If they’re severe, aren’t going away, or get worse, let your healthcare provider know.
There have also been cases of intestinal paralysis (ileus) with semaglutide. Because of this, the FDA has added ileus to the list of potential side effects. In some cases, ileus can result in a bowel obstruction (blockage). During the same study mentioned above, there were also higher rates of bowel obstruction with semaglutide and liraglutide compared to Contrave.
Does semaglutide cause long-term side effects?
Ozempic, Rybelsus, and Wegovy have been on the market for less than 10 years. So researchers are still studying their potential long-term side effects, such as how they might affect the thyroid and gastrointestinal tract. The FDA also continues to review side effects that are reported with these medications while they’re on the market.
Currently, the longest semaglutide trials have lasted 2 years. Two examples are the SUSTAIN-6 and STEP 5 trials. During these trials, more people who received a placebo (an injection without medication) reported serious side effects than those who received semaglutide. And no new safety concerns came up during these trials.
When should you contact your healthcare provider about side effects from semaglutide?
Many semaglutide side effects may improve on their own as you continue to use semaglutide. If mild stomach-related side effects don’t subside over the course of a few weeks, contact your healthcare provider. If they’re severe at any point, get medical attention right away. This may be a sign of something more serious.
Hypoglycemia isn’t common with semaglutide, but it’s good to know the indicators of low blood glucose and how to treat it. Contact your healthcare provider if you’re finding that your blood glucose levels are dropping too low. They may need to adjust the dosage of other blood glucose-lowering medications you’re taking.
The Bottom Line
Common semaglutide (Wegovy, Ozempic, Rybelsus) side effects include nausea and vomiting, diarrhea, and stomach pain. Fatigue, constipation, and headaches are also possible. Most digestion-related side effects improve over time as your body gets used to the medication.
More severe semaglutide side effects, such as pancreatitis, gallbladder disease, and kidney damage are rare. But it’s important to know what to look for and when to get medical attention.
Talk to your healthcare provider or pharmacist if you have questions or concerns about potential semaglutide side effects. If you’re having difficulty tolerating the medication, they can give you tips for how to manage certain side effects.
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