What Is Ozempic?

Ozempic, chemically known by its active ingredient Semaglutide, is a glucagon-like peptide-1 (GLP-1) receptor agonist or analogue secreted by the L-cells of the pancreas. This means that it is a synthetic form of GLP-1 which makes the islet cells in the pancreas secrete more glucose-dependent insulin whenever one eats anything and simultaneously increases glucose uptake by muscles.(1) (2) It also acts by slowing the release of glucagon from the pancreas. GLP-1 agonists when taken in higher amounts also delay gastric emptying, induce a feeling of satiety, and reduce the appetite. Ozempic is also known for its cardioprotective and neuroprotective effects.(1)

How Does Ozempic Benefit People?

Semaglutide is primarily known to be a type 2 diabetes drug Ozempic, used as a once-daily injectable medicine to keep blood sugar levels under check. However, Semaglutide, the main active ingredient in Ozempic has also been regulated to be taken in high doses by the US FDA under the brand name Wegovy.

• Weight Management & Ozempic: Since semaglutide works as an appetite suppressor in addition to glucose metabolism in the body, Ozempic’s weight loss properties have also been the topic of intensive research. So much so that semaglutide is formulated in a higher dose as Wegovy to manage obesity and weight-related issues in children above twelve years and adults alike.(3) Semaglutide signals the hypothalamus in the brain that one is full and also reduces the emptying of gastric juices in the stomach, thereby reducing appetite and keeping the stomach fuller for longer. Semaglutide has been clinically shown to reduce the body weight of obese patients by ~15%.(4)
• Cardiovascular Health & Ozempic: Ozempic is a type 2 diabetes drug, and type 2 diabetes is a risk factor for cardiovascular diseases (referred to as major adverse cardiovascular events or MACE); hence a considerable amount of research has also gone into establishing the cardiovascular effects of Ozempic or semaglutide. Large-scale clinical trials have shown that GLP-1 agonists, irrespective of structural homology, have been successful in significantly reducing risks of MACE among patients with type 2 diabetes.(5) Moreover, even in patients without type 2 diabetes, those with obesity issues and pre-existing cardiovascular issues also lost 9.4% of their body weight and had a 20% reduction in the number of heart attacks, strokes, and deaths when they took semaglutide for three years.(6)

Are There Any Side Effects Of Ozempic?

Ozempic has been declared as an overall safe medication post clinical trials. However, like every other medicine, Ozempic side effects have also been reported in some patient populations. Hypoglycemia, diarrhoea, nausea, constipation, gas reflux, and flatulence are the most reported Wegovy and Ozempic side effects. However, semaglutide side effects resolve on their own within a few weeks.(3)

Severe semaglutide side effects include worsening of diabetic retinopathy in patients who are already on insulin and taking Ozempic. People with severe allergies should avoid taking Ozempic. For patients on Wegovy, there are risks of thyroid C-cell tumors, and hence patients with a medical history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should be extra cautious if advised to take Wegivy. Wegovy side effects can be severe for patients with a history of pancreatitis, gallstones, acute kidney injury, increased heartbeat, suicidal tendencies, or hypotension. (7) (8)

How To Use Ozempic Correctly?

Semaglutide, when taken as a prescription medicine for type 2 diabetes, is an Ozempic injection. The Ozempic injection is given as a 0.25 mg once a week dose for the first four weeks, and increased to 0.5 mg once a week from the fifth week. Depending on individual cases, the doctor may also increase dosage to 1 mg. These doses are delivered best with a 0.25mg or 0.5mg Ozempic injection pen with a strength of 2 mg per 1.5 mL of liquid solution. The maximum dosage is 2mg per week.(7) Ozempic injection pens come with strengths of 1mg and 2mg used for additional control. The strengths of these syringes are 4 mg/3 mL of liquid solution and 8 mg/3 mL of liquid solution respectively. The 1mg syringe should be used once weekly for four weeks for additional glucose control and the 2mg syringe should be used once weekly if the doctor asks for further control post the initial monitoring process. (7) (9)

Semaglutide when taken as Wegovy, is recommended at higher doses for people fighting obesity, defined as having a BMI ≥30 kg/m2, or are overweight with a BMI ≥27 kg/m2 in the presence of a weight-related comorbidity, and for obese children over 12 years of age and older with an initial BMI at ≥95th percentile standardized for age and sex.(10) Wegovy dosing is also recommended initially as 0.25mg for the first four weeks, with an escalation to 0.5mg per week from the fifth to the eighth week. Further escalation when prescribed for additional control ranges from 1mg each week from the ninth to the twelfth week to 1.7mg once weekly from the thirteenth till the sixteenth week. Many cases will require the patient to stick to this dosage. If the target weight is still not reached, a further escalation to 2.4mg per week from the seventeenth week onwards till however long the doctor prescribes, as per the patient’s health and weight goals.(10)

It is imperative to understand that the dosing should only be modified under expert, professional opinion backed by laboratory test results.

Ozempic pricing can be on the higher side, ~ $1000 for a supply of 1.5mL. Hence it is also important to use the drug judiciously and be informed about insurance coverage whenever applicable.(11)

How To Deal With Missed Doses Of Ozempic? What To Do If There Is An Overdose?

In the Ozempic dosing schedule, the patient should stick to the same day for injecting the doses on all weeks. e.g. If the patient is taking the dose on a Tuesday on the first week of dosing, they should continue taking the doses on all the following Tuesdays for the entire duration. However, if the patient misses one dose and remembers this within five days of the scheduled dose, they can take it immediately within those five days. In case they do not remember to take the missed dose within these five days, they should just continue with the next dose and forget about the last dose missed. There is absolutely no need to make up for a missed dose by taking an extra dose. (7) (9) Patients should not stop using Ozempic in between doses and should stick to the dosing schedule, unless and until advised otherwise by the doctor or consulting specialist.

Ozempic dosing when done in excess can lead to consequences like nausea, vomiting and diarrhoea apart from other complications due to comorbidities. Patients are advised to contact the nearest emergency center in need of medical attention.

Semaglutide when taken as Wegovy should also be taken on the same day of the week after starting dosing. In case a patient forgets to take a dose and remembers it within the next 48 hours, they should take the missed dose immediately. In case it has been more than 48 hours since the patient has missed a dose, they should continue with the next dose as per schedule and not take an extra dose to make up for the missed dose. In case two or more doses are missed by the patient consecutively, they should just continue with the dosing as scheduled. In this case, however, the patient can restart the dosing at the escalated schedule after consulting a doctor. They may face gastrointestinal symptoms which subside on their own after a few weeks of the escalated schedule.(10) In any case, patients should always have an emergency number at their disposal for immediate medical attention.

What To Avoid While Using Ozempic? Any Contraindications?

Patients taking sulfonylurea (glimepiride or glibenclamide), and/or insulin should not take Ozempic or Wegovy; if they need to, they should do so only if prescribed by the doctor under full cognizance of the other oral medications the patient is on. Ozempic or Wegovy dosing and escalations will depend on the other medications that the patient is on.

Pregnant women are not advised to take semaglutide, and if planning to get pregnant, should stop using semaglutide at least two months prior to conceiving. Patients with ketoacidosis or/and type 1 diabetes should also avoid taking semaglutide or take only if recommended by endocrinologists.

Remember While Using Ozempic or Wegovy….

Both drugs are forms of Semaglutide but function at different concentrations. The US FDA has regulated the use of semaglutide for weight loss as Wegovy and semaglutide for type 2 diabetes as Ozempic. Despite having the same active ingredient, both medications have different dosing schedules which patients should stick to. For people taking Ozempic weight loss can be another benefit, but Ozempic is primarily prescribed for type 2 diabetes and should not be mistaken as a weight loss drug.

Semaglutide and weight loss have been studied extensively and have shown beneficial results but patients should not self-medicate with Ozempic off-label just because the active ingredient is regulated for weight loss. There is a reason why both drugs have different dosing and one should have a clear prescription for using any drug. Compounding both forms of semaglutide for weight loss is not regulated by the US FDA due to adverse events reported by patients.(12)